Inspection on 26/04/06 for Merrimans, 3 (Adult Respite)

This inspection was carried out on 26th April 2006.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merrimans, 3 (Adult Respite) 28/09/07

Merrimans, 3 (Adult Respite) 30/11/05

Merrimans, 3 (Adult Respite) 25/05/05

Merrimans, 3 (Adult Respite) 02/09/04

Merrimans, 3 (Adult Respite) 26/04/04

Merrimans, 3 (Adult Respite) 20/10/03

Merrimans, 3 (Adult Respite) 16/07/03

Merrimans, 3 (Adult Respite) 16/12/02

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

CARE HOME ADULTS 18-65 Merrimans, 3 (Adult Respite) West Drayton Road Hillingdon Middlesex UB8 1JZ Lead Inspector Ms Pauline Griffin Unannounced Inspection 27 April & 4th May 2006 14:15 th Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Merrimans, 3 (Adult Respite) Address West Drayton Road Hillingdon Middlesex UB8 1JZ 01895 234039 01895 813757 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 Ms Jannette Angelia Thomas Care Home 9 Category(ies) of Learning disability (9), Physical disability (2), registration, with number Sensory impairment (9) of places Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: Merrimans is a purpose built home constructed in the 1970’s and is situated on a busy road that is near to Hillingdon Hospital and close to public transport links. 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 bedrooms are most suitable for people with physical disabilities and 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. Service Users staying in the home continue to attend their day centres, colleges and clubs whilst staying at Merrimans. They remain with their registered General Practitioners. The referrals come from within the boundaries of the London Borough of Hillingdon with only a few exceptions. There are parent/carer’s meetings that include Staff held at six weekly intervals. There are approximately 50 Service Users on the current list for regular respite care. Two Service Users were staying in the home on the day of the inspection. The Staff complement is currently supported by about 20 agency or reserve team Staff. The home accepts emergency placements both from their existing wait list and others referred by Hillingdon Social Services for whom there is no background information. The majority of these placements are for people with challenging behaviour and who have high needs. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over two days for a total of six hours. Two members of Staff were interviewed (including the Deputy Manager) and one Service User was spoken to. One Service User’s file was examined and two Staff files. Recording systems were examined together with logs and maintenance records. Seven telephone calls were made to Service User’s representatives/carers. All knew that there were plans to change and extend the service. This had been a subject for discussion at the Carer’s meeting held at the home on the morning of the inspection. The conversion building work is due for completion in May 2007 and it is planned that the home will offer two sets of facilities on each of the two floors. A decision has not yet been made as to how to offer respite during the time Merrimans is out of commission and this was a source of great concern to the Carers interviewed. Work has been carried out to the exterior of the home to ensure the window frames are secure and some windows have been replaced with double glazed units. The interior of the home has been decorated to a satisfactory standard. The gardens and patio areas offer a pleasant place to relax and play ball games. The home is currently using about 25 agency or reserve team Staff and this is much less than in the recent past. The Deputy Manager said that profiles were now required from the agency to ensure the Staff supplied had the right experience. 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 core team of staff provide good care to the Service Users based on their knowledge and experience of their needs. Of the seven Service Users/Carers interviewed/spoken to, six praised the commitment and care provided by the permanent Staff team. Staff receive regular one to one supervision and annual Performance Development appraisals to establish training needs. Staff receive mandatory and other specialist training provided by London Borough of Hillingdon. Of the eight permanent Staff, seven have achieved an NVQ level 2 & 3 including two who are currently studying level 4. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 6 Two of the seven Carers interviewed said that the home was well managed by the Deputy Manager and that they would be sorry to lose her positive approach. 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. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3 & 4 The Statement of Purpose and Service User’s leaflet require review. EVIDENCE: The Statement of Purpose and Service User’s information must be reviewed, especially in view of the changes in the facilities offered by the service when it re-opens in May 2007. Information must also be included regarding the management structure and management details. Staff shortfalls must be included in the details of the Staff group. The description of Emergency Admissions must be reviewed. The complaints procedure must give up to date details of The Care Standards Commission (CSCI) and include the telephone number. Reference to Registration and Inspection on page 24 must be re-worded to reflect that inspections are carried out by the CSCI who make requirements and recommendations from unannounced inspections carried out annually or more frequently if the situation requires it. The Statement of Purpose should include all the elements of Standard 1 of the National Minimum Standards. Service Users and their representatives must be provided with a copy of the Statement of Purpose and Service User Guide. New Service Users must only be admitted on the basis of a full assessment. This must include all available information from professional sources. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 9 Placements and emergency placements must only be accepted when risk assessments and the care management assessments indicate that the placement does not compromise the needs of other Service Users and ascertain that Staff levels and specialist requirements can be met. The Deputy Manager said that referrals are made by the CTPLD to the home with a needs led assessment, risk assessment and basic care plan. The Service Users and their representatives have tea time visits followed by an overnight stay. Discussions and feedback result in a decision on both sides as to the appropriateness of the respite placement for the individual. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 the following standard(s): 6,7,9 & 10 Each Service User has an up to date individual Care Plan that includes information on all aspects of their care, health needs and daily living routines. Staff, Service Users and their representative(s) work together to provide a positive framework of care provision based on detailed assessments. EVIDENCE: One of the two Service Users’ files resident in the home was examined and found to contain comprehensive and up to date information. The Care Plan and assessments were detailed and contained evidence that the Service Users’ wishes had been included. Where Service Users prefer ‘same gender’ for their personal care, the Deputy Manager said that this is agreed and the Staff rota was offered as evidence to confirm this. Facilitating Service Users to take risks forms part of the Care Plan and risk assessment. The Deputy Manager gave examples of Service Users who wanted to smoke and go out at night unescorted. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 11 The home has a policy on the subject of confidentiality and this is in accordance with the Data Protection Act 1998. Confidentiality is included in the Staff Code of Conduct. Records in the home are stored in locked cabinet and the IT system is code secure. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 the following standard(s): 11,12,13,14,15,16 & 17 Service Users’ choices in their care/service provision and preferred routine are respected within the home’s resources. EVIDENCE: Service Users follow their routine during the week by attending their usual day centre and clubs. The home does not offer weekend or evening excursions but offers good facilities in the form of a music room with audio/visual equipment and a large garden with aviary and room to enjoy ball games. The home has seasonal parties, bar be cues and disco evenings. Two of the seven Carers interviewed on the telephone commented on the lack of stimuli offered by the home when their sons/daughters visited at weekends. The Deputy Manager said that Service Users help with baking and cooking and with gardening in the home’s greenhouse. The Deputy Manager said that Service Users are offered the key to their room where appropriate and that Staff always knock before entering a bedroom. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 13 Following the last inspection report, the Deputy Manager said that parents/representative(s) were provided with a menu in advance of the respite stay so that they can tick off preferences and make special requests. The evening meal was in the process of being cooked during the course of the inspection. Although there was disruption due to a fire alarm going off and a visit from the emergency services, the meal was not served by the Staff member responsible at 18.15 even though it was ready at that time and waiting in the oven. The meal consisted of tinned potatoes, gammon steak and salad. The Senior on duty said that they had run out of fresh potatoes. The Senior had made a blackberry and apple crumble for dessert. The freezer was well stocked with food. The kitchen was clean and hygienic. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 the following standard(s): 18 & 21 Care Plans contain details of how Service Users need personal support and all relevant healthcare information. Service Users and their representative(s) have the opportunity to choose the gender and culture of the person providing their personal care to ensure that intimate tasks are carried out in a manner that maximises their privacy and dignity. EVIDENCE: The Deputy Manager said that the home takes into account the wishes for same sex care and offered the Staff rosta to demonstrate this. However, this was an issue with some of the Parents/Carers interviewed who said that men had provided personal to female Service Users in the past. Choice for Service Users of gender and culture of those providing their personal care must be included in the written information provided by the home. Medication was not inspected on this occasion. There have been no medication errors since the last inspection. The issues of ageing, illness and dying are included in the training provided by the Local Authority but the service provision is of a temporary, respite nature Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 15 and does not have the usual emphasis on loss as applies to mainstream establishments. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 the following standard(s): 23 Staff have received up to date training in the protection of vulnerable adults provided by the Local Authority to ensure that Service Users are protected from abuse. EVIDENCE: All Staff have received up to date training in adult protection and the home has procedures for identifying any signs or suspicions of abuse. Staff have also received training in de-escalation of aggression. The home has policies on protection of vulnerable adults and whistleblowing. The home has polices and guidance on practice regarding dealing with Service User’s money and financial affairs. Service User’s individual cash floats are held in a locked safe in separate containers and records are kept of transactions. All policies are produced by the London Borough of Hillingdon and the information is used in induction training and supervision of Staff. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 the following standard(s): 24 & 27 The home provides a service for short respite stays and although the rooms cannot be personalised, the home offers comfortable accommodation that is clean and contains specialist equipment required to promote independence and ensure safety. EVIDENCE: The issues raised in the previous inspection report have been addressed. The windows in rooms 8 & 9 have been replaced with double glazed units and the other rotting frames have been strengthened and fitted with stronger restrictors. The shower in the bathroom near rooms 8 & 9 was broken and the shower lever in the pink bathroom also needed attention. There was a mal odour in bedroom 9. The home is due to close for major re-furbishment within the next few weeks and the nature of the service provision is expected to change when the home re-opens in May 2007. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35 & 36 The home is not currently relying so heavily on agency and reserve team Staff and this has improved the quality of the service to Service Users. Six of the seven Service Users/Carers interviewed said that the permanent Staff provided an excellent service. EVIDENCE: Two Staff files were examined chosen at random and these were found to be satisfactory. The home uses the recruitment procedure of the Local Authority and carries out all checks and obtains declarations. Staff receive mandatory and other specialist training provided by the Local Authority. Of the eight permanents Staff, seven have NVQ at levels 2,3 or 4. Staff receive regular one to one supervision and annual Performance Development appraisals to establish training needs Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,40 & 42 The home’s policies/guidance and training in safe working practice, protect Service Users. EVIDENCE: The quality assurance system needs to be developed to include other input from professionals and stakeholders in the home as well as information taken from logs/records. The overview and outcomes must be produced annually and copies made available to Service Users/representative(s) and sent to the CSCI. The home receives a monitoring visit from a Senior Manager monthly and copies of these are received by the CSCI. The home has a comprehensive set of policies and procedures supplied by the London Borough of Hillingdon. The Deputy Manager is aware that policies need to be signed and dated and regularly reviewed. Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 20 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 2 2 2 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x x 3 x x 2 3 x 3 x Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 21 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 YA1 Regulation 5(1)(a to f) (2) & 6 Requirement The Statement of Purpose and Service User information must be updated and include all the information listed in Reg. 5(1) and Standard 1 of the Care Homes Regulations 2001. Service Users must be provided with copies of this information. This was a requirement of previous inspections. Latest timescale given 01/04/06. Not Met. 12(1)(a) New Service Users are admitted 01/05/07 14 only on the basis of a full (1)(d)(2)(b) assessment. This must include all available information from professional sources and family. Placements and emergency placements must only be accepted when risk assessments indicate that the placement does not compromise the needs/safety of other Service Users. Staff levels and specialist requirements must be assessed and met. This was a requirement of Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 22 Timescale for action 02/10/06 2 YA2YA3 3 4 5 YA24 YA27 YA39 16(2)(k) 23 (2) (j) 24 the previous inspection. Timescale 01/04/06. Not met. The odour in Room 9 must be 25/05/06 eliminated. Two shower fitments on the first 25/05/06 floor were broken and required repair. The quality monitoring system 02/10/07 must be developed to include more feedback than the questionnaires. Feedback seeking the views and input of other professionals and stakeholders as well as monitoring complaints/compliments, accidents and staff retention etc. A copy of the annual overview must be produced for Service Users/representative(s) and sent to the CSCI. This was a requirement of the previous inspection. Timescale 01/04/06. Not Met. 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 YA17 YA18 Good Practice Recommendations Staff preparing food for Service Users should ensure that meals are cooked and served in a manner and at a time that is appropriate to their needs. The option to choose same gender care for personal care should be provided in the information prepared for Service Users and their representative(s). Merrimans, 3 (Adult Respite) DS0000032534.V286911.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection West London Area Office 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. 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