Inspection on 27/03/08 for Merlyn House

This inspection was carried out on 27th March 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merlyn House 08/09/06

Merlyn House 15/12/05

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 Chris Johnson Unannounced Inspection 27 March and 31st March 2008 11:35 th Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 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.V360271.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. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 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) jodie.morrison@scope.org.uk www.scope.org.uk SCOPE Vacant post Care Home 10 Category(ies) of Physical disability (10) registration, with number of places Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th September 2006 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. Some of the people attend social services day services once or twice a week. Other day service provision and activities are arranged by the home. Fees for the care provided by the home range from £501to £914 a week. Additional charges are made for social events, outings and holidays. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The purpose of this inspection was to assess how well the home is doing in the meeting of all key National Minimum Standards, compliance with regulations, previous requirements and to assess what the outcomes are for people who live at his home. The findings of this report are based on a number of different sources of evidence. These included: An unannounced visit to the home, which was carried out over two days on 27th and 31st March 08 whereby we looked at all key standards. Previously to this, we carried out an annual service review of the home on 13th September 2007 and as this raised concerns about the support provided for the management of the home and the way the home was being managed we brought this key inspection forward. The home has been without a full time registered manager since 28th August 2007 and since this time has been managed by an acting manager. On the first day of this visit the acting manager was unavailable and we could not access all records, therefore we arranged to go back for a second day to view staff records and to clarify issues. All regulatory activity since the last inspection was reviewed and taken into account including any notifications sent to the Commission for Social Care. The acting manager completed an Annual Quality Assurance Assessment (AQAA) prior to the annual service review. Surveys were sent to all ten people living at the home, fourteen members of staff, one healthcare professional and two care managers. Relative surveys were sent to the acting manager for her to distribute. At the time of writing this report we had received completed surveys from everyone living at the home, six members of staff and one GP. Comments made by people in the surveys are included throughout this report. During this visit we looked at the physical environment including, people’s bedrooms and all communal areas of the home. Staff and care records were inspected. Some members of staff were spoken with and others were observed during their day-to-day interactions with those living at the home. We examined records, policies and procedures. We spoke with eight of the people who live at the home. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 6 The acting manager was present on the second visit to answer questions and discuss issues. Verbal feedback was provided at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The recording of peoples’ care needs and the frequency that these are reviewed needs to improve. Currently there is a risk that peoples’ needs will be overlooked. This is especially important as the home relies a lot on agency staff and they are less familiar with peoples’ needs than the permanent staff. Staffing levels are not always sufficient for staff to be able to meet everyone’s needs. Whilst all evidence showed that the homes’ policies suggest that people have the right to choose to engage in activities of their own choosing we saw Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 7 that in practice this does not always happen due to staffing shortages and this leaves people feeling frustrated. Whilst improvements have been made to the physical environment, further improvements are needed. It is an old building is not purpose built and looks tired and dated in many areas. Some carpets need to replaced others need to be cleaned and maintenance issues can often take a long time to put right. The home has been without a registered manager for several months and the current acting manager’s hours are not sufficient to ensure the efficient running of the home. 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. Merlyn House DS0000011918.V360271.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 Merlyn House DS0000011918.V360271.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): 2,3 and 4 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ needs are fully assessed prior to admission so that the individual and the home can be sure that the home is right for them and will meet the person’s needs. EVIDENCE: The last two occasions that we have visited this home have not raised any concerns with this outcome area. During this visit we looked pre admission assessments and care notes for people who had moved into the home since our last visit. These demonstrated that people had been assessed prior to admission to determine whether the home could meet their needs. For both people there were copies of the homes’ own assessment, care management assessments, notes from their previous home and medical notes. We saw evidence that people are able to visit the home and offered integration visits prior to making a decision as to whether the home was right for them. We were able to discuss the moving in process with these people. They confirmed that an assessment process had been carried out. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 10 One person said, “I visited the home twice and had the opportunity during these visits to meet the staff and other people living at the home”. Another person said, “I Looked around the home twice. I wasn’t sure the first time and came back a second time and liked it and the people”. The results of surveys were that nine of the people living at the home said that they had been asked if they wanted to move in and one person responded that they had not. This was not however someone who had moved into the home recently. When asked whether they had been given sufficient information about the home on which to make a choice, eight people responded that they had and two people said that they had not. One person commented that they had been given information but that it was not all relevant to Merlyn House. The acting manager said that Scope plan to introduce a new assessment form and process, which the acting manager said would be more focused on what the person wants as opposed to what the home can offer. Merlyn House DS0000011918.V360271.