Inspection on 20/02/07 for Merchiston House

This inspection was carried out on 20th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merchiston House 10/10/05

Merchiston House 27/06/05

Merchiston House 27/09/04

Merchiston House 24/05/04

Merchiston House 19/01/04

Merchiston House 01/10/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Merchiston House 1 Colham Road Hillingdon Middlesex UB8 3RD Lead Inspector Ms Jean Bovell Key Unannounced Inspection 20th February 2007 11:00 Merchiston House DS0000032543.V328006.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 Merchiston House DS0000032543.V328006.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. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merchiston House Address 1 Colham Road Hillingdon Middlesex UB8 3RD 01895 235920 01895 232797 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) London Borough of Hillingdon Mr Timothy Green Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The carpet in the front hallway and corridor must be replaced by 31 July 2003. Care Homes Regulations 2001. Reg 23(2)(d). The kitchen must be refurbished by 31 July 2003. Care Homes Regulations 2001. Reg 23(2)(b). 10th October 2005 Date of last inspection Brief Description of the Service: Merchiston House is a spacious five bed roomed house standing in its own grounds in Hillingdon. The accommodation comprises of four bedrooms for service users and one for staff. There is a bathroom on the first floor and a toilet on the ground floor. The home is owned by Hillingdon Health Authority and managed by the Social Services Department. The home is located in Colham Road, near Hillingdon hospital and is a short walk away from local shops and amenities. Merchiston House provides a home for four service users with severe learning difficulties who can present a challenge to the service. At the time of the inspection three service users were being accommodated at the home. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on Tuesday 20th February 2006. The Registered Manager and one ancillary worker were at the home. The Inspector was informed by the Registered Manager that two service users were being supported by care support workers in separate activities within the community and one service user was attending a day resource centre. During the course of the inspection the home’s records, documents, policies and procedures were examined. A tour of the building was undertaken and observations were made. Two service users were spoken with and discussions were held with two Senior Support Workers and three Support Workers. All key Standards were examined. The Registered Manager was co-operative and provided appropriate assistance throughout the inspection. What the service does well: The service users appeared appropriately dressed, comfortable and well adjusted within their environment. They moved freely around the home and related in a friendly and spontaneous manner with the various support workers who covered duty at the time of the inspection, and also with the Registered Manager. Service users who spoke to the Inspector expressed satisfaction with the care and support they received at the home. The records were indicative of support workers being appropriately trained for working constructively with service users who present challenging behaviours and a one to one service is being provided in meeting their individual needs. All policies, procedures and records viewed were up to date and indicated that the health, safety and welfare of the service users were being protected at the home. The overall environment was supportive, lively and homely. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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 Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are appropriately assessed prior to being admitted into the home. EVIDENCE: The records of three service users were viewed and it was evidenced that background information and assessments of need that had been carried out by placing Authorities were submitted at the point of referral. A subsequent assessment was undertaken by the home and initiated with a visit to prospective service users in their own environment. Relatives, social workers, previous carers and medical professionals, where appropriate, participated in the process of assessing separate personal, healthcare, emotional and communicative skills, and identifying specific social interests and aspirations. This formed the basis on which related care plans were drawn up. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are being appropriately carried out. Service users are able to make decisions in relation to their daily living routines. EVIDENCE: Care plans that had been drawn up in relation to three service users were inspected. It was reflected that separate personal and health care needs were assessed and social interests and aspirations were identified. Action plans and set goals had been put into place. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 10 Risk assessments relating to specific activities and behaviours identified within care plans had been undertaken and included crossing the road safely, damage to property and aggression in public places. The Registered Manager confirmed that the service users made decisions regarding meals, activities, clothing and personal purchases. A Senior Support worker reported that service users were able to make telephone calls, receive confidential mail and meet with visitors in their bedrooms or within separate communal areas. Service users were observed moving freely around the home and appeared happy and enthusiastic when they informed the Inspector of the various outdoor activities that they had chosen to participate in on the day of the inspection. Individual choices and interests were also reflected in personalised lockable bedrooms Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to participate in separate activities of interest within the community and maintain contact with their relatives. Service users are responsible for carrying housekeeping tasks – as appropriate. Varied and wholesome meals are being provided. EVIDENCE: Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 12 It was evidenced on care plans viewed that service users received opportunities for personal development and were able to attend college and day resource centres and received assistance with developing life skills. Annual holidays were arranged. Service users attended evening clubs and were supported during separate activities within the community such as swimming, horse riding, bowling, football, shopping, meals out and visits to pubs. They were also encouraged to pursue particular interests such as music and painting. Service users were observed returning from and being accompanied to, a variety of separate outdoor activities at the time of the inspection. The home has an open visiting policy and contact with relatives and/or friends are encouraged and facilitated. Service users who spoke to the Inspector confirmed that they received regular visits and telephone calls from the respective relatives. The Inspector was informed by the Registered Manager that service users were supervised whilst carrying out housekeeping tasks such as tidying bedrooms, undertaking laundry and preparing meals or drinks. The kitchen is at all times accessible to the service users and a considerable amount of food including fresh fruit, cakes and drinks were on view. Nutritious and varied meals were reflected on the menus. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive assistance with personal care as required and their healthcare needs are being met appropriately. The home’s policy and procedures on medication are satisfactory. EVIDENCE: The Registered Manager confirmed that the service users received assistance and/or supervision with their personal care routines, as required. However, personal care tasks were always carried out in privacy within bedrooms or bathrooms and that service users independently chose what they wore each day. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 14 The records were indicative of service users receiving appropriate access to GPs and being supported during psychiatric outpatients appointments. Regular dental and eye checks were arranged by the home. The home’s policy and procedures on medication were in place. Training on Medication and Rectal Diazepam had been delivered to the Senior Support Workers who are responsible for administering of medicines to the service users. However, a named Senior Support Worker holds overall responsibility for the monitoring of medication at the home and ensuring that prescribed medicines are reviewed when appropriate. The storage of medication including PRN drugs were satisfactorily stored, administered and recorded. Risk assessments relating to possible side effects had been undertaken. It was indicated on medication administration sheets that medicines were being administered to all service users that are currently placed at the home. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedure is satisfactory and service users are being protected from abuse. EVIDENCE: The complaints procedure was clear, concise and accessible to the service users and their relatives. The records were reflective of complaints being appropriately investigated and satisfactorily resolved. A policy on Adult Protection was in place and it was indicated that staff training on the Protection of Vulnerable Adults had been delivered. The Registered Manager reported that relatives or placing authorities held responsibility for the financial affairs of the service users. However, monetary allowances were held in safekeeping at the home. The financial records relating to three service users were examined and no discrepancies were identified. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall environment of the home is safe, comfortable and adequately maintained but appropriate attention is required in specific areas. EVIDENCE: The communal areas within the home are spacious, suitably furnished and appropriate for shared and/or individual activity. The garden was adequately maintained but slabs that had been placed at the top of stone steps that led onto the lawn were broken with protruding jagged edges. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 17 There were no issues regarding the laundry. An ancillary worker was carrying out cleaning duties at the time of the inspection and the home was essentially clean, tidy and hygienic. However, a specific carpeted area on the ground floor and an en-suite toilet/washbasin also on the ground floor required cleaning and refurbishment respectively. The glass panel that was fitted into a door on the first floor was cracked and needed replacement. The visitors’ book was worn and dislodged from its binding. The Registered Manager produced recorded evidence in confirming that requests had been made in relation to additional repairs that were required at the home. The overall atmosphere within the home was comfortable, supportive and lively. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The support workers are appropriately trained and qualified for meeting the needs of the service users. The recruitment policy and practices are satisfactory. EVIDENCE: A training programme was in place and it was indicated that support workers received Induction Training and that subsequent staff training included Protection of Vulnerable Adults, Moving and Handling, Fire Safety, Infection Control and Basic First Aid. Six support workers achieved National Vocational Qualifications and Applied Behaviour Analysis training was delivered to all support workers. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 19 The records were indicative of appropriate strategies being used in working with service users who presented challenging behavioural patterns and that related risk assessments had been carried out. Support workers were also focused on developing life skills and ensuring the service users received appropriate opportunities for personal development. A one to one staff to service user ratio is operated at the home and support workers were observed being competent and attentive in meeting the separate needs of the service users A number of recruitment files were viewed at random and were found to contain the required documents such as photo-identification, CRB disclosure certificates, application forms, references and signed contracts/statement of terms and conditions. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is appropriately experienced and qualified. Systems for effective quality assurance are in place The health, safety and welfare of the service users are being satisfactorily protected. EVIDENCE: Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 21 The Registered Manager has been in post for seven years. He has had eighteen years experience within the care profession, holds Certificates in Management Studies and Social Service and has received accredited training in Applied Behaviour Analysis. Service users were observed freely entering the Office and relating in an open and friendly manner with the Registered Manager. Seniors and support workers that were spoken with reported that the Registered Manager was open, approachable and supportive. Documented evidence that effective quality assurance had been undertaken was in place. Health and safety checks such as gas maintenance, emergency lighting, fire alarms, portable appliances and water temperature were up to date. Fire drills were carried out on a monthly basis and were appropriately recorded. Environmental risk assessments had been carried out. The records indicated that staff training on Health and Safety had been delivered. Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 23 N/A 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 YA24 Regulation 23(2)(d) Requirement The Registered Person must ensure that the carpet on an identified communal area on the ground floor is cleaned. The Registered Person must ensure that an en suite toilet/washbasin on the ground floor is refurbished. The Registered Person must ensure the replacement of the cracked glass panel on a door on the first floor. The Registered Person must ensure that broken/protruding stone slabs in the rear garden are removed or replaced. Timescale for action 30/04/07 2 YA24 23(2)(d) 31/05/07 3 YA24 23(2)(b) 30/04/07 4 YA24 23(2)(o) 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Merchiston House DS0000032543.V328006.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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