Inspection on 30/11/05 for Merrimans, 3 (Adult Respite)

This inspection was carried out on 30th November 2005.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 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) 26/04/06

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 14.00 30 November, 1 & 8 December 2005 th st th Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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.V261076.R01.S.doc Version 5.0 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.V261076.R01.S.doc Version 5.0 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.V261076.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th May 2005 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. Sevice users staying in the home continue to attend their day centres, colleges and clubs when they stay at Merrimans. They remain with the registered General Practitioners. The referalls 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 50 Service Users are on the current list for regular respite care. Five 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. The home accepts emergency placements and the majority of these have challenging behaviour. Of the 50 Service Users offered respite about 30 have high needs and/or challenging behaviour. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried over three days for a total of 11 hours. The Inspector had the opportunity of speaking with the Registered Manager before she took a 6 month career break and conducted the rest of the inspection with the Team Manager and a Senior Staff member. One Senior and 2 Care Workers were interviewed and one Service User. A staff file and two Service User files were examined (chosen at random). Recording systems were examined together with logs and maintenance records, policies and guidance. A total of six telephone interviews were conducted with one Service User and five Carers. Three expressed concern at the heavy reliance on agency Staff, the high turnover of the agency Staff, their lack of training and interest. Two Carers said that the agency Staff ‘just hung around’ and that they were ‘just making up the numbers’. Three Carers were nervous because the behaviour of other Service Users presented a risk to their daughters. Four said that the attention Staff need to pay to those with challenging behaviour and high needs, compromised the care and attention provided to the less demanding. Three commented on the lack of fresh food and reliance on convenience food. Three said that male staff often provided their daughters with personal care and that they had never been given a formal choice of gender care although one Carer had been told that toilet assistance is always carried out by same sex Staff. All six knew that there were plans to change and extend the service. Two said they were very concerned about alternative arrangements for respite whilst the changes were taking place as they had been given no information regarding this. The home is in urgent need of attention to the exterior of the building, where five of the front windows have been boarded up to prevent them falling out through rotting window frames and others have been fitted with metal supports for the same reason. This gives the home a neglected, derelict appearance. All the windows in the home need to be assessed to ensure overall safety. The decorative order of the interior of the home is still in need of improvement. Although there have been improvements following the previous inspection there are still areas where the paintwork needs attention. The paved patio in the garden that had suffered subsidence has been rectified and the area made safe. The home is still using 40 agency or the Local Authority ‘reserve team’ support. The agency provides for most of the staff deficits. The Registered Manager said that staff provided by the agency did not have the right Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 6 background to work with the Service Users with challenging behaviour. The turnover of agency staff is also high and, therefore, different staff are continually coming into the home who are not familiar with the Service User’s needs. Management and Staff in the home continue to express concern regarding emergency placements made by the London Borough of Hillingdon’s Community Team for People with Learning Disabilities (CTPLD). The Registered Manager said that emergency placements were regularly exceeding periods of between a month and eighteen months and the majority of these Service Users displayed challenging behaviour. Staff at all levels interviewed said that the issues concerning challenging behaviour and the provision of care for people with high needs had put great strain on the service and presented a risk to both Service Users in the home and the Staff on duty. In the past 6 months, 4 violent incidents and 29 minor incidents were recorded. What the service does well: What has improved since the last inspection? Staff (including Agency Staff) have received Team Building training. The paved patio area of the garden that had subsided has been ‘made good’ and the interior decorative order has improved. The dining room has been redecorated and the scale on the tiled floor has been cleaned. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 7 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.V261076.R01.S.doc Version 5.0 Page 8 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.V261076.R01.S.doc Version 5.0 Page 9 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 and 4 The Statement of Purpose and Service User’s leaflet require review to provide an up to date description of the service. Service Users and their representatives must have full details about the service provision to enable them to make informed decisions. EVIDENCE: The Statement of Purpose and Service User’s leaflet must be reviewed to provide an up to date description of the service. The management structure and management details must be updated. Staff shortfalls must be included in the details of the Staff group. The description of Emergency Admissions must be reviewed 5 (7.). 