Inspection on 04/06/07 for Blossom Place

This inspection was carried out on 4th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blossom Place 24/05/06

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Blossom Place 24 Allenby Road West Thamesmead London SE28 0BN Lead Inspector Maria Kinson Unannounced Inspection 4th June 2007 10:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blossom Place Address 24 Allenby Road West Thamesmead London SE28 0BN 020 8855 3322 020 8855 8139 blossomplace@btconnect.com www.oliveservices.com The Olive Services Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Olufunke Oluleye Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 30th August 2006, one named service user, over the age of 65 years, can be accommodated. The CSCI must be informed when this service user no longer resides at the home. 16th February 2007 Date of last inspection Brief Description of the Service: Blossom Place is registered by The Commission for Social Care Inspection to provide personal care for fourteen male or female service users, aged 18 to 65 years of age. The home provides a period of rehabilitation or treatment for people with a mental health disorder. The home is located in a small cul de sac, on a new housing estate, on the borders of Plumstead, Thamesmead and Woolwich. The home is within walking distance of a mainline railway station, local bus routes and shops. The home consists of two, two-storey houses (House A and B) and a detached house, which staff refer to as the activity block. All of the bedrooms are single occupancy, fully furnished and have an en suite shower and toilet. The activity block includes a computer suite, office space, meeting rooms and a kitchen. All of the service users living in the home have use of the laundry area, which is located between house B and the activity block. There are four parking bays at the front of the home. The fees charged by the home range from £850 - £1000 per week. This information was provided to the commission on 4.06.07. Service users were responsible for meeting additional costs such as hairdressing, holidays, transport charges and private health care fees such as consultation with a psychologist. Further information about this home can be obtained by requesting a copy of the Statement of Purpose or visiting www.oliveservices.com Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 4th and 8th of June 2007, and was unannounced. The Inspector spoke with four of the people living in the home, three members of staff, the Art Therapist and the Manager. Written feedback about the service was obtained from six service users and two relatives. All of the communal areas were seen, and a selection of bedrooms were viewed. Care, staffing, health and safety and medication records were examined. What the service does well: What has improved since the last inspection? The range and type of activities that were provided in the home had improved. Arts and crafts sessions were taking place regularly and plans were being made for a yoga class to start. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 6 Medication records had improved but some external and internal medicines were not stored separately. Medicines received in the home were recorded but it was not possible to establish from the records how much medicine had been used. The arrangements for checking the suitability of new staff had improved but the home did not assess if applicants were in good health. Access to training had improved and the training programme now included more sessions about issues that affected people with a mental health disorder. The home had introduced a number of initiatives to assess and monitor the quality of care provided in the home. The directors were visiting the home regularly, audits were taking place regularly and feedback was obtained from the people using the service. What they could do better: Staff had developed an individual care plan and activity programme for each person. The plans seen indicated that some service users would be supported to go to church, to do their laundry and to learn how to cook. The records seen did not always show if people were being supported to undertake the tasks and activities listed in the plan. One person had a feeding tube that required regular flushes to stop the tube blocking. Although staff stated they had attended a training session about care of a PEG feeding tube there was no written evidence such as certificates or an attendance record to support this. The people living in the home said they liked the meals provided but there was little access to food and snacks between meals. There were no soap or hand towels in a number of toilets and one toilet was locked. The home was maintaining the staffing levels that were agreed prior to registration. However a number of service users had both physical and mental disabilities and required a considerable amount of support with personal care. Some staff said they were not getting regular breaks. Staff received induction training but the content of the course did not provide adequate information for new staff. Records of service users money were maintained but the records seen were not up to date and were recorded on loose pieces of paper that could easily be mislaid. Accidents and incidents were recorded but staff did not notify the commission about significant events. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 7 The fire extinguishers had not been serviced, there was no guidance for staff about the use of hazardous substances and action was not taken to protect service users from the risk of burns and scalds. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided written information about the service and encouraged people to spend time in the home before making a decision to move in. Staff obtained information from the funding authority and carried out an assessment before deciding if they could meet a person’s needs. EVIDENCE: The ‘Statement of Purpose’ provides information about the service. This document was reviewed in August 2006 to include information about staff qualifications, the staffing structure and room sizes. A copy of the revised Statement of Purpose was supplied to the commission and was seen in the bedrooms viewed. Information about prospective service user’s needs was obtained from the funding authority. This included comprehensive information about the person’s physical and mental health needs, a risk assessment and care plan. The manager visited prospective service user’s to verify the information provided, to obtain additional information if necessary and to meet the person. One of the assessments was difficult to read. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 10 People that were referred to the service were encouraged to visit and spend time in the home before making a decision to move in. The duration and type of visit arranged varied from person to person. One person that was admitted in recent months had spent two days and nights in the home before moving in. Another person received information about the service but moved straight in without viewing the facilities because they would have found a change in routine difficult to manage. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support plans provided information for staff about the action they should take to maintain service users health, safety and wellbeing. Service users said they were able to choose how and where they spent their time in the home and received support from staff, other professionals and their family to make important decisions, if necessary. EVIDENCE: Two sets of care records were examined. Staff used information they had obtained during the assessment period to develop an individual support plan for each person. The care plans seen included similar information to the Care Programme Approach (CPA) plans but provided more detail about the action that staff should take to meet their needs and personal goals. Information was easy to follow and both of the plans seen were reviewed regularly. It was difficult to establish from the records if service users were making any progress with some of the personal goals outlined in their care and activity Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 12 plan. For instance one plan indicated a service user would be supported to make their own breakfast and do their own laundry. There was no reference to these issues or information about their progress in their daily care notes. See recommendation 1. The inspector spoke with four people during the inspection and six of the people living in the home provided written feedback about the service. Service users said they were able to make decisions about what they did during the day, evening and at weekends in the home but some people said they would like to go out more frequently. See standards 12 –14. During the inspection one person went out cycling, some people spent time in their rooms and others spent the day in the lounge. Staff encouraged service users to take part in the art therapy session but respected their decision if they did not want to join in. There was a risk assessment on the front of each file and staff had developed action plans to maintain peoples safety and to reduce the risk of accidents and injuries where possible. Potential risks such as the risk of fire for a person who smoked and had some involuntary movements, and the risk of choking for a person that had difficulty swallowing were identified. Smoking was only permitted in designated areas and people that were assessed to be at risk were supervised by staff. The person who was at risk of choking was supposed to be using a beaker and straw but was seen drinking a hot drink in a mug. The manager addressed this issue at the time of the inspection. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had access to a varied and stimulating programme of activities in the home but some people said they would like to go out more frequently. The choice of food provided in the home met peoples needs and tastes, but there was little choice of food between meals. EVIDENCE: There was a general programme of activities that any of the people living in the home could take part in and an individual activity programme was developed for each service user. The general activity programme was displayed in each house and included quizzes, group discussion about topical issues and beauty therapies such as hair and nail care. Care staff were responsible for organising most of the activities but a voluntary art therapist provided support during art and craft sessions and the cook provided some support with cooking. Some of the artwork was displayed in the dining room Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 14 and some people showed the inspector greeting cards and jewellery that they had made. People spoken with said they enjoyed the monthly outings and had visited a local pub and farm in recent months. One person said they were bored and wanted to go out more frequently and one person said they preferred to go out rather than do activities in the home. Records showed that some of the service users had attended the outings listed above, had been out with their family and had been shopping with staff. The manager must review staffing levels to ensure that all of the service users that are not able to go out alone have some dedicated, one to one time with their key worker each week to go out. See requirement 5. Individual activity plans provided personal information about peoples interests and hobbies, work and educational opportunities, and skills training such as support to manage money and budget or to do their own laundry. See comments under standard 6. The home has a computer room, a small library and is hoping to develop an activities room. The manager had started to arrange a yoga session in response to suggestions from relatives. Records of group activities were satisfactory but it was not always possible to establish if people were receiving support to undertake all of the rehabilitation or personal development activities listed on their individual programme. The activity programme indicated that there were weekly service user meetings. Records indicated that meetings were not always held this frequently but were taking place at least once a month. The meetings provided an opportunity for people to make suggestions about the food provided in the home, discuss ideas for trips and activities and comment about the service. Service users were encouraged to maintain contact with their friends and family where possible. There was a pay phone in each of the houses and some of the people