Inspection on 27/06/05 for Merchiston House

This inspection was carried out on 27th June 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

Merchiston House 20/02/07

Merchiston House 10/10/05

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 Rekha Bhardwa Unannounced 27 June 2005 at 09.50am 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. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Merchiston House Address 1 Colham Road, Hillingdon, Middlesex UB8 3RD 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) 01895 235920 01895 232797 London Borough of Hillingdon Mr Timothy Green Care Home 4 Category(ies) of Learning Disability (4) registration, with number of places Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/9/04 Brief Description of the Service: Merchiston House is a spacious five bedroom 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 present a challenge to the service. At the time of the inspection the four service users were at day care. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 7 hours were spent on the inspection process. The Inspector undertook a tour of the premises and inspected staff records, service user plans/records and servicing records. Service users, one visitor and 6 staff were spoken to as part of the inspection process. At the time of the inspection there were four service users accommodated at the home. It must be noted that it is sometimes difficult to ascertain the views of service users with who are non verbal. What the service does well: What has improved since the last inspection? What they could do better: A training and development programme must be in place. Evidence of training undertaken by staff must be available for inspection. The Registered Manager must have in place a system, which provides information on the training undertaken by staff. A business plan specific to Merchiston House must be available for inspection. Reports of Regulation 26 Visits must be sent to the Commission. Care plans must be reviewed as per the homes policy. Moving and Handling assessments must be reviewed. Where it is indicated that a Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 6 service users weight needs to be monitored this must be addressed. Night staff must receive regular fire drill training. 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. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.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 Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.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) 1,2,3,4 and 5 Service users are provided with information about the home and all service users have a written agreement. Prospective service users and their representatives are encouraged to visit the home in order to allow them to make an informed choice. EVIDENCE: A Statement of Purpose and Service User Guide were available. The salient parts of the Service User Guide were available in pictorial form. The home has a stable group of service users. In the event of a vacancy arising in the home the Registered Manager would receive a referral from The Community Learning Disabilities Team; with the referral would be a completed Needs Led Assessment. Other information would be obtained from other professionals involved in the care of the service user. Once all this information has been received the Registered Manager would undertake his own assessment as to whether the home could meet the needs of the service user. Potential service users would be introduced to the home in accordance with their needs and wishes. Any restrictions placed on the service user would be discussed and agreed with the potential service user during the assessment process. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 9 Service Users have access to specialised services and professionals. This includes behavioural therapists, psychiatrists, speech therapy and psychologist. Staff working in the home are able to communicate with the service users using signing and makaton. All service users have an adult residential placement agreement issued by the London Borough of Hillingdon. Independent representatives, mainly the parents of the service users, sign these on behalf of the service users. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 10 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 There is a clear care planning system in place, which provides the staff with the information they need to meet the needs of the service users. Shortfalls in the annual reviews do not provide an up to date picture of the service user. The home has a good risk management system in place, which protects the safety of the service user. EVIDENCE: Care plans were in place for all service users. A sample of care plans were viewed by the Inspector. These identified the individual service users needs and how these needs were to be met. There was evidence that where service users have been unable to agree and sign the care plan this has been signed by the service users representative. The Inspector noted that one care plan had not been reviewed for over one year. This is poor practice and was being addressed by the Registered Manager. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 11 Details on how the service user behaviour is managed is detailed in the care plans viewed. Daily recordings are completed on each shift. Individual risk management plans are also in place for individual service users. The staff within the home use a range of risk management strategies to manage service users challenging behaviour. Care plans are discussed with the service user and their representative. Service users are encouraged to make decisions about their daily lives within their capabilities. At the time of the inspection none of the service users were able to go out unaccompanied. Any limitations are agreed with the service user (where possible) and their representative. