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Inspection on 25/05/05 for Merrimans, 3 (Adult Respite)

Also see our care home review for Merrimans, 3 (Adult Respite) for more information

This inspection was carried out on 25th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Several members of staff have worked in the home for long periods and are familiar with all the service users who come to the home for their respite breaks. This staff core provide good care to the service users based on their knowledge and experience of their needs. Service users benefit by the higher staffing levels at peak times of the day.

What has improved since the last inspection?

Staff have received training in Autistic Spectrum Disorders and Adult Protection.

What the care home could do better:

The external maintenance of the home and interior decorations are in need of attention. The dining room floor has an unsightly build up of scale around the edges. The wash hand basin in the kitchen was dirty and sink and baths throughout the home were stained with lime scale. Risk assessments carried out are not generic and do not include action to be taken to reduce or eliminate the risks identified. Service users have no access to activities outside the home at the weekends and evenings during their respite stays. The two service users who have been awaiting permanent placements for over six months are particularly effected by this lack of choice.

CARE HOME ADULTS 18-65 Merrimans, 3 (Adult Respite) West Drayton Road Hillingdon Middlesex UB8 1JZ Lead Inspector Pauline Griffin Unannounced 25th & 26th May, 9th & 16th June 2005 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. Merrimans, 3 (Adult Respite) Version 1.10 Page 3 SERVICE INFORMATION Name of service 3 Merrimans (Adult Respite) Address West Drayton Road, Hillingdon, Middlesex UB8 1JZ 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 234039 01895 813757 J.Thomas@hilingdon.gov.uk London Borough of Hillingdon Ms Jannette Angelia Thomas Care Home 9 Category(ies) of Learning Disability (0), Physical Disability (0), registration, with number Sensory Impairment (0) of places Merrimans, 3 (Adult Respite) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Registered for a total of 9 people - 9 with learning disabilities/sensory impairement and/or 2 with physical disability. Registration for both sexes with no age specied. Date of last inspection 2/9/04 Brief Description of the Service: Merrimans is a purpose built home constructed in the 1970s and is situated on a busy road that is near to Hillingdon Hospital and close to public transport. The home provides respite care for up to nine people with learning disabilities, physical disabilities and/or sensory disabilities. There are nine bedrooms, seven on the first floor and two on the ground floor. The ground floor bedroooms are most suitable for people with physical disabilities and the rooms have a dual purpose for either physical or learning disabilities. One of the bedrooms on the first floor is used by Hillingdon Social Services Department as an emergency bed for people with learning disabilities. The communal rooms on the ground floor are large and airy. There is also a large, enclosed garden with lawns and spacious patio areas. The home currently has two service users who are awaiting transfer to appropriate permanent accomodation more suited to their needs. Sevice users staying in the home continue to attend their day centres, colleges and clubs when they stay at Merrimans. They remain with their registered General Practitioners. The referals come from within the boundaries of the London Borough of Hillingdon with only a few exceptions. Staff hold parent/carers meetings every six weeks. Approximately fifty service users are on the current list for regular respite care. Four service users were staying in the home on the days of the inspections. The staff complement currently has to be supported by 40 agency or reserve team staff. Merrimans, 3 (Adult Respite) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over three separate inspection visits for a total of ten hours thirty minutes. Three members of staff were spoken to and two service users. Three service users’ carers were contacted by telephone. Two staff files were examined and two service users files. The recording systems were checked including the maintenance records of the home. The decorative order of the home requires attention. Some of the furnishings in the home are worn and much of the furniture does not match. The paintwork is dirty and chipped and several of the curtains were falling off the rails. An area of the patio in the has been garden sealed off because of subsidence of paving slabs and has been the subject of requirements in previous inspections. An immediate requirement was, therefore, issued. The home is using 40 agency or reserve team support. This agency provides for most of the staff deficits. The Registered Manager did not consider that the staff provided by the agency had the right background to work with the service users with challenging behaviour. The turnover in the agency staff is also high and, therefore, different staff are continually coming into the home who need training and supervision and need time to familiarise themselves with the service user’s needs. Two service users are still awaiting permanent placements after seven months in the home. One of these service users has mood swings and is subject to challenging behaviour and there have been a high number of incidents/accidents recorded involving injuries to staff and damage to the property. An immediate requirement was issued regarding the need to address the safety risk the behaviour of this service user causes to other service users and staff. What the service does well: Several members of staff have worked in the home for long periods and are familiar with all the service users who come to the home for their respite breaks. This staff core provide good care to the service users based on their knowledge and experience of their needs. Service users benefit by the higher staffing levels at peak times of the day. Merrimans, 3 (Adult Respite) Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Merrimans, 3 (Adult Respite) Version 1.10 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 Merrimans, 3 (Adult Respite) Version 1.10 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) 1,3 & 5 The home has a Statement