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): 6,7,8,9 and 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has an individual care plan and staff have a good knowledge of peoples’ care needs. However written information needs to be reviewed more frequently and be more in depth especially when someone exhibits challenging behaviour. This is especially important due to the fact that the home is very reliant on agency staff. EVIDENCE: The care plans of three people were looked at during the visit to the home. People had signed their own care plans, however no one held a copy of their own plan. When we asked why people did not have a copy no reason was provided. One person spoken to said that although they did not have a copy of their plan they were not concerned about having it. However this should be something that is discussed with people and provision should be made to enable people to do so. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 12 At the last key inspection of the home on 8th September 2006 it was found that risk assessments had not been reviewed regularly and a requirement was made. We saw that this had been addressed. However none of the three care plans looked at were dated and although the home stated in the AQAA that they were reviewed monthly the evidence showed that this was not always the case. Two of the care plans looked at had not been reviewed since November 2007 and one of these did not have a specific date of review other than the month. There was no evidence to demonstrate that a review had been completed between March 2007 and November 2007 in respect of two of the care plans. Care plans did provide detail around peoples’ personal care support needs such as; the support they required with getting up going to bed, dressing, using the toilet, eating and drinking. Written risk assessments were in place regarding peoples’ moving and handling support needs and there was evidence that these had been reviewed. In general risk assessments were thorough and demonstrated that people were supported to take risks. Examples of this being guidance for staff regarding hoisting or specific trips out whereby it was evident that the activity had been thought through and planned. The home has several additional forms to use to detail peoples’ support needs and to gather background information about people such as their life history. These had not been consistently completed. As an example the life history for one person who had lived at the home for nearly a year had not been completed. No reason could be provided for this and there was no indication that the person had been asked these details or that they had declined to provide the information. Another part of the care plan is intended to detail communication support needs and these had not been recorded in all cases. An additional part of the plan asked whether ‘In the event of receiving news that you find upsetting would you like to give us the details of a person you would like us to contact?’ this had not been completed in all cases and although may not have been relevant there was not any indication that it had been discussed with the person concerned. In discussion with staff they were able to demonstrate that they were aware of peoples’ care needs and were able to describe peoples’ needs in much more detail than was recorded in the care plans. Whilst this demonstrates that staff have a good understanding of peoples’ support needs, it does demonstrate the importance of keeping the care plans up to date and accurate. As an example it was reported that one person could at times be verbally aggressive. Staff spoken with were able to demonstrate that they were aware of possible triggers and how this should be dealt with. However this was not documented and neither was there a risk assessment or management plan for this. This means that a lot of information is retained mentally by staff and relies on memory. The importance of recording and monitoring behaviour is especially important due to the fact that the home is very reliant on agency staff. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 13 Results of staff surveys were that staff considered that they were provided with enough up to date information and that they considered communication between the staff team to be good. We saw that handovers are completed at the end of each shift. Important information is recorded in ‘Daily life diaries’ that are held for each person. These act as daily notes for individuals and from looking at a sample of them we saw that they are updated daily. People were observed to make their own choices during the visit and minutes of house meetings demonstrated that people could input into the day-to-day running of the home and make decisions such as purchases for the home. During discussions with people living at the home they told us that they had regular house meetings. People told us that they considered that their views were taken notice of and that they were listened to. One person commented “We can talk about all sorts of things such as, what we want done with the house”. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15,16 and 17 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to keep in contact with friends and family and enjoy the food and choice of food on offer. Whilst all evidence showed that the homes’ policies promote choice we saw that in practice this does not always happen due to staffing shortages. EVIDENCE: Information recorded in the AQAA listed a variety of educational and leisure activities available to people at the home. These included; college courses, shopping trips, attending religious meetings and attending social and community based activities. We confirmed through speaking with people, responses to surveys and from looking at records that people do engage in a variety of activities of their own choosing. People said that they could exercise choice over whether they did or did not engage in an activity. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 15 People told us however that at times this choice is limited due to staffing levels and staff availability. When asked in the survey whether they could do what they wanted to throughout the day, night and at weekends, people made the following comments, “Can sometimes be limited by staffing”, “I sometimes wish there was more opportunities for me to be accompanied during the evening and weekends. I feel this is restricted by staffing”, and “If there were more staff I would like to go out more at weekends”. When we talked to those living at the home many commented on the way that staffing levels impacted on their lives. People said that they had not had the opportunity to have regular one to one time with their key workers on a regular basis due to staff shortages. Whilst all evidence showed that the homes’ policies suggest that people have the right to choose to engage in activities of their own choosing we saw that in practice this does not always happen due to staffing shortages. The activity calendars for the day of the visit showed that three people were due to attend a drama course at college. Due to the number of staff on duty this would not have been possible, as one of the people needed the support of an additional staff member. People were offered the option of watching a course related video at home and two people chose this option. However from discussion with staff it was clear that for the person who required the support of an additional staff member there was no other option. The ‘Daily life diaries’ of three people were looked at during the visit to the home. These demonstrated that people could exercise choice over when to get up go to bed and whether or not to engage in activities and which activities to do. We saw for example that there were not fixed times for breakfast and one person was having breakfast when we arrived at the home, which was late morning. People told us that they were free to choose how to spend their time and that there were not any restrictions placed upon them. Diaries provided evidence to show that people are supported to engage in their own interests such as accessing the Internet and cooking. People told us that that they could receive visitors as often as they chose and that their visitors were made to feel welcome. They also said that they could keep in touch with family and friends. Several people had their own phones and all had their own particular interests such as listening to talking books, watching television, DVDs, using computers and said that they could pursue these as and when they pleased. One person said, “It is a free and easy lifestyle”. Overall people were in agreement that they were free to make their own choices about how they lived their lives. Several people commented on the fact that they liked being able to spend time in the kitchen preparing a meal. People have the option to cook meals or bake cakes etc with assistance and support usually at individual sessions on a regular basis. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 16 The cook holds weekly discussions with people to determine what menu choices people would like. In discussion with people they all said that they were able to contribute to menu planning and were provided with a choice. It was clear that the cook was aware of peoples’ dietary needs and catered for these accordingly. Comments received included “The food is very good”, “I don’t know how she does it” and “Smashing”. Records were available to demonstrate that people have a varied and healthy diet. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 17 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 People who use the 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 are fully supported with their healthcare needs and have access to a range of specialist healthcare support. The administration of medication is managed safely and in line with procedures. EVIDENCE: The healthcare records for three people were examined. Records demonstrated that the home liaises with outside professionals and other agencies as appropriate and that people had access to a range of healthcare services such as podiatrists, GP’s and opticians. We saw evidence that peoples’ healthcare support needs are monitored and that people are supported to attend appointments as necessary. Discussions with people living at the home substantiated this. The medication administration records were checked for two people during the visit and these balanced with stock held at the home. From examination of these records it was evident that staff were following correct administration Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 18 recording procedures and medication was stored safely and correctly. The home has a written medication policy and clear procedures. Evidence was seen to demonstrate that staff undergo training before being able to administer any medication. The home supports people to manage and self administer their own their own medication if this is appropriate. One person spoken with said that they had managed their own medication in the past but had decided that they preferred staff to look after it as they often used to forget to take it. They told us that they were happy with this arrangement. People reported that they considered that their privacy was respected and maintained while receiving assistance with their personal care needs, that staff were polite and always knocked on their doors before entering. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory systems are in place for people to address any concerns or complaints that they may have. Procedures are in place to offer them protection. EVIDENCE: No complaints regarding the home have been reported to the Commission for Social Care Inspection since the last inspection. Results of surveys showed that everyone knew whom they could speak to if they were unhappy about anything. The home has a complaints procedure and the results of surveys and discussions people living at the home showed that people knew how to make a complaint. People living at the home have access to an independent advocacy service and people said that they had used the support of an advocate in the past to raise issues with the home. People also said that they could raise issues with the acting manager or other members of staff. Everyone spoken with said that issues are dealt with satisfactorily. Examination of staff training records demonstrated that staff undertake Protection of Vulnerable Adults training. Staff spoken with demonstrated that they were aware of the issues and their responsibilities towards safeguarding people. Merlyn House DS0000011918.V360271.