Inspection on 27/05/05 for Merlyn House

This inspection was carried out on 27th May 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Merlyn House 27/03/08

Merlyn House 08/09/06

Merlyn House 15/12/05

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 SO30 3BT Lead Inspector Wendy Thomas Unnannounced 27.05.05 11:00 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 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 Stationary 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 H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Merlyn House Address West End Road West End Southampton Hampshire SO30 3BT 02380 473166 Telephone number Fax number Email 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 CRH 10 Category(ies) of Physical Disability, PD - 10 registration, with number of places Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03.02.2005 Brief Description of the Service: Merlyn House is a registered home that provides personal care for 10 physically disabled adults. It is owned 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 home’s 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 H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The people living in the home refer to themselves as residents and those asked said they would like this term to be used in the report. Therefore this term is used throughout the report. The home was inspected on Friday 27 May 2005 between 11:00 and 18:30. The inspector spent time individually with five residents, two permanent care staff, a member of staff from an agency, the cook and the cleaner. A phone conversation took place at the end of the inspection to feedback to the home’s manager who was working in another SCOPE home at the time of the inspection. A partial tour of the premises was undertaken and two residents’ records were examined along with some of the home’s recording. When the inspector arrived six of the ten residents were out. They returned to the home at various points during the day. What the service does well: What has improved since the last inspection? Residents are having more opportunities to take part in activities outside of the home. Work has begun on promoting the value base and attitudes expected of staff by the organisation. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 6 The level of lighting in the dining room has been increased. A new manager has been appointed and is introducing positive changes e.g. changes to the staff rota and the way in which day services are structured. What they could do better: 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 H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 standard(s) 2 The admission process ensures the home are able to meet residents’ needs prior to admission. EVIDENCE: Since the last inspection a vacancy for a resident had been filled. The person who had moved in was already well known to the home and residents as they had been receiving a day service at the home for some time. They had had a gradual introduction to living in the home and expressed their happiness with the arrangement despite feeling homesick at times. They continue to have very close links to their parents, with whom they had been living until becoming resident at Merlyn House, and visit them at weekends. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 standard(s) 6, 7 and 9 Improvements to service user plans with more frequent, documented, reviewing and updating would lead to a more consultative and person centred approach to carrying out assessments, care planning and risk assessing. Residents are supported to make realistic decisions about their lives. EVIDENCE: The inspector looked at two residents’ service user plans in detail. One of the residents discussed these with the inspector; the other preferred the inspector to look at theirs without them. The resident who discussed theirs with the inspector showed them the files they kept in their room which included information about their finances, medical matters, the home’s bill of rights, complaints procedure, and care reviews (dated June 2001 and June 2002. They said they had one booked for June this year). Their file kept in the office contained their personal details, which included a description of their needs, and care plans to meet these. Personal aims and objectives had been identified but had not been reviewed since June 2004. All resident’s files contain a moving and handling assessment for the person and approximately three other risk assessments. The files also Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 10 log medical appointments, healthcare professionals the resident is in touch with, and notes about time spent with their key-worker. In general the detail in the care plans matched the needs of the resident. Those who were moderately independent and able to direct staff in their care had brief notes about how to support them, and those with higher physical dependency and/or communication difficulties had more detailed directions for staff. However, the changes in the needs of one resident were not reflected in the care plans, which should have been updated. In general reviewing and updating service user plans including assessments, care plans and risk assessments was not occurring frequently enough. Plans should be signed and dated when reviewed so that this can be monitored. An agency member of staff, who had worked in the home on a number of occasions, said that the information they had been given about residents had been verbal and that they had not looked at residents’ files or care plans. The home’s manager has been in post since March. In a telephone conversation at the end of the inspection she described changes that she was planning to implement to address some of the issues above and improve some of the record keeping in the home. She had prioritised risk assessments as an area she would focus on initially. Once implemented, these plans should rectify some of the areas identified above, and others can then be addressed. Residents described making decisions about issues that affect them. One person enjoys taking part in sports activities with a sports club for disabled people, others attend churches, and some choose to spend time in their own rooms rather than the shared rooms in the house. Residents spoke positively about the residents meetings held in the home, although they were not able to say when the last one had been. One person said they thought they should be held more often. The residents who spoke with the inspector, who were asked about their finances, all managed their own finances. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 standard(s) 12, 13, 15, 16 and 17. Residents are benefiting from the current drive to improve and develop opportunities and activities within the local community. Support to see friends and relatives promotes the maintenance of personal relationships. The range of meals offered enables residents to have a balanced and varied diet. EVIDENCE: The manager was initiating changes in the programme of activities the residents participate in. Both residents and staff informed the inspector that they thought there were now more opportunities for residents to go out. All saw this as a positive development. Opportunities utilised by some residents include social services day services, sessions at a further education college, dancing, hydrotherapy and an in-house cookery session run by the home’s cook. Individuals can go shopping, to the theatre and other local places of interest or recreation. One resident said that they enjoyed the trips out to the Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 12 New Forest, and another told the inspector that they were hoping to visit the zoo soon. Holidays also feature as a significant event for residents. Several described having holidays through the Winged Fellowship Trust and others enjoyed an annual pilgrimage to Lourdes. Scope staff do not support residents on holidays so they are limited to specialist organisations that can support their physical needs. Residents have relationships with people outside the home through their churches, social interests, relatives and the League of Friends. Those residents asked, said that they valued the involvement of the League of Friends who are people living in the local area who support the home and are involved in coffee mornings, craft sessions and an annual garden party at the home. In her telephone conversation with the inspector at the end of the inspection the manager outlined some ideas as to how to further promote residents’ rights. The inspector saw the food records, which showed that the residents were receiving a varied and balanced diet. Residents said that the food was good and that the cook would prepare something else for them if they did not want what was on the main menu. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 13 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 standard(s) 18, 19 and 20 Residents’ personal care support plans reflect the support needed. The proposal to increase the amount of information will improve continuity and enhance the care given. The involvement of appropriate healthcare professionals enables healthcare needs of residents to be met. Tightening up on medication procedure will promote the safeguarding of residents from mistakes in the administration of their medication. EVIDENCE: Detailed care plans were in evidence for supporting residents’ physical needs. Some of these were displayed on the outside of their wardrobes so that staff had ready access to the information. Guidance from healthcare professionals was comprehensive, such as instructions on physiotherapy exercises. Where health needs were identified the appropriate referrals were being made. Medical appointments were being logged in residents’ files. The manager described plans to develop these to give more detail and any follow up needed. This will enable more effective monitoring and tracking than the previous system, where all information was recorded together in residents’ diaries. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 14 The previous inspection report had required some amendments to be made to the home’s medication procedure. The procedure that the inspector examined in the home’s policies and procedures file had not been amended. When asking the manager about this in the phone conversation at the end of the inspection, the manager assured the inspector that this work had been done. All the old copies must be replaced throughout the home. As the updated procedure was not available to the inspector, a requirement is made regarding this. The medication records and the medication cabinet were examined. There were some anomalies, which were discussed with the manager. These included updating the GP/pharmacists instructions to reflect the current times and doses, making sure reasons are given when medication is not administered, and following up where medication had been signed as having been given but was still in the monitored dosage system. There was discussion about the procedure for decanting residents’ medication for them to self-administer a week at a time. Further clarification needs to be sought regarding this. The medication cabinet should only contain items of a medical nature. Other items should be removed. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 15 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 standard(s) 22 A more proactive approach to seeking residents’ views and concerns would enhance residents’ participation, as would ensuring that all residents had a copy of the complaints procedure. EVIDENCE: The inspector saw that a resident had a copy of the complaints procedure in the files they kept in their room. Another resident was not aware that they any information about the home in their room. They allowed the inspector to look through their files, but none was readily to hand. Both people said that they had never had any cause to complain and that they were happy living in the home and with the way that things were done. A requirement was made in the previous inspection report that the complaints log should contain comprehensive information regarding how complaints had been dealt with. The inspector did not inspect the complaints log as the manager was not available to provide access. Since the last inspection the inspector had visited the home in response to a request from a resident who had some concerns. These had been addressed and the manager had agreed to meet with the resident regularly (monthly) to discuss any problems. Although file notes showed discussions had occurred the resident did not feel this was happening. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 standard(s) 24 The heat in the building was causing distress to residents and staff. Residents are happy living at the home, having all that they need when spending time in their own rooms or in the communal areas of the home. EVIDENCE: The home is comfortable and homely. The communal areas are pleasantly decorated. At the time of the inspection the house was excessively hot as it was a very hot day and it was not possible to turn the central heating off. Residents and staff were complaining about the heat. Staff and residents have mentioned in the past to the inspector that maintaining a satisfactory temperature in the home is problematic. Appropriate action must be taken to ensure that all residents have accommodation suitable for their needs and comfort, specifically that they can control the temperature. Two of the six bedrooms that the inspector saw were in need of redecoration. One of these was mentioned in the last two inspection reports. The manager Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 17 reported that it was hoped that this would be done whilst the resident was away on holiday in the summer. The residents who showed the inspector their rooms were satisfied with them. The room of the resident who had moved into the home most recently had been decorated and re-furnished just before they moved in. The lighting in the dining room had been improved since the last inspection. The exterior of the building continues to need repainting. Some window frames looked in pressing need of attention. The home has a very pleasant landscaped garden. The larger area is up a steep slope and staff explained that although some residents like to sit by the pond it is the small seating area just outside the backdoor, which is, utilised most. A cleaner is employed ten hours a week. There had been a period without a cleaner and the new cleaner had been catching up on jobs that had not been done for some time. The home however was clean with a satisfactory standard of hygiene. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Training in relation to attitudes and values would further enhance the quality of the dedicated and enthusiastic staff team. EVIDENCE: A member of the care staff who spoke with the inspector spoke positively about working in the home. They expressed satisfaction with the training they had been provided with and were currently working towards NVQ2. In-house training had included moving and handling, first aid, equal opportunities, and the role of the key-worker, managing complaints, COSHH and food hygiene. They had not had any specific training about cerebral palsy or in relation to the particular needs of the home’s residents. Two members of staff asked about the changes the new manager was introducing spoke positively about these, including a new shift pattern at weekends. Staff explained that with residents going out more, early mornings could be hectic. Since the last inspection one full-time and one part-time member of staff have left the home. The process to recruit to these posts was underway. In the previous inspection report made a requirement that staff have training in the awareness and prevention of abuse and in valuing and respecting residents. The discussion with the manager revealed that the there was still Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 19 work to do and that she was working to support attitude change within the staff group. On one occasion the inspector observed a member of staff enter a resident’s room without knocking. The manager and deputy manager are both currently part-time and this affects the support and supervision available to the staff team. This should now improve, as the manager will shortly cease to be responsible for another home as well as Merlyn House. Her increased presence will enable her to give greater input to the staff team. Staff described being able to approach the management team with queries and concerns. One informed the inspector that staff supervision was scheduled approximately every six weeks. The rotas showed that staff meetings are scheduled every Monday. The folder in the office labelled staff meeting minutes contained minutes from meetings (held approximately 2-4 weekly) up to the beginning of February 2005. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 43 The manager being able to give a full-time commitment to the home will enhance the positive outcomes that have been initiated. Improvements are needed in the regularity of tests and checks to the fire detection and fighting equipment in order to safeguard residents. In other health and safety areas the residents were being protected by satisfactory tests and services of plant and equipment. EVIDENCE: A new manager has come into post since the last inspection. She is not yet registered with the Commission for Social Care Inspection. She has been managing another SCOPE home nearby and has continued to have responsibility for this whilst a manager was recruited. A manager has now been appointed and Merlyn House’s manager will shortly be able to be in the home full-time. Although positive developments are being put into place, once the manager is in the home full-time the staff can be more fully supported and the changes monitored more effectively and developed further. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 21 Documentation was seen that fire training was last given to all staff, bar two, in October 2004. There were no records of the catch up training the two that missed it should have had. Staff fire training should be delivered every six months and was hence overdue. One of the residents explained to the inspector what they would do if the fire alarms went of and informed her that they had fire drills. Records of fire drills were seen. Inspection of the tests and checks to fire fighting and fire detection systems showed that these were not being carried out at the expected intervals. A requirement is made regarding this and staff fire training. Certificates were seen which demonstrated that servicing was being carried out for the fire detection system, the call bell system, the electrical wiring, and portable electrical appliances. The water system had been tested for legionella bacteria and a valid employers liability insurance certificate was seen. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 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 3 x x x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Merlyn House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x 2 H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 23 yes 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 6 Regulation 15 Requirement Residents service user plans (assessments, care plans and risk assessments) must be regularly reviewed and as residents needs change. The medication procedure must be reviewed and amended and staff training given to ensure procedure is followed. This requirement is carried over from the previous inspection report. A complaints log listing all complaints must be kept. Full details of complaints and their resolution must be kept. This is carried over from the previous inspection report as it was not possible to assess compliance on this . Action must be taken to ensure that residents can control the heating in the building to a comfortable temperature. Fire training and testing of fire detection and fire fighting equipment must occur at the stipulated intervals. Timescale for action 26/8/05 2. 20 13 (2) 26/8/05 3. 22 22 26/8/05 4. 24 23 (2) 24/6/05 5. 43 23 (4) 26/8/05 Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 24 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. Refer to Standard 22 24 35 Good Practice Recommendations All residents should have a copy of the complaints procedure appripriate to needs. It is recommended that one residents bedroom and the outside of the building be redecorated. Further work to develop the value base of staff in line with the organisations aspirations is recommended. Merlyn House H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 25 Commission for Social Care Inspection 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 H54 S11918 Merlyn House V230292 270505.doc Version 1.30 Page 26 - 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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