of Purpose dated January 2005. Information provided to service users and their families came in the form of different leaflets and letters and it was not clear what information is provided. Heavy use of agency and temporary reserve team staff, compromise the home’s capacity to meet the needs and specialist needs of service users. The home is not able to deal with the specialist needs of service users who are placed as emergencies and who display challenging behaviour. EVIDENCE: Service users have a contract with the Local Authority for their respite stays. A copy of the Statement of Purpose and Service User Guide were available and should be given to each service user and/or their representative and be easily accessible in the home. The Service Users guide has not been produced in accordance with the Standards but there are several different leaflets and letters available. It was, therefore, not clear what information is provided to the service users and their representatives. Service users in the home whose emergency placements have become longer stay must have their specialist needs and any aggressive behaviour assessed Merrimans, 3 (Adult Respite) Version 1.10 Page 9 to measure the effect on both other service users and the staff in terms of safety, risk and quality care time available. Action must be taken to reduce or eliminate risks and provide the specialist needs required. Merrimans, 3 (Adult Respite) Version 1.10 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) 7,9 and 10 Service users have individual care plans that include up to date information on all aspects of their care, health needs and daily living routines. Service users are shown respect and courtesy and looked well groomed and contented. EVIDENCE: Care plans were examined and they were up to date and comprehensive. Files included a daily log with daily entries detailing any care procedures, behaviour issues or notable aspects of daily routine. Staff spoken to demonstrated their commitment to assisting service users to make decisions about their daily routine. Records in the home are stored in locked cabinets in accordance with the Data Protection Act 1998. Merrimans, 3 (Adult Respite) Version 1.10 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) 11,12,13 & 16 Service users continue to attend their usual day care services and other social clubs whilst at the home and their daily routine is supported to maintain continuity during their respite stays. The home lacks alternative resources to offer service users at weekends outside the home. Service user’s choices in their care and routine are respected within the homes resources. EVIDENCE: The home has few resources to offer service user’s at weekends for any outings outside the home as there is no vehicle available and staffing levels also dictate what can be done. The home has good indoor equipment in terms of audio/visual facilities and there are also these facilities in each bedroom. There is a large secure and secluded garden that is accessed by french windows from the ground floor accommodation. The main meal is prepared by the cook each day to a prescribed menu. The cook is provided with an index of the special diets and preferences of each service user. The meals being prepared corresponded to those described in Merrimans, 3 (Adult Respite) Version 1.10 Page 12 the menu and included a good balance of fresh vegetables and fruit. The cook said that if a service user dislikes what is on the menu for the day, they can choose from a selection of other meals and a good selection of frozen choices are available. One service user chose another meal on one of the inspection days because he did not like the meal on the menu that day. Staff were observed to be interacting with the service users in a relaxed and respectful manner. Merrimans, 3 (Adult Respite) Version 1.10 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 & 20 The home has detailed care plans for each service user that includes daily logs of care routine and events. Staff have a handover meeting when they change over duties to exchange all relevant information and ensure continuity of care to the service users. The care plans include all relevant healthcare information required by the home for the respite care they provide. The home has a satisfactory medication policy and system of administration. EVIDENCE: The home is operating with the use of 40 agency/reserve team staff and whilst use of temporary staff gives flexibility to the ‘ebb and flow’ of the respite nature of the home, the current heavy dependence prevents a satisfactory service being provided. One staff member said that there was sometimes only one permanent staff member on duty to two agency staff. Standard 33 comments on this issue. The home has a satisfactory medication policy and system of administration. Service users keep their own GP and health care services whilst they stay at the home. Health care records seen were detailed and satisfactory and the home ensures that service user’s health care needs are met. Merrimans, 3 (Adult Respite) Version 1.10 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Staff spoken to confirmed they had received training in adult abuse and were able to demonstrate a high awareness of adult protection and connected issues. EVIDENCE: The home has policies produced by the London Borough of Hillingdon that are used in induction and supervision of staff. Staff have received training in dealing with aggression and autistic spectrum disorders. Service user’s money is held in a locked safe in separate containers and the records were in order. Merrimans, 3 (Adult Respite) Version 1.10 Page 15 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) 24,28 & 30 The behaviour of some of the service users sometimes compromises the safety of other service users. The interior of the home is in need of re-decoration and the furnishing need re-assessment as some items are worn and do not match. Some areas in the home were not clean and one area had an odour or urine. These issues prevent the home from providing a homely, safe and comfortable environment for the service users. EVIDENCE: A review must be made of the interior decoration of the bedrooms and communal rooms. Re-decoration work must be carried out to a suitable professional standard with appropriate colour schemes. There were areas of the home that required cleaning e.g. the dining room floor had a build up of scale on