Inspection on 01/06/09 for Blossom Community Care

This is the latest available inspection report for this service, carried out on 1st June 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Blossom Community Care 48 Kelvin Avenue London N13 4TG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Margaret Flaws     Date: 0 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Blossom Community Care 48 Kelvin Avenue London N13 4TG 02088880323 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: blossomcare@hotmail.co.uk John McGown,Mr Luke Fantham care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The home was established to provide residential care to young men with enduing mental health needs. It is a three bedroomed house in a residential street in Palmers Green, North London and is a short distance from Wood Green. The home is well served by local transport, shops, parks and community facilities. The home is an ordinary small terraced house and has been refurbished to a good standard. There are two bedrooms on the first floor and one on the ground floor. All rooms have an ensuite facility consisting of a toilet and a washbasin. The rooms are furnished to a good standard. The bathroom is on the first floor and there is an additional toilet downstairs off the lounge. There is an ordinary galley kitchen and the fridge, washing machine and dryer are under the stairs. The small lounge/dining is pleasantly furnished. There is an ordinary garden and patio area at the the back of the house. 0 5 0 1 2 0 0 9 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home The fees for the home are from £650-750 pw. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unnannounced inspection took place over one day. One of the Registered Providers, John McGown, was present for part of the inspection and we were assisted throughout by the Manager, Sandra Hancock. This inspection consisted of discussions with two residents, interviews with the Registered Provider, the Manager and the care staff on duty. We toured the premises and observed interactions between staff and residents and their routines. We inspected care, staff and general records. The home provided CSCI with a good Annual Quality Assurance Assessment (AQAA),which contributed information to this inspection. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? The home has met all the requirements from the last inspection. The Statement of Purpose has been updated and the home now has clear written guidelines for referral, assessment and admission. The home must has a copy of the local authoritys safeguarding policy and procedure readily available and an infection control policy and procedure to protect residents. A pre-recruitment checklist is now in place to ensure that, before new staff are appointed, the home obtains all the information set out in Schedule 2 of the Care Standards Act 2000. The home has a sound staff training programme covering mandatory and other staff training areas, to ensure they meet the needs of the residents. Staff and managers are due to commence formal mental health training in September. The home is working to support staff to achieve NVQ qualifications. Staff have been trained to support people with diabetes. Regulation Thirty Seven reports have been sent regularly to CQC. The Registered Providers have kept CQC up to date with how the home is being managed. The home has recruited a Manager who is applying to CQC for registration. The Registered Providers have familiarised themselves with all the National Minumum Standards and Regulations and the responsibilities these outline. The service has worked to build its mental health expertise and capacity. The home has improved its office systems. A fire safety risk assessment has been completed and fire drills are held regularly and documented. Care Homes for Adults (18-65 years) Page 7 of 27 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents have good information available to them before they move into the home. They can be confident that their needs will be properly assessed and that they will be able to visit the home before they move in. Evidence: This home began to operate in April 2008. Since that time, no new residents have moved in. The first three residents to move in are still living there. The residents are young men with enduring mental health needs, in line with the stated purpose of the home. We checked the files for all the people living in the home. Assessments have been updated and the Manager told us that the local authority had recently completed its annual placement reviews with the residents, their families and staff present. The Manager has been working on the homes policies and procedures. She has produced a sound referral, admission and admission policy and procedure. The home is also working to increase the mental health knowledge of the management and staff Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: team to ensure that they can work knowledgeably with prospective referrers. This meets a previous requirement. The home has a Statement of Purpose, which has been updated to include all the information outlined in the National Minumum Standards. This also meets a previous requirement. At the time of the inspection, the Registered Providers had commenced converting the loft space. It will provide space for a fourth bedroom and a larger office. The Registered Provider told us that they intend to apply to the Care Quality Commission for a variation to increase the number of places in the home to four. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their care planned according to their needs and wishes, and they are actively involved in identifying and planning for their needs. They are supported to make their own decisions and choices and work towards degrees of independance. Risks to their wellbeing are assessed and managed to protect their interests. Evidence: We saw the care files and plans for the three people living in the home. There were good care plans for each person, which had been regularly reviewed. The Manager has produced a new, simple care plan format, which will be written and updated by staff on the computer. It was straightforward and easy for staff and residents to understand. All staff and the Registered Providers are currently undertaking an IT course to improve their computer literacy so that they can easily Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: work with the new care plan model.The care plans reflect peoples physical, social, emotional and mental health needs, their individual wishes, goals and life stories. The home has a key worker system and there was good evidence on file and from our discussions in the home to show that this is working well. The Manager and staff were able to give a good account of how the home worked in a person centred way to consider, plan and meet the individual needs and wishes of each resident. The daily notes also gave a reasonable account of how the home worked with each person. Risks were assessed and documented for each person. The risk assessments reflected the homes common sense, practical approach to supporting the residents and protecting their wellbeing. We observed positive and supportive communication throughout the day between the residents and the staff. The two residents we spoke to during the day told us that the home worked to meet their needs and wishes and that they felt good living there. There is a good system in place for supporting people with their finances. The Manager told us that the residents manage their own finances and the staff support them with budgeting and managing their money. Each person has a safe in their room. One resident currently has an action plan to improve his independance. This includes him taking responsibility for his own budget. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to direct their lives how they wish. Contact with relatives and friends is supported in line with residents wishes. Their rights and responsibilties are respected and promoted and they enjoy balanced and varied meals that meet their needs and preferences. Evidence: We spoke to two residents who were at home on the day of the inspection. Both residents said that they enjoyed living in the home and felt supported to live their lives the way they wanted to. Residents go out into the community, for example, to day centres, shopping, to the library, sports centre, to the cinema and other community leisure activities. Residents also pursue their own interests at home, by listening to music, watching films or Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: television. Two residents maintain good contact their families, who live nearby. One resident keeps in regular touch with his family by phone. The home has a stated aim of rehabilitation and increasing peoples independance. The residents participate to an increasing degrees in the running of the home. For example, they plan the menus, do shopping, clean the home, do their washing and other household tasks. While the menus follow a four weekly cycle, with ordinary home cooked meals amended by the residents preferences. The Manager told us that, in the good weather, they were eating lots of salads and seasonal food. There was a good supply of fresh fruit and vegetables in the home and during the inspection, there was a large food delivery made. Menus included the cultural choices of the residents. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not need personal care support. Their physical and mental health needs are assessed and met, with specialist support as required. They are also protected by the homes medication policies and procedures. Evidence: The residents do not need support with personal care, other than occasional prompting and verbal support. We saw the files for all the residents. All had had regular physical health checks and the Manager described how she has advocated with health professionals on the residents behalf where necessary. One resident has an operation to remove a cataract and is due to have another. He said he felt pleased with the operation. A requirement is made under the Staffing section of this report for the home to access diabetes training for staff has been met. The Manager told us that the local GP surgery diabetic nurse is in regular contact with the home and has provided training and support. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: Peoples mental health needs are supported by community mental health teams and we saw evidence on file of how the home works with these teams on regular basis. The Manager told us how she consults with professionals as and when required. She had a good understanding of the mental health needs of the residents and how to support them. Staff commented on how the wellbeing of the residents has improved since living in the home. The Manager gave clear examples of how the home understood the residents mental health needs and how they worked to help them maintain their wellness. The home has a sound medication policy and procedure, which incudes a section on self administration. Two residents self administer their medications, with staff observing. We saw the medication storage arrangements in a medication cupboard in the office, which was in good order. Controlled drugs are stored seperately in a locked cupboard. We checked the Medication Administration Records. There were no errrors or omissions on these records. Medication cupboard and fridge temperatures are checked and recorded daily, to ensure medications are stored at safe temperatures. Staff who administer medication have been trained to do so. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can express their views and concerns and know that these will be addressed appropriately by the home. They are also generally safeguarded from harm by the homes policies, procedures and staff understanding of how to put these into practice. Evidence: The home has an accessible complaints policy and procedure, which is displayed in the home. Residents we spoke to said that they knew what to do if they had any concerns. No complaints had been recorded since the home started operating. The home also had a safeguarding adults policy and procedure, meeting a requirement from the last inspection. The Manager has completed a Train the Trainer course for safeguarding and will provide this training to the staff. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is well decorated and maintained to meet their needs. The home was clean and tidy throughout and residents said that they liked their physical surroundings. Evidence: We toured the building throughout the inspection. The home has been refurbished to a very high standard, with pleasant decoration and furnishing. Residents said they liked the space. There is a small, comfortable lounge with TV (with freeview access), DVD and music system and a small galley kitchen. The fridge, washing machine and dryer are under the stairs next to the kitchen. The bathroom is upstairs and there is a second toilet off the lounge on the ground floor. The Registered Provider told us that once the loft conversion is completed, he will build a a games room, conservatory and small, covered smoking area off the lounge. The front garden looked welcoming. One of the staff who enjoys gardened has put in new plants and tidied this area up. Residents rooms are pleasantly furnished and highly personalised. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: The home was clean and hygienic and now has an infection control policy and procedure, meeting a previous requirement. The home felt like a real home and was in no way institutional. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the staff recruitment, training and support policies and procedures. Evidence: On the day of the inspection, there was one staff member and the Manager on each shift. The Registered Providers and two bank staff provide additional cover to the home. This was reflected in the staff rota. At the last inspection, we made a recommendation that the home keep the staffing level under review to ensure that there is adequate cover for the residents needs. The Manager told us that, as the residents wellbeing was improving, the staffing level seemed well matched. But we still recommend that the home keep the staffing under review. Changes will also need to made if the home is successful in being registered for four residents. The home has a satisfactory staff recruitment process. No new staff have been appointed since the last inspection in January 2009. The Manager showed us the preemployment checklist she has produced and told us that this would be completed for any new staff that the home employs. This meets a requirement from the last inspection. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Most staff have come to work at Blossom from other care homes and had had a range of training prior to starting work. These included areas of mandatory training, including first aid, medication, safeguarding adults, fire and health and safety, inspection control, food hygiene and challenging behaviour. Staff have also received recent training in these areas. The home has developed and implemented its own staff training programme covering the mandatory areas of training. They have also made progress in supporting staff to obtain NVQ qualifications. Staff and the Manager are also enrolled to start an NVQ3 in Mental Health in September 2009. The Registered Providers will also do this course in when they have completed initial NVQ qualifications. Staff have been trained by the local nurse in diabetes support. All training requirements from the last inspection have been met. The Manager had recently attended a workshop on the Mental Capacity Act and Deprivation of Liberty Standards. It is recommended that all staff receive training in this area. We saw the supervision files that demonstrated that staff received this formal, individual support at least bimonthly. Staff meetings are held regularly. Staff we spoke to were very positive about the home and said they were pleased to be able to work in place where they could make a difference in peoples lives. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the homes management arrangements and health and safety arrangements. Residents are consulted and their views are taken seriously. Evidence: The Registered Persons and Manager have kept CQC in touch with the service using Regulation thirty seven reports.They have also kept us informed changes to the management arrangements. This meets requirements from the last inspection. Since the last inspection, Sandra Hancock has been appointed Manager. She has completed an NVQ4 in Care and the Registered Managers Award. She has applied to CQC for Registration and put good management processes into place in the home. She has the confidence of residents, the staff and the Registered Providers. Management requirements from the last inspection are met. The office computer system has improved and now works well. Records are also properly kept in the home. This meets previous requirements. Staff, the management team and some are residents are also taking an onsite IT course to improve their Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: computer skills. All health and safety certificates were up to date and in order. The home now has a fire risk assessment and has regular fire drills, meeting previous requirements. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 31 35 That the home keep the staffing level under review. That the home provides training to staff in the Mental Capacity Act. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!