living in the home had a mobile telephone. The manager had recently started a carers support group and one relative was supported to resume contact with their family member. Written feedback about the service was obtained from two relatives. Relatives said that care staff usually provided adequate support and were able to meet their family members needs. Relatives said that most staff had adequate skills to look after their family member but one person said that communication between different shifts was not always effective. The manager should review staff handover. The home employs a part time cook; support staff were responsible for preparing meals at other times. The menu included a variety of different foods and had recently been reviewed in response to feedback from service users who said they wanted more potatoes. There was little food apart from bread, jam and cereal stored in the refrigerator and cupboards on the individual houses and access to the kitchen in house A was restricted. If a service user wanted to make a snack they would be able to make some toast or a bowl of cereal or staff would have to obtain supplies from the main kitchen. See recommendation 2. The manager said that access to the kitchen was Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 15 restricted during certain times of the day as some people would continually eat and drink to their detriment. The manager should ensure that the reason for the restriction is clearly recorded in the relevant service users files and service users are reminded about the times that they can gain access to the kitchen. There were adequate supplies of fresh, frozen and tinned food in the main kitchen but much of the food seen was ‘basic’ or ‘smart price’ brands. All of the people spoken with on the day of the inspection said they enjoyed their lunch and told the inspector there was “always plenty to eat” and “the food is usually good”. One person said they particularly liked the shepherd’s pie and chips and another person said they would like more salads. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some health care procedures were carried out without reference to a care plan and prior to staff receiving adequate training. This could compromise people’s health and safety. The management of medication had improved since the last key inspection. Records of receipt and storage of external and internal medicines must be reviewed to provide greater safeguards for service users. EVIDENCE: Nine comment cards were sent to health and social care professionals that were in regular contact with the home. None of the cards were returned to the commission. The manager had developed a network of local professionals that she could contact for advice and support. All of the people using the service were registered with a local GP and were supported to attend appointments if necessary. Care plans included guidance for staff about the signs that may indicate that a person’s health was declining or they were becoming unwell. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 17 One of the people living in the home had a peg feeding tube. This tube was not in use but required regular flushing with water to prevent it from blocking and cleaning around the entry site. The care plan did not state how often the tube should be flushed or how much water should be used. The manager said staff had received training but there were no records of this and no evidence that staff were assessed as competent to undertake this task. There was a form for recording when the tube was flushed. The form was ticked but it was not signed so it was not clear who was completing the procedure. The manager said that she was cleaning the peg site. Care of the peg site and rotation of the tube is the responsibility of the community nurse in care homes that do not provide nursing. See requirement 1. Some of the people living in the home required assistance or prompting with personal hygiene. Information about the level of support required was recorded in the care plan. People were satisfied with the support they received and said that staff maintained their privacy. All of the rooms had an en suite shower and toilet. Medication was stored in the admin block and was transported to the different houses in a bag. Storage facilities were generally satisfactory but some internal and external medicines were stored on the same shelf. The medicine room was maintained at a satisfactory temperature and there was adequate storage space for supplies. Records of receipt of medication were maintained but were difficult to use for auditing purposes because it was not clear how much medication was left over when the new supply arrived. Staff had transferred one week’s supply of medication into a compliance device. The compliance device was named but there was no indication on the box about the type or amount of medication that it contained or any instructions. This arrangement is called ‘secondary dispensing’ and is considered by the Royal Pharmaceutical Society and the Nursing and Midwifery Council to be “an unsafe practice”. A pharmacy inspector visited the home on 19/06/07 to assess this issue. The pharmacy inspector said the manager had already taken action to resolve the concerns identified and had arranged for the local pharmacist to supply medicines in a monitored dosage system. The pharmacy inspector will return to the home to reassess the new arrangements in July 2007. Some staff had attended medication training provided by the supplying Pharmacist and said they had completed a competency assessment. The manager should ensure that copies of medication assessments are kept on staff files. See requirement 2. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were systems in place to manage complaints. Staff had a good understanding of the procedure for protecting vulnerable adults but further work was required to safeguard people’s personal money. EVIDENCE: The home provided each person with a copy of the complaints procedure and a flow chart to show the various stages that they could follow. The procedure included information about the timescale for investigating complaints and contact details for the commission. The people living in the home said they knew how to make a complaint and would speak to the manager or staff if they had any concerns. Relatives were familiar with the homes complaints procedure and were confident that the manager would investigate and address their concerns properly. The home had received two complaints about staff conduct since the last inspection. Both of the issues were thoroughly investigated and action was taken where necessary to improve performance. The home had an adult protection procedure, which indicated that Social Services, CSCI and the Police would be notified about allegations of abuse. A number of staff had attended safeguarding adults training since the last inspection. Staff had a good understanding of abuse and were confident that the manager would report allegations to the relevant authority. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 19 Service users were encouraged to manage their own money where possible and a safe was provided in each room for this purpose. The personal money records for two of the people living in the home were examined. Some of the entries were recorded on loose pieces of paper and some of the money spent by one of the service users in recent days was not recorded. The manager said receipts were kept for all purchases but they were not in any order and would take a significant amount of time to audit. See requirement 3. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides a comfortable environment for the people using the service. The home did not provide adequate hand washing facilities to minimise the risk of cross infection. EVIDENCE: The home was maintained to a satisfactory standard but some of the drawer and cupboard doors were loose in the kitchen in House A. Since the last inspection work had been undertaken to install new window restrictors, stair rails and electronic fly killers in the kitchens. New radiator covers had been delivered and work was in progress to fit these throughout the home. Communal areas were pleasantly decorated and furnished. All of the bedrooms had an en suite shower and toilet and personal toiletries were seen in the rooms viewed. Some of the people had bought personal Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 21 items such as family photographs, posters, ornaments and small refrigerators with them. This made the rooms feel more homely and welcoming. Some people did not have an adequate supply of coat hangers and one person said they had difficulty getting up from bed because the bed was very low. See recommendation 3. Recruitment checks were in progress following the appointment of a new cleaner. The home was mostly clean and tidy but the cream coloured walls and chair covers in the conservatory in house A were stained and dirty and the area under the radiator in this room was dusty. The manager agreed to purchase replacement covers for the chairs so that they could be washed more frequently and said she would arrange for the conservatory walls and skirting boards to be cleaned. The appointment of a new cleaner should resolve these issues. The gardens were well maintained but lacked colour and interest. Garden seating had been purchased. Some of the toilets did not have adequate hand washing facilities and there were no hand towels in the laundry room. One toilet was locked. See requirement 4. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels did not enable staff to provide regular support for people in the community. Staff had access to relevant training sessions but the training provided for new staff did not meet the required standard. Recruitment practices had improved but further checks must be carried out to comply with legislation. EVIDENCE: Three care staff had a vocational qualification in care. Seven staff were undertaking this programme, some of which had completed the course and were awaiting their results. The home was actively working toward meeting the standard set by the Department of Health for 50 of staff to achieve this qualification. The staffing duty sheets indicated that there were two members of staff on duty, on each shift. The manager said the number of staff on the morning shift had recently increased from two to three, as the home was almost full. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 23 A number of people living in the home had both physical and mental health disabilities. Some people required supervision with swallowing, continence and mobility. The duty rosters indicated that the number of staff on night duty had decreased since the last key inspection. Discussions with staff indicated that it was difficult to take a proper break on some shifts because there were no staff to cover the units in their absence. Staffing levels must be reviewed and the duty roster must include all of the staff that work in the home such as the manager, administrator and cook. See requirement 5. The home had not used any temporary care staff as most of the permanent staff had undertaken additional shifts to cover staff sickness and absence. This ensured good continuity of care for service users. Staff were seen interacting with service users in a professional manner but most of the communication seen was task orientated such as asking a person to go into the dining room for lunch or responding to requests for cigarettes. Written and verbal feedback was obtained from service users. Most people said that staff usually listened to what they had to say and acted on the information but one person said they wished staff spent more time talking with them. Three staff recruitment files were examined. There was no evidence that the manager had assessed if the applicants were physically and mentally fit for the role. All of the other documentation required by regulation was in place. See requirement 6. A standard interview format was used. Induction training was provided for new staff about the homes procedures and health and safety issues but the training did not cover all of the common induction standards. See recommendation 4. Staff had attended various in house and external training sessions since the last inspection such as adult protection, COSHH, challenging behaviour, customer care, substance misuse, an introduction to mental health issues and medication. The manager had developed a training programme for 2007, which will include sessions about the care of older people, health and safety issues, activities, computer skills and mental health. Now that the home is established the manager should also arrange some team building and equal opportunities training and develop a training matrix so that she can see when staff last completed mandatory training sessions and when they require an update. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was well managed overall but some safety issues had been overlooked. The home had started to develop systems to monitor and improve the quality of care provided in the home. EVIDENCE: The manager was registered with the Commission and had been assessed as having the skills and experience needed to manage this service. The manager has a degree in education, a Post Graduate Diploma in Counselling and is a Registered Mental Health Nurse. In the period since the last inspection the manager had completed the Registered Managers Award and had undertaken training relevant to her role. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 25 The home was well managed overall but the manager was undertaking a number of tasks that would usually be undertaken by administration or senior staff, in addition to her management role. The home had developed a quality assurance programme. The programme included auditing or assessing people’s satisfaction with a particular issue such as food, documentation or medication, every two months. The manager said an external person had carried out an audit to assess how the service was marketed. The manager had not received the results from the audit but had arranged an open day to promote the service in response to the feedback she received. Service users had completed a survey about the food provided in the home and the results had been collated. The manager said the menu was revised in response to the survey. There were no action plans to show what the manager had done to address issues identified during audits. See recommendation 5. The home had a set of policies and procedures and new policies were being developed about the sudden or unexpected death of a service user and gifts to staff. The records of accidents and incidents were examined. Many of the issues related to disputes between service users. Some of the service users involved required medical attention and on some occasions the police were called. The commission were not notified about these events. See requirement 7. Fire escape routes were clear and the fire alarm and emergency lighting system were serviced regularly. Regular fire alarm tests and drills were taking place and service users were encouraged to take part where possible. The fire extinguishers had not been serviced since 2005. See requirement 8. Health and safety records were sampled. The sample included the service records for gas appliances, the main electrical installation and portable electrical appliances. All of the certificates were up to date. Some of the hot water temperatures were checked in May 2007. It was not clear from the records, which outlets were tested and some of the temperatures recorded were above the recommended level. There was no evidence that any action was taken to address this issue. Some staff had attended COSHH (control of substances hazardous to health) training but there were no assessments in place for staff to refer to. See requirement 9. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 3 2 X 2 2 X Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 12 Requirement The Registered Person must ensure that staff have the skills and competencies to meet people needs. Staff that are responsible for flushing feeding tubes must receive specific training on the practical aspects of safe use and must be assessed as competent by the person that has delegated the task i.e. the community nurse. The training must be fully documented and the persons care plan must provide adequate guidance for staff about the procedure. The Registered Person must ensure that suitable arrangements are made for the safe recording and storage of medicines. The Registered Person must ensure that adequate and up to date records are maintained about service users money. The Registered Person must ensure that the people living and working in the home have adequate access to hand washing and toilet facilities. DS0000061203.V338101.R01.S.doc Timescale for action 29/08/07 2. YA20 13 01/08/07 3 YA23 17 01/08/07 4. YA30 13 01/08/07 Blossom Place Version 5.2 Page 28 5. YA33 18 6. YA34 19 7. YA41 37 8. YA42 23 9. YA42 13 The Registered Person must review the current staffing levels to ensure that there are adequate staff on duty at all times to enable staff to take their breaks and to ensure that service users receive adequate support in the home and community. The Registered Person must not employ a person to work at the care home unless he has obtained, in respect of that person, the information and documents specified in Schedule 2. Information and documents missing from existing staff files must be obtained. Restated requirement, as the previous timescale of 09/08/06 and 06/04/07 was not met. The Registered Person must notify the commission in writing about significant events that occur in the care home. The Registered Person must ensure that fire equipment such as fire extinguishers and fire blankets are serviced regularly. The Registered Person must ensure that COSHH assessments are completed and made available to staff and that action is taken to reduce the risk of burns and scalds from hot water. 01/08/07 01/08/07 01/08/07 01/08/07 29/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The Registered Person should ensure that records show DS0000061203.V338101.R01.S.doc Version 5.2 Page 29 Blossom Place 2. 3. 4. 5. YA17 YA26 YA35 YA39 that staff are following the plan of care and individual activity programme. The Registered Person should ensure that there is an adequate supply of nutritious snacks on each unit. The Registered Person should ensure that residents have access to adequate hangers for their clothing. The Registered Person should provide structured induction training for new staff. The training should cover all of the common induction standards. The Registered Person should ensure that action plans are developed to address survey or audit findings. Blossom Place DS0000061203.V338101.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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