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 twice a year. 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 are admitted only on the basis of a full assessment. This must include all available information from professional sources. Placements and emergency placements must only be accepted when risk assessments and the care management assessments indicate that the placement does not Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 10 compromise the needs of other Service Users and ascertain that Staff levels and specialist requirements can be met. Prospective Service Users’ needs and wishes and that of their carer(s) are taken into account (Standard 4.3, 4.4 & 4.5). The Registered 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 a tea time visit 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.V261076.R01.S.doc Version 5.0 Page 11 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 and 8 Each Service User has an up to date individual Care Plan drawn up with details of their assessed needs, specialist programmes, personal goals and individual procedures for dealing with behaviour. Staff, Service Users and their representatives work together to provide a positive framework of care provision based on assessed risks, choices and management strategies. EVIDENCE: Two Service User files chosen at random were examined and found to contain up to date and comprehensive information. The Care Plans were detailed and provided evidence that the Service User’s wishes were included. Minutes of the six weekly Service User/parent/carer meetings were examined. The Registered Manager said that these were always well attended and the minutes circulated to every Service User. Carers interviewed on the telephone, confirmed that they valued the meetings and the opportunity to speak to Staff and other Carers. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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): 13, 14 and 17 The home does not have the staffing levels to offer Service Users weekend or evening excursions. Although the home offers good facilities and a large garden, activities are restricted to those that the Service Users normally receive from their regular day care centres and social clubs. EVIDENCE: The home is unable to offer outside entertainment at weekends and evenings due to staffing levels. The home has a music room with audio/visual equipment and there are also these facilities in each bedroom. There are generous secluded gardens that are accessed by French doors from the ground floor accommodation. The garden has a large paved area with seating and there is a small aviary of birds. The meals are currently being prepared by members of Staff. There was a menu of meals and an index of Service User’s special dietary needs kept on file. The meals corresponded with those described in the menus but included pies on two days in the week and a vegetable casserole on the third day of the inspection. Staff currently make up the menu. The freezer was well stocked. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 13 and the cupboard contained a selection of tinned food. One Service User spoken to in the home said that he often did not like the meal offered or the alternative. Three of the five Carers interviewed on the telephone, commented on the lack of fresh food and reliance on convenience foods. However, on the third unannounced inspection, there were fresh vegetables, potatoes, and a selection of fresh fruit. The menu for the week included pies on two days and a vegetable casserole on another day. The Senior said that the menu was put together by a member of Staff because it was difficult to have input from Service Users who were staying for such short periods. Staff are currently cooking the evening meal reducing the number of Staff on the floor at peak times of the day when Service Users are returning from their respective day centres. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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): 20 Service Users must have the choice of the gender of the person providing their personal care to ensure that intimate tasks are carried out in a manner that maximises their privacy, dignity and choice. None of the Service Users are able to manage their own medication. The home has a satisfactory medication policy and practice guidance for the administration that ensures Service Users are protected by the procedures the Staff use for dealing with medicines and health related procedures. EVIDENCE: Three of the six Parent/Carers said that their daughters were not given the choice of the gender of the person providing their personal care. The home has a satisfactory medication policy and system of administration. Service Users keep their own GP and health care services when they are staying at the home. Health care records seen were detailed and confirmed that the home ensures that the Service Users’ health care needs are met. Only Senior Staff members administer medication and those who have received training. Medicines for each Service User were stored in separate compartments of a lockable drugs cabinet. The medication administration records were satisfactorily maintained and controlled drugs were held Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 15 separately in another locked wall mounted cabinet. No notification of medication errors had been reported to the CSCI in 2005. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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): 22 Service Users and their representatives must have clear information regarding how to make a complaint or raise a query. Service Users and their representatives must feel enabled by the complaints procedure and be reassured that making a complaint will not result in any form of reprisal. EVIDENCE: The home has received three complaints since the previous inspection in May 2005. All three of the complaints were with regard to the facilities offered in the home and all three were resolved in the first stage. The home also received two compliments in this period. Four of the six people interviewed on the telephone said that they would be confident to complain if there were an issue that concerned them. The Statement of Purpose and Service User Guide do not provide adequate information about making a complaint or raising a query and do not include adequate information as to how to contact the CSCI at any time. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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, 25, 26, 27, 28, 29 and 30 The accommodation is not personalised due to the short term nature of service, however, the accommodation is clean and contains all the specialist equipment required to promote independence and ensure safety. The condition of the windows in the home need urgent attention and assessment for safety. EVIDENCE: Five of the first floor bedroom windows were boarded up to prevent them falling out due to rotten window frames. Two further windows have metal braces to support the window frames and glass. This is particularly noticeable outside the building and gives it a look of dereliction. Windows in the home have either flimsy chains to ensure they don’t open too far or they have stronger restrictors. All windows in the home must be reassessed for safety in terms of restrictors and sturdiness of the window frames and glass. The windows in rooms 8 and 9 (used for people with challenging behaviour) must be assessed to ensure they are sound enough to withstand any type of Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 18 force. The glass in these windows is not safety glass and there are no safety devices. The bedrooms are clean and contain adequate furnishing. All the bedrooms are decorated in plain pastel emulsion. Some of the furnishing consists of oddments from other homes and some of the pieces are old fashioned looking and worn. There is a contracted handyman who carries out small repairs and decorations to the home. There are still areas in the home where the paintwork is chipped and scuffed. All the bedrooms and communal areas are above the sizes given in Standard 24. The two downstairs bedrooms are suitable for people who use wheelchairs and have hoisting and assisted bathing equipment in the bathroom. There are several toilets and 4 assisted bath/showers on the first floor. In the yellow bathroom on the first floor, the assisted bath cannot be used because it leaks. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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 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): 31, 32, 33, 34 and 35 The home still relies heavily on the use of agency staff and are currently over 60 permanent hours short per week. Staff said that the Service Users with challenging behaviour (who were long stay for over a year) in the home recently put pressure on the Staff Team and the quality of the service they could provide to other less demanding Service Users. EVIDENCE: Staff interviewed said that an agency was used to meet staffing levels. Staff said that in the past, the home benefited from the use of the Local Authority Reserve Team to meet staffing levels because the Staff in this pool of workers were employed by the Local Authority and had received accredited training. Staff said that the reason that staffing was an issue in the past year or so was due to the use of the agency instead of the Local Authority Reserve Team and this had had a detrimental effect on the service provision. Staff said the some of the agency workers were very good but confirmed that there was a high turnover of staff coming through the agency, whereas the use of Reserve Team Staff had been much more stable. Three Carers/Parents interviewed on the telephone, expressed concern at the heavy reliance on agency Staff, the high turnover of the agency Staff, their lack of training and interest in the Service Users. Two Carers/Parents said that agency Staff just hung around making up the numbers. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 20 Several Service Users in the home at the time of the inspection had high to moderate needs and Staff interviewed said that it was difficult to provide a safe service for them as well as the pressure of having one or more people in the emergency beds with challenging behaviour (as they had in the past). Staff said that more should be done to refuse emergency admissions or long stay emergencies that proved too challenging for other Service Users’ safety or for the Staff Team to cope with safely. Three Carers/Parents interviewed on the telephone said that they were nervous for their daughters when they had respite due to incidents of shouting and challenging behaviour by other Service Users. One Carer/Parent said that there was often a ‘dangerous mix’ of Service Users in the home and there was ‘an accident waiting to happen.’ One Service User interviewed said he/she preferred to sit separately in the evenings away from some of the more restless or disruptive behaviour of other Service Users. The Staff interviewed demonstrated a sound knowledge of the Service Users and were observed to be quick to anticipate and divert any problems. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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 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): 37, 38, 39, 41, 42 and 43 The home must ensure that Service Users are safeguarded and cared for by a stable Staff team who receive training and support. EVIDENCE: Five of the eight Staff have achieved an NVQ qualification at either level 2 or 3 and two Staff have achieved NVQ level 4. The Registered Manager is taking a career break of 6 months and a senior member of the Staff team has been identified to act as manager in her place. There was no evidence that a quality assurance system has been put in place. Questionnaires for Carers/Service Users have been used in the past but there is no evidence that outcomes have been produced from them. Monthly monitoring visits are made by the Team Manager and a copy of the report is sent to the CSCI. Record keeping in the home is satisfactory. Records examined were up to date and comprehensive. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 22 Three health and safety issues were identified in this inspection. • • The windows in the home are in poor condition. The frames are loose and rotting and many have flimsy chains acting as opening restrictors. Staff levels need to be re-assessed when the behaviour and care needs of the Service User guest group requires it. The heavy use of agency staff who do not have sufficient training or knowledge of the Service Users is placing a considerable burden on the permanent Staff Team. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 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 2 1 2 2 X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 2 14 2 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 2 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Merrimans, 3 (Adult Respite) Score 2 X 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 2 X 3 2 3 DS0000032534.V261076.R01.S.doc Version 5.0 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 Standar d YA1 Regulation 5(1)(a-f) 5 (2) & 6 Requirement Timescal e for action 01/03/06 2 YA2 14 (1)(d)(2)(a)(b) The Statement of Purpose and Service User Guide 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 have a copy of this information. Previous timescale of 30/09/05 not met. New Service Users are 01/01/06 admitted only on the basis of a full assessment. This must include all available information from professional sources. Placements and emergency placements must only be accepted when risk assessments and the care management assessments indicate that the placement does not compromise the Version 5.0 Page 25 Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc 3 YA3 13(4c)(6)14(1d)(2a,b ) 4 YA24 13(4)(a)(c)23(2)(b) needs and safety of other Service Users and ascertain that Staff levels and specialist requirements can be met. (Standard 4.3, 4.4 & 4.5). New Service Users and emergency admissions placed for intermediate/short term must not be admitted for long term care unless Standards 1,2,3 & 6 are met. See also Standards 24.5 & 33.5 concerning accommodation and staffing. Previous timescale of 22/07/05 not met. All the windows, window frames and width restrictors must be assessed for safety. IMMEDIATE REQUIREMENT 15/12/05 FOR ACTION BY 23/12/05 The assisted bath in the yellow bathroom leaks and cannot be used. There must be sufficient numbers of Staff with the relevant skills on duty to effectively meet the Service Users needs at all times. The heavy use of agency Staff must be re-viewed to ensure safety of both the Service Users and Staff. Previous timescale of 22/07/05 not met. All Staff (including agency Staff) must be 01/01/06 23/12/05 5 6 YA27 YA33 23(2)(b)(c) 18(1)(a) 01/03/06 01/01/06 7 YA34 18(1)(a) 01/02/06 8 YA35 18(1)(a)(c)(i) 01/02/06 Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 26 9 YA39 24 adequately trained to ensure the needs of Service Users are met and that safety is maintained. A quality assurance 01/03/06 system must be produced that seeks to facilitate Service Users, their representatives and other stakeholders like Day Care link workers to express their views. Feedback from meetings, compliments/complaints , accidents, Staff views and a suggestion box etc must be used to produce feedback on the performance of the service. A copy of the annual overview must be forwarded to the CSCI. 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 YA4 Good Practice Recommendations Emergency admissions should not give the right to stay in the home. Service Users placed in an emergency must be fully assessed and relocated if the care provided is not appropriate to their needs The home does not have the Staffing levels to offer any leisure activities outside the home and the Service Users would need individual assessments to ensure all risks were assessed. Whilst there are no long stay guests, this is not an issue and the six people interviewed on the telephone, had no concerns about the lack of facilities in that area. Staff who are cooking and shopping for the Service Users Must ensure that the meals are planned and consist of DS0000032534.V261076.R01.S.doc Version 5.0 Page 27 2 YA13 3 YA17 Merrimans, 3 (Adult Respite) 4 YA22 5 YA24 appealing meals with choices. Meals should include regular amounts of fresh vegetables and fruit. The Service User Guide and Statement of Purpose should provide adequate information to ensure that Service Users and the representatives have sufficient information if they wish to make a complaint or raise and issue. They should know that they may contact the CSCI at time during the complaints procedure. The paintwork in some areas of the home is chipped and scuffed and requires attention. Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI Merrimans, 3 (Adult Respite) DS0000032534.V261076.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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