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,and 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst some improvements have been made to the building and the general cleanliness further improvements are needed. Maintenance issues are not dealt with quickly and there is not any evidence that there are sufficient systems in place to monitor the general upkeep of the home. EVIDENCE: During the visit to the home we saw all communal areas and a selection of peoples’ bedrooms. Peoples’ bedrooms reflected their individual tastes and needs with specialist equipment such as hoists in place where necessary. People had been able to personalise their rooms with pictures, belongings, televisions and audio equipment. People were observed to access and spend time in their rooms as they chose. At our last visit to the home we made a requirement regarding the cleanliness of the home. At this visit we saw that a cleaning schedule has now been Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 21 implemented. This detailed specific cleaning tasks and the frequency that each task should be carried out. The home had introduced a new policy whereby staff are now required to sign when each task has been completed. Staff did say however that cleaning had to take second priority over care duties and when they were short staffed it was not possible to do all the tasks. Feedback from surveys and from discussion with people living at the home was that the home is kept clean. From looking around the home we observed there to be some areas that would benefit from additional attention as regards cleaning, repairs and replacements. At the bottom of the stairs the carpet was very worn and the stair carpet had some staining, the carpet between the kitchen and hallway looked greasy and was very worn. The windows in one person’s bedroom were dirty as was the curtain pole. In another person’s room the carpet needed to be replaced due to its’ poor condition, their blind was broken and the person said that it had been broken for a while. One person said that things are not always fixed quickly. People have lockable storage facilities within their rooms to store personal belongings etc. However currently these consist of a large padlock and fastening fitted to drawers. These could not be described as attractive or homely. We also saw that people are unable to secure their bedroom doors when inside unless they hold a key to their room and they physical needs enable them to use a key. At present people do not have keys to their rooms and we could not find any reason why they do not. One person said that that this had been spoken about in the past and one manager did talk about having locks put on although this did not happen. Some improvements have been made to the physical environment since the last time that we visited the home. A flat roof has been replaced. There has been redecoration of some bathrooms, the dining room and hallways. Monies allocated from a donation made to the home were spent on redecorating the lounge and we saw that people living at the home are consulted on the colour schemes and furnishings. More improvements are needed however. Several of the suspended ceilings throughout the home were stained especially in the hallway, some of this due to water damage from leaks in the past. In one small upstairs toilet, the toilet did not have a seat or lid and we were told that this was used by some of the male residents. People reported that the lift did not always work and said that this sometimes meant that they could not get downstairs. The home had a maintenance book to detail whereby any faults are recorded however this did not provide sufficient evidence to demonstrate that repairs are dealt with in a timely manner. Very little of the repairs reported had been signed to indicate that they had been rectified. It was noted for instance that it had been reported in October 2007 that the dining room door was not rebating. During our visit to the home we saw that the door was still faulty. Merlyn House DS0000011918.V360271.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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and caring. However the home does not maintain sufficient staffing levels at all times and this impacts on the people living at the home meaning that they do not always receive the support they need in a timely fashion and limits their opportunity to engage in activities. Pre employment recruitment checks need to be improved to make certain that two references are obtained before someone starts work at the home. EVIDENCE: On arrival at the home there were two care staff on duty, the cook and a ‘Day care officer’ who is employed to drive the minibus and accompany people to day centres and colleges. From examination of the home’s staff rota on the day of the first visit we saw that the home was operating with one care staff member short on both the morning and afternoon shift and the acting manager was also not at the home. Staff reported that they had that they had attempted to get additional cover from an agency but the agency had been unable to supply the cover. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 23 From examination of the home’s rota for the forthcoming week we saw that several shifts had yet to be covered. Responses to staff surveys indicated that this was a frequent occurrence. In response to the question ‘Are there enough staff to meet the individual needs of all the people who use the service’? One person responded ‘always’, two people said ‘usually’ and three people said that there ‘sometimes’ were. Comments included, ‘Staffing is always a problem. Agency is often used’. ‘We could do with some more bank workers. Full time workers seem to be scarce due to illness presently’. ‘We should have three staff on every shift. We are short staffed which makes this difficult but with the use of agency staff this usually means there are three staff on duty. It would be nice to have more staff to enable our service users to go out and about more’. In discussion with staff they told us that it was not easy when there were only two carers on a shift. We were told that this impacted on the people living there, as it was difficult to provide the level of support that each person needed. People living at the home told us that this impacted on their leisure activities, their opportunity to get out of the home as discussed in the ‘lifestyle’ section of this report) and their personal care needs. One person explained that it impacted on them when there were less staff as it meant that they if there were only two staff members on duty they had to wait a lot longer to be assisted to get off of the toilet. People were also less than happy with the constant use of agency staff and felt that at times this compromised their dignity as the agency staff were less familiar with their individual needs that the permanent staff. Overall people were complimentary about the attitude of the staff and assistance that they provided with nine out of the ten people who completed a survey answering that the staff ‘always’ treated them well and one person responded that they ‘sometimes’ did. We looked at the recruitment and training records of two members of staff who had been recruited since our last inspection of the home. In both cases we saw evidence that checks such as Criminal Records Bureau and Protection of Vulnerable Adults are undertaken prior to someone staring work at the home. What was lacking however was evidence that two written references had been obtained for each person. In both cases there was only one reference on file. The acting manager felt this to be an oversight and