the ceramic tiles and there were cobwebs on the ceilings in some of the rooms. The walls and other areas in the kitchen required cleaning. Curtains were hanging from their tracking in some of the rooms. There was an odour of urine on the first floor landing and one of the bedrooms. The double glazing had ‘blown’ in some windows and had become partially opaque. The wash hand basin in the kitchen was dirty and sinks and baths throughout the home were stained with limescale. Merrimans, 3 (Adult Respite) Version 1.10 Page 16 An area of the patio in the garden had been sealed off because of subsidence of the paving slabs. This was identified to be made good in inspections over several years and has not been addressed. The inspector made an Immediate Requirement under the Care Homes Regulations 2001. Merrimans, 3 (Adult Respite) Version 1.10 Page 17 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) 31,33, & 36 Discussion with staff indicated that they were unsure of each other’s roles and job titles. The Registered Manager said this might be due to the use of agency staff who had been employed in the home for long periods and other staff movements within the staff structure. Staff said that the heavy use of agency staff put extra pressures on the permanent staff regarding the quality of the service provided. EVIDENCE: The home has four careworkers who are supported by two agency and two waking nightworkers. Staff also said that there were six team leaders and other staff said that there were five team leaders and one senior. The use of agency staff further complicates the role and responsibilities within the staff team. Staff said that of the three members on duty, there were sometimes two agency workers with one permanent staff member on duty at any one time. The permanent staff team demonstrated a good knowledge of the service user’s needs and displayed a strong team spirit. Staff spoke positively about the support they received from management. Merrimans, 3 (Adult Respite) Version 1.10 Page 18 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) 39,40 & 42 Families of service users were spoken to by the Inspector and one family member was not able to answer questions with regard to what choices the service users might be given. Another family member said that they would not wish to comment unfavourably at the parent/carer meetings (run every six weeks by the home) for fear the facility might be withdrawn from them. The aggressive behaviour of one of the service users in the home, puts the health and welfare of other service users at risk. EVIDENCE: The quality assurance system should include input from other professionals/stakeholders in the home. One of the carer’s spoken to said that there were a lot of questionnaires but no results seen from them. A senior manager makes monthly quality visits to the home and copies are sent to the CSCI. The CSCI is also notified of any serious incident or accident occurring in the home. The home has a record of 36 violent incidents recorded in the past 12 Merrimans, 3 (Adult Respite) Version 1.10 Page 19 months and 6 dangerous occurrences. 11 violent incidents were recorded for the month of May 2005 and these involved one particular service user. An Immediate Requirement was issued under the Care Homes Regulations 2001. The home’s records confirm that fire drills, fire equipment tests, lighting, electrical appliances, gas and water has been tested by accredited organisations. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x 1 x 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 Merrimans, 3 (Adult Respite) Score x 3 x 3 Standard No 24 25 26 27 28 29 30 Score 1 x x x 2 x 2 Page 20 Version 1.10 10 LIFESTYLES 3 Score STAFFING Standard No 11 12 13 14 15 16 17 3 3 2 x x 3 3 Standard No 31 32 33 34 35 36 Score 2 x 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 3 x 1 x Merrimans, 3 (Adult Respite) Version 1.10 Page 21 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 1 Regulation 5(1)(a-f)5 (2) 21(2) Requirement Information provided to service users in the form of a Service Users Guide must include all the elements listed in Regulation 5(1) of the Care Homes Regulations 2001. This is re-stated from the previous three inspections. The Registered Person must demonstrate how it aims to meet the specialist needs of service users both at the present time and in the future. The Registered Person must plan a schedule of arrangements for service users to have some access to trips or short excursions outside the home at weekends on a regular basis. The Registered Person must make an urgent review of the external maintenance and the internal decorations and furnishings of the home. A prioritised programme must be produced with dates and timescales. The Registered Person must ensure that the home is clean throughout and that any unpleasant odours are Version 1.10 Timescale for action 30/09/05 2. 3 12(1)(a)( b) 22/07/05 3. 13 16(m)(n) 22/7/05 4. 24 & 28 23(2)(b) 22/7/05 5. 30 16(k)(j) 30/6/05 Merrimans, 3 (Adult Respite) Page 22 eliminated. 6. 31 18(1)(a)( b) 18(1)(a) 13(2)(c)( 6) The Registered Person must review use of agency staff and reduce the current level of usage. The Registered Person must ensure that vacant positions are filled with permanent staff. The Registered Person must urgently address the safety risk that the behaviour of one service user is causing to other service users and to staff and provide an action plan to detail how the identified risks will be minimised or eliminated. (Immediate Requirement). The paving in one area of the garden has subsided and been sectioned off and must be made good. (Immediate Requirement). 22/7/05 7. 8. 33 42 22/7/05 30/6/05 9. 24 23(2)(b) 1/7/05 10. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 39 39 Good Practice Recommendations The quality monitoring process should include all available strands of input from those who are associated with the home. The quality monitoring process should enable the service users and their carers to make comments and criticisms about the service they receive, with the confidence that action will be taken to resolve their issues and that no repercussions will result as a consequence. Merrimans, 3 (Adult Respite) Version 1.10 Page 23 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 Merrimans, 3 (Adult Respite) Version 1.10 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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