Inspection on 15/12/05 for Merlyn House

This inspection was carried out on 15th December 2005.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merlyn House 27/03/08

Merlyn House 08/09/06

Merlyn House 27/05/05

Merlyn House 03/02/05

Merlyn House 05/11/04

Merlyn House 13/08/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Merlyn House West End Road West End Southampton Hampshire SO30 3BT Lead Inspector Ms Wendy Thomas Unannounced Inspection 15th December 2005 11:00 Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 1 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 Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 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. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Merlyn House Address West End Road West End Southampton Hampshire SO30 3BT 023 8047 3166 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) SCOPE Care Home 10 Category(ies) of Physical disability (10) registration, with number of places Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th May 2005 Brief Description of the Service: Merlyn House is a registered home that provides personal care for 10 physically disabled adults. It is owned and run by Scope. The home is situated on the outskirts of Southampton within easy reach of local shops and amenities. The home consists of a two-storey building. The garden is landscaped and is maintained by volunteers. All the homes bedrooms are single. There is a passenger lift. Two of the residents attend social services day services once or twice a week. Other day service provision and activities are arranged by the home. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on Friday 15 December 2005 between 11am and 4.30pm. The inspector spoke in depth with three service users, three members of staff and the manager. There was also a brief group discussion with five of the service users. The inspector also examined records and service user files pertinent to the areas covered by the inspection. What the service does well: What has improved since the last inspection? What they could do better: Strategies around managing areas of risk for individual service users are not sufficiently developed. Some risk issues have gone unidentified, so there are no consistent guidelines for staff to support people with these. Despite being required to amend some aspects of the mediation procedure at the last two inspections, the out of date policies remain in the home’s policy documents. It is reported that the amendments have been made. The out of date policies must therefore be replaced with the amended version. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 6 Some washbasins and baths were in need of cleaning, and the carpets in the communal areas did not look as if they had been vacuumed for a day or two. Staff are not having the regular formal supervision sessions that would provide them with a forum to raise concerns, discuss their performance and plan for their future development. A start has been made however, and most staff had supervision in October 2005. 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. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 7 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 Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. Service user plans contain sufficient detail for service users to receive support appropriate to their needs. The lack of risk management strategies for individual service users in some areas of risk means that service users are not receiving consistent support around risk issues. EVIDENCE: The inspector looked in detail at one service user plan and at parts of two others. The manager agreed that these were typical, and that comments made apply to all service user plans. The files contain a personal profile, which sets out the person’s needs and gives some information as regards to meeting these. The “daily living and support requirements” break the day down into sections such as rising, showering/bathing, dressing, retiring. The support needed with these is then described, such as which sling a person needs for a hoist and how to attach it to the hoist. The manager explained that she and the deputy manager were working to improve the service user plans and were planning to include more detail in the Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 10 personal profiles. Where appropriate they will develop information regarding managing issues relating to service user behaviour. Records showed that care plans were being reviewed and updated at the timescales set by the home. At the last inspection the inspector had been informed that risk assessments were being reviewed and updated and a wider range of potential areas of risk were to be included. The inspector noted that some of the risk assessments in the service user plans were the same as those seen at the last inspection. They had not been reviewed or updated for over a year. The home has some service users who sometimes behave in ways that upset others. Without clear risk management strategies/guidelines, the approach by staff is inconsistent and does not support the person to learn appropriate responses to the situations they find difficult. The manager explained that it was the part-time deputy manager’s responsibility to update risk assessments and that she has prioritised moving and handling. Those moving and handling risk assessments seen were up-todate and of good quality. However the assurances given at the last inspection about upgrading all risk assessments have not been carried out. The service user plan examined in detail contained risk assessments for moving and handling and finance. The manager agreed that there should be more risk assessments and explained that a list had been drawn up identifying the areas of risk for each service user that needed assessing. The next stage is to carry out the risk assessments and develop guidelines for supporting service users with these issues. She agreed that this would be done. For this reason this is not being made a requirement on this occasion. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The key standards in this section were inspected at the previous inspection and found to be satisfactory. During this inspection the members of staff spoken with all commented that they thought that there were now more opportunities for service users to go out. They described this as being a positive development. Those service users spoken with were happy with the level of activities they were involved with, although one service user would like to recommence an activity they had been involved with in the past. The manager explained that this was already in hand. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. Continued improvements to the medication procedure would further promote the safe administration of service users’ medication. EVIDENCE: At the last inspection the inspector was informed that amendments required, at the previous inspection to the medication procedure had been made, although the updated copies were not available in the home. The position remains unchanged. For staff to be able to ensure their practice follows procedure, out of date procedures must be replaced by the new one. The improvements to the recording of medical appointments, discussed at the previous inspection, had been carried out. This information was now easily accessible in service user files and it was easy to identify any further action needed. Improvements to the administration of medication had been made, and an example described to the inspector indicated that any errors are being picked up promptly, and can then be dealt or rectified. At the last inspection the need to update GP/pharmacists’ instructions for the administration of medication was discussed. However a number of medications are instructed to be given “as directed”. The home must ensure Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 13 that specific instructions, and not “as directed”, are given on the pharmacist’s label and medication administration sheets. The home uses a monitored dosage system for administering medication, which is compiled on large brackets that hang in the medication cabinet. However medication that cannot be included in the monitored dosage system is kept in the bottom of the medication cabinet and in another medication cabinet. These areas are untidy making it difficult to locate an individual service user’s medication. It is suggested that the Royal Pharmaceutical Society of Great Britain’s guidelines on the administration and control of medications in care homes and children’s services are consulted for guidance on this. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Service users have access to a complaints procedure and their views are taken seriously. Systems are in place to promote the protection of vulnerable adults from abuse. EVIDENCE: The inspector examined the complaints log. The procedure for recording and following up complaints follows the format and procedure set by Scope. This proved to be effective and included all necessary information. The details of complaints are kept in a secure cabinet in line with confidentiality. A log with briefer details is kept accessibly in the office. Since the last inspection the home had received one complaint. The records showed that this was found to be unsubstantiated and that all parties were satisfied with the outcome. Following a recommendation at the previous inspection the manager is planning to reissue all service users with a copy of the complaints procedure. She has prepared a sheet outlining the procedure and details of those to contact. The next stage is for all key workers to discuss these with the service users before they added to the service users’ files. The home has a copy of the Hampshire strategy for the protection of vulnerable adults (July 2003). There is also a copy of “Scope’s Adult Protection Procedures” (November 2002). The deputy manager is the home’s adult protection advisor who coordinates any action necessary following and Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 15 allegation or suspicion of abuse. A member of staff said that they had had training about abuse a few months ago and they said that it was “good” and that they “had learnt something”. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Service users benefit from a comfortable and safe environment. Planned improvements to the exterior of the house will improve the perception of the home locally. Service users would benefit from more regular and thorough cleaning of the home. EVIDENCE: There was a requirement in the previous inspection report concerning the heating system. Although the home was satisfactorily heated at the time of the inspection, the heating system continues to be a problem. Both service users and staff commented that some areas of the home are sometimes too hot whilst others are too cold. The manager reported that, in the next financial year, she is planning to get additional heating for two bedrooms that get particularly cold. It was also reported that the heating system had been serviced the week before. It is advised that the organisation consider a permanent solution to the heating problem. Plans outlined by the manager indicate that some of the longstanding environmental issues are to be dealt with. Scope are making money available in addition to the home’s budget to address the external decoration and Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 17 repairs. Money has also been allocated in next years budget to replace the dining room flooring and decorate two bedrooms and part of the upstairs hallway. Since the last inspection one service user has had their bedroom redecorated and two service users have had overhead hoists installed in their bedrooms. Another is planned for the downstairs bathroom. The manager explained that the service user whose bedroom was referred to in the previous two reports, as needing redecoration and new furniture did not want this. So despite plans for the bedroom to be redecorated, this had not happened. The home does not currently have a cleaner. It was noticeable that the carpets had not been vacuum cleaned on the day of the inspection and that some washbasins and baths were in need of cleaning. The need for a cleaner was discussed with the manager, but she was clear that there was sufficient time within the care staff’s responsibilities for them to include the cleaning. Although cleaning was needed on the day of the inspection, there was not a significant build up of dirt. So on the whole routine cleaning is getting done. The need for periodic thorough cleaning was discussed. Service users were happy with the environment, and the person who had had an overhead hoist installed in their room was particularly pleased with this. A member of staff commented that they liked the fact that although the service users had physical disabilities, the home was not purpose built, which they thought made it feel more homely. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Service users are supported by staff whose training is regularly updated. The recruitment process and its inherent checks ensure that service users are supported by properly vetted staff. The shortfall in formal staff supervision sessions means that service users cannot be sure of a properly supported and supervised staff team. EVIDENCE: The manager informed the inspector that a number of training activities had taken place since the last inspection. It was explained that the training regarding the value base of members of staff was ongoing and involved leading by example and one-to-one work with individual members of staff. The manager’s view was that progress was gradually being made. The two members of staff accredited to deliver moving and handling training had been on a refresher course and were planning to pass on information to the rest of the staff team. The nominated member of staff responsible for adult protection issues had been on an update course run by Scope. All staff had received medication training as the home had changed to a different pharmacist and a different monitored dosage system was now being used. The pharmacy had provided this training. There has also been training for all staff regarding pieces of equipment that individual service users have started to use. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 19 The home meets the National Minimum Standards for staff qualifications with more than 50 holding, or working towards, NVQ at at least level 2. It was reported that a further four staff are planning to do NVQ level 2. The manager and deputy are both qualified as NVQ assessors. The home is satisfactorily staffed with three staff on duty during day time hours and an additional day service co-ordinator working approximately 9am to 5pm Mondays to Fridays. The home currently has two full-time, two parttime and bank staff vacancies, although the manager reported that, if checks were satisfactory, an appointment would soon be made to the full-time support worker vacancy. The full-time vacancy for a senior support worker has a significant impact on the home, as responsibilities that would normally be delegated to the senior have to be picked up by the manager, and as a consequence her time is pressured. For example, staff supervision sessions are not happening at the regularity of six a year as expected in the National Minimum Standards. The staff file for the most recently appointed member of staff was examined and contained all the expected information and checks. Some staff were finding the staff shortage difficult, especially when they were working with two agency staff. However they agreed that there was consistency with the agency staff with the same staff being used regularly. One of the service users spoken with thought that the home would benefit from more staff. The manager was clear that with judicious use of their time, staff could fulfil their responsibilities and provide support to service users in relation to their personal care needs and social and recreational activities, and maintain the cleanliness of the home. The home employs a cook to provide the midday and evening meals five days a week. The views of staff regarding the support that they got from the home’s management varied. Some felt very supported and thought that the manager was open and approachable, others found it more difficult to discuss their concerns. The manager said that staff meetings occur every six to eight weeks, and that “lots of issues” are discussed. There had been a staff meeting the previous day. She said that the aim is for staff to have one-to-one staff supervision monthly, however for many staff their first session for 2005 had taken place in October. The manager and deputy both work on shift alongside support workers so there are opportunities for issues to be raised. The National Minimum Standards state that formal supervision should be carried out at least bi-monthly. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The service user centred approach of the manager provides service users with a home that is run with the aim of promoting their development and wellbeing. There are opportunities available for service users’ views to be incorporated in the quality monitoring and development of the home. The improvement in the tests and checks of the fire detection and fire fighting equipment promotes the health, safety and welfare of service users. EVIDENCE: The manager is competent and qualified. She holds an NVQ level 4 in management and has NVQ level 2 in care. She is currently working towards her registered manager’s award. (She is also a qualified NVQ assessor.) Her value base promotes service users’ well-being and rights. She is developing a wider range of activities on offer to service users. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 21 Following a requirement in the previous inspection report, the records of tests and checks to the fire detection and fire fighting equipment were examined. These are all being carried out at the expected intervals. In a follow up telephone call the manager confirmed that all staff had had fire training since the last inspection. This had been a requirement made at the previous inspection, as staff were not receiving six-monthly fire training. The manager also explained that Scope consults with service users by giving out annual questionnaires. Service users send this to head offer. The home’s manager receives feedback from these. She said that the Friends of Merlyn House are also involved in quality assurance and address quality issues in their four-monthly meetings at the home. She reported that give input on issues related to the building and the environment. In the service user meetings that occur every six to eight weeks service users have the opportunity to raise issues regarding service quality. The manager reported that they could also do this through their annual review process. The area manager visits the home monthly and produces a report, which includes action points to be implemented. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Merlyn House Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000011918.V273303.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? 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 YA36 Regulation 18 (2) Requirement Staff must have regular supervision sessions with a member of the management team. Timescale for action 10/03/06 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. 2 Refer to Standard YA30 YA20 Good Practice Recommendations Consideration should be given to systems for ensuring the hygiene and cleanliness of the home. The storage of medication not included in the monitored dosage system should be improved. Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Merlyn House DS0000011918.V273303.R01.S.doc Version 5.0 Page 25 - 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. 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