lack of filing and said that she would look for the references and send confirmation to us within forty eight hours that these had been obtained prior to either of the people starting work at the home. These could not however be located and the acting manager has since notified us that new copies of the references have been obtained. Staff reported that they considered their recruitment to have been thorough and that their initial induction and subsequent training had covered all that Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 24 they needed to know about the job. One person commented, “The induction I received was very thorough and I felt comfortable with the residents and equipment afterwards. Anything, which I felt unsure about, was sorted and I was shown within the first couple of weeks. Also I was put on my NVQ level 2 after two months of work which was brilliant”. From discussion with staff and from examination of staff training records we saw that all new members of staff undertake induction training within the ‘Skills for Care’ guidelines and that staff receive training in core areas such as moving and handling, and medication and that this training is updated regularly. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 25 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): 37,39 and 42. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present the lack of a full time registered manager has meant that aspects of care planning, maintenance of the building, record keeping, staffing levels and the general monitoring of the home’s procedures is not being carried out effectively EVIDENCE: As stated in the summary of this report we carried out an annual service review of the home on 13th September 2007 and as this raised concerns about the support provided for the management of the home and the way the home was being managed we brought this key inspection forward. This inspection Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 26 has raised a number of issues to support this. Such as the irregularity that care plans are reveiwed, the lack of risk assessments for aggressive behaviour, staffing levels, the maintenance and upkeep of the home and lack of records such as references. The home has been without a registered manager since August 2007. The home currently has an acting manager in post. However this person also manages another registered home within the organisation. The acting manager was not at the home on the first day of this inspection. From examination of the home’s rota we saw at the time that due to other commitments the acting manager is not at the home on a daily basis and is at times in other parts of the country carrying out regulation 26 visits at other homes or at the other home. In discussion with the acting manager it would appear that this is not something that is likely to change and we were informed that the organisation intends to submit an application for a registered manager to manage both Merlyn House and another home. This inspection has highlighted the need for a full time registered manager to be in post. To make certain that the shortcomings highlighted throughout this report are addressed and that improvements are sustained. Although the home does have some quality assurance processes in place these are not at present effective at recognising all the shortfalls in the service. Neither were these all identified within the AQAA. The acting manager reported that ‘residents meetings’ were held regularly. Discussion with people living at the home confirmed this and from examination of the minutes of meetings and from discussion with people living at the home we saw that people could contribute to the running of the home. We saw a selection of service contracts for equipment used within the home to evidence that they are regularly checked and serviced. We saw that fire drills had taken place and these were comprehensively documented, demonstrating that each staff member’s reactions and responses to drills are recorded and discussed with them. From examination of the fire logbook it was clear that regular checks of the fire detection equipment are carried out. The home has a policy that states that fire doors are to be checked monthly. However records at the home indicated that this had not been done since January 2008 or that a monthly check of the fire fighting equipment had been completed. Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 27 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 X 2 3 3 3 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 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 2 X X 2 X Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? ¦#ZTREQT¦# Use Section 1 button to insert Standards in the Standard column 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. 2. 3 Standard YA6 YA9 YA14 Regulation 15 (2) (b) 13 (4) (c) 16 (2)(m) Requirement Care plans must be reviewed on a regular basis. Risk assessments must be put in place for anyone who exhibits aggressive behaviour. People must have the opportunity to take part in a range of external social and leisure activities according to needs and wishes. The provider must ensure that the following issues are dealt with. • Worn and stained carpets must be cleaned and replaced carpet as appropriate. • The blind in the bedroom identified at the inspection must be replaced. Timescale for action 18/05/08 18/05/08 18/05/08 4 YA24 23 (2)(b) 31/05/08 • 5 6 7 YA27 YA30 YA33 23 (2) (j) 23 18 (1) (a) The staining on all ceilings throughout the home must be removed. The upstairs toilet must be repaired. The home must be kept clean 31/05/08 18/05/08 The provider must ensure that 30/04/08 staffing levels meet the dependency needs of those living DS0000011918.V360271.R01.S.doc Version 5.2 Page 29 Merlyn House at the home at all times. 8 YA37 8 The provider must ensure that the home is managed by a suitably qualified and experienced person. The provider must make sure that important maintenance issues such as faulty fire doors are attended to so as not to put people at risk. 31/05/08 9 YA42 13 (4) 30/04/08 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 3 4 Refer to Standard YA6 YA26 Good Practice Recommendations People should be consulted as to whether they hold copies of their own care plans. The padlocks on the lockable storage in peoples’ rooms should be replaced with a more appropriate and domestic means secure storage such as lockable drawers. People should be provided with a means of locking their rooms appropriate to their needs. The home should consider employing a domestic person to undertake cleaning duties. YA26 YA30 Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Merlyn House DS0000011918.V360271.R01.S.doc Version 5.2 Page 31 - 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. 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