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 12 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) 11,12,13,14 and 15 Service users participate in a range of activities that meet their individual needs. The home promotes individuality, positive relationships between service users and their families and supports service users to have a lifestyle that suits there individual needs and preferences. EVIDENCE: The home accesses local amenities that are suitable for the service users to access and meet their individual needs. Opportunities for individual development of the service users are assessed and addressed via the care plan. None of the service users are able to take up opportunities for employment, education or voluntary work due to the nature of their learning disability. All the service users attend day care for five days of the week and attend a variety of clubs in the evening and at the weekends. Service users are encouraged to participate in community-based activities and maintain positive links with families and friends. This includes going for walks, Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 13 visiting the local shopping centre, swimming and attending the local pub. Two service users had an annual holiday last year. Ad hoc activities and planned activities take place. Service users listen to music, dance and spend time in the garden. Any visits by families or friends are planned with the service user, staff and family member. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 14 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 Personal support is offered in such a way as to promote service users’ privacy, dignity and independence. Overall the health care needs of service users are well met with evidence of good multi disciplinary working. Minor shortfalls identified in relation to moving and handling and weights potentially place service users at risk. The systems for the management of medication were in place and well managed. EVIDENCE: The home’s philosophy of care is based on the recognition that all service users have a right to be treated with respect and in a dignified manner. Details of the personal support required by the service users are recorded in the care plan. Where possible service users are guided and supported in meeting their personal hygiene needs. All the service users at Merchiston House are fully mobile. The home has a routine for each individual service user, this is agreed in the care plan and is flexible. The service users at the home have access to a range of health care professionals and are supported to access NHS healthcare facilities. The records viewed indicated that the staff support service users to attend appointments at the hospital. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 15 For one service user the moving and handling assessment had not been reviewed since March 2004. This service user was last weighed on 18/9/03. None of the service users are able to self medicate. A policy on the management and administration of medication was in place. The home uses the Boots Monitored Dosage System. The Registered Manager explained that there had been several issues with the dispensing pharmacist. An example given was where a service user was due regular medication, the instructions on the MAR recorded that this was to be administered as a required medication. For another service user the full months supply of one medication was not available. These issues had been raised with Boots. The Inspector also requested that the pharmacist inspector for the CSCI discuss these issues with Boots. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 16 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 and 23 Staff have knowledge and understanding of adult protection issues which protect service users from abuse. The home has a good complaints system in place, whereby service users and their representatives are able to raise concerns. EVIDENCE: A complaints procedure was in place. This was also available in pictorial form for the service users. The Registered Manager said that home had not received any complaints since the last inspection. One relative who spoke with the Inspector confirmed that she had understood the process for making a complaint. The London Borough of Hillingdon’s Protection of Vulnerable Adults procedure and policy are used by the home. The majority of staff have received training on POVA. Some members of the staff team have received training in managing service users physical and verbal aggression. Further training had been planned in this area. The Registered Manager is undertaking the Diploma in the Psychology of Learning Disability at Canterbury University. Some of the management strategies learnt on this course have been implemented in managing some of the service users behaviours. The Registered Manager stated that there has been a reduction in the number of incidents involving service users behaviour as a result. This is positive for the service users and has enhanced the quality of their daily lives. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 17 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) 24,25,26,27,29 and 30 The overall standard of the environment within this home is good providing service users with an attractive, comfortable and homely place to live. EVIDENCE: The home was clean and odour free on the day of the inspection. Each service user has a single bedroom, which is located on the first floor. There was evidence of personalisation in all service users bedrooms viewed. This included photographs, pictures, and personal belongings. The location of the home offers easy access to local amenities. The décor, fixtures and furniture were satisfactory. Where possible the service user is involved selecting colour schemes and furniture for their bedroom. Staff introduce changes gradually to the service users as changes to routine and environment can be upsetting to the service users. The carpet outside of the kitchen was badly stained. The Registered Manager said that this was this was due to be cleaned. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 18 Each service user has a washbasin in their bedroom. There is one bathroom with a toilet, and a separate toilet on the first floor. There is also a separate toilet on the ground floor. The Inspector noted that the lino in the separate toilet on the first floor was damaged by water. The design of the home is not suitable for service users with physical disabilities. All four service users are mobile. They do not require at the present time any adaptations in the bathrooms or toilets. The home was clean and odour free. Staff undertake the cleaning, where possible the service users are encouraged to undertake small cleaning tasks like dusting and polishing. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 19 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) 32,33,34,35 and 36. The home was adequately staffed to meet the assessed needs of the service users. The service users are well supported by a well established staff team which is well managed, supported, supervised and effective in meeting the individual and joint needs of the service users. Evidence that staff training has taken place must be in place. The home must have a training and development plan, this would ensure that assessment and planning for training needs are met to meet the needs of the service users. EVIDENCE: Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 20 Two care staff have now completed their NVQ training. Three other care staff were due to complete in August 2005. Staff have access to the London Borough of Hillingdon’s Corporate training programme. Evidence of the training undertaken by staff was not always available. The Inspector found it difficult to ascertain whether all staff had undertaken mandatory training, and suggested that the Registered Manager have in place a training matrix which would detail what training had been undertaken by staff. It was not clear what training and development plan was in place for the staff working at Merchiston House. The home does not use volunteers. Two staff files were viewed at this inspection. They contained the required information with the exception of the staff members medical declaration. The Registered Manager stated that this was kept at the personnel department at the Civic Centre. The Inspector suggested that written confirmation be sent to the home that the medical declaration is held at the Civic Centre. There are three staff on duty at peak times in the day. Staffing levels vary when the service users are at day care. Addition al staff are employed when specific activities have been planned. On the day of the inspection the staffing levels were appropriate to meet the needs of the service users. The home has a total of staff. Staff vacancies are covered by long term agency staff or bank staff. On the day of the inspection a staff meeting was scheduled. Regular staff meetings are held and minutes were available. Two of the service users in the home are non-verbal. Staff are able to use sign language and makaton. A picture board had been developed for one service user as a communication method. The Registered Manager stated that he had a system of formal staff supervision. Records of supervision sessions are kept, and signed by the supervisee and the supervisor. There is also ongoing supervision with the staff working on the floor this includes working alongside staff and discussing care issues. The home also has an appraisal system in place. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 21 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) 37,38,39, 42 and 43 The home is well managed and the Registered Manager has an open style of management. Meeting the service users needs is a priority with all staff and there is good support from the management team. Staff work together to meet the needs of the service users. It was not clear what development and future planning was in place for the home. EVIDENCE: One visitor and staff spoken with commented on the fact that the Registered Manager manages the home well, has good leadership and communication skills and maintains a regular presence throughout the home. The Registered Manager informed the Inspector that he has an open door policy and that he encourages staff, service users and their relatives to voice their opinions. Staff confirmed that an open door policy was operated in the home. The Inspector observed that the atmosphere of the home is one of staff inclusion and good teamwork. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 22 The home has a corporate business plan, this was not specific to Merchiston House. The Registered Manager stated that there was a business plan for the home but this could not be located at the time of the inspection. Regulation 26 Visits had been taking place, reports following these visits were not always being sent to the CSCI. Generic and specific risk assessments were available. Servicing records were viewed at random by one Inspector and found to be satisfactory. The last recorded fire drill was dated 17/11/04. No further fire drills for night staff had taken place since. Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 23 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 N/A 3 N/A Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 N/A 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 N/A N/A Standard No 31 32 33 34 35 36 Score N/A 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Merchiston House Score 3 2 3 N/A Standard No 37 38 39 40 41 42 43 Score 3 3 2 N/A N/A 2 2 G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 24 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 2 Regulation 15 Requirement The service users care plan must be reviewed at regular intervals. Following the review the care plan must be updated to reflect the changinging needs of the service user Moving and handling assessments must be reviewed and updated. Where it is indicated that service users require weighing this must be actioned by the home. The lino in the single toilet on the first floor must be replaced. The Registered Manager must have in place a training and development programme for the home. Evidence of all training undertqaken by staff must be available at the home. Copies of Regulation 26 Visit reports must be sent to the CSCI each month. Night staff must undertake regular fire drills. Recorded evidence that fire drill training has taken place must be available for inspection.(timescale of 15/11/04 not met) There must be in place a Timescale for action 8/8/05 2. 19 12(1)a,b 8/8/05 3. 4. 27 35 23(2)b 17(2), Schedule 4-6(a), 18(1)(a),( c)(i) 26 23(4)e 29/8/05 29/8/05 5. 6. 39 42 8/8/05 8/8/05 7. 43 24 29/8/05 Page 25 Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 business plan for Merchiston House which is available for inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing, London W5 2ST 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 Merchiston House G61-G10 s32543 Merchiston House v214437 270605 Stage 4.doc Version 1.30 Page 27 - 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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