Care Home: Merchiston House

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What the care home does well The care home produces information about the services on offer. Assessments are done before anyone moves in. Detailed care plans are prepared, which are also in picture format. The plans are kept under review and residents and their relatives attend review meetings. The care plans cover personal care, health care and social care. Experts such as speech therapists and advocates are also used. The home aims to assess the needs of new residents and to promote their Independence so that the resident may return home or move into supported living. The home has a pictorial food menu and a pictorial complaints procedure. Residents are safeguarded against abuse. The premises are adequate. Staffing levels are good, staff are skillfully recruited, and a high level of training is provided. The home is well managed, and quality assurance and health and safety procedures are in place. What has improved since the last inspection? Four requirements concerning the building and garden were made in the previous CSCI report two years ago, and these have been acted upon. Some other cosmetic improvements have been made to the building and its contents. Last summer the staffing situation in the home was poor with a substantial number of vacant posts that were covered by temporary agency staff. Almost all of those vacant posts have now been filled by permanent staff. The new Manager has said that `care pathways` were not always followed last year but they will be from now on. What the care home could do better: The home`s Statement of Purpose was produced over a year ago and is not up to date, nor is it complete in terms of what the Care Home Regulations require. The care plan we examined was produced after the resident concerned had been in the home for over two months. The Manager said the initial care plan should be produced within the first two weeks. The care plan had not been signed by anyone. The FACE risk profile we saw had not been updated, and the risk assessment was not signed by any staff to show they had read it. The resident`s weight chart we saw had not been completed monthly. The bedroom we saw did not contain a table to sit at, and did not contain a lockable space for the resident to use for their private possessions. The recording of fridge and freezer temperatures was not accurate. The premises are not of a modern standard with en suite facilities and showers. The Manager has not yet applied to be registered in this position by the CSCI. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Merchiston House 1 Colham Road Hillingdon Middlesex UB8 3RD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Robert Bond     Date: 0 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Merchiston House 1 Colham Road Hillingdon Middlesex UB8 3RD 01895235920 01895232797 tgreen@hillingdon.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : London Borough of Hillingdon care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Merchiston House is a spacious five bedroomed house standing in its own grounds in Hillingdon. The accommodation comprises four bedrooms for residents and one for staff. There is a bathroom on the first floor and a toilet on the ground floor. The home is owned by Hillingdon Health Authority and managed by the Social Services Department. The home is located in Colham Road, near Hillingdon hospital and is a short walk away from local shops and amenities. Merchiston House provides a home for four residents with severe learning difficulties who can present a challenge to the service. At the time of the inspection three service users were being accommodated at the home. The aim is to assess residents and promote their independence so that they may return home or move to supported living accommodation. The usual length of Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home stay is from 3 to 18 months. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection where we assessed the homes performance against the expected outcomes identified in the Department of Healths National Minimum Standards (NMS) for care homes for younger adults. We received in advance a completed Annual Quality Assurance Assessment (AQAA) from the home, and completed surveys from a member of staff and from a resident supported by a member of staff. On the day of the inspection we visited unannounced and interviewed the Manager, met other staff, met two of the three current residents, toured the premises, and examined a sample of the records and files. Care Homes for Adults (18-65 years) Page 6 of 30 Equality and diversity were considered throughout the inspection. The last key CSCI inspection took place on 20th February 2007. Annual Service Reviews were also conducted on 28th February 2008 and 16th December 2008. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 30 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided to prospective residents is generally good but is not complete or wholly up to date. The assessment processes undertaken in advance of a placement being offered are good but the production of a first care plan had been delayed in the example we saw. Evidence: We examined the homes Statement of Purpose, which was dated October 2007. Minor errors were noted such as reference to the National Care Standards Commission and the Registered Homes Act 1984, both of which have been supplanted. Also missing were details of the managers qualifications and room sizes as required in Schedule 1 of the Care Home Regulations. We examined in detail (case-tracked) the care file of one of the residents. A referral had been made by a respite care service, an initial assessment of need had been provided, and a FACE Risk Profile. All were completed in April 2008 for the placement which commenced on 6th June 2008. The first care plan was dated 15th August 2008. Care Homes for Adults (18-65 years) Page 11 of 30 Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know what is in their care plans because picture formats are in use and because residents attend review meetings. Residents are consulted about their wishes individually and collectively, and are supported by advocacy as appropriate. Residents are supported to live as independent lifestyles as possible, and risks are assessed. Evidence: We examined in detail a care plan that was dated 15/08/08. It was in picture format. A Summary had been completed on 11/12/08 ready for a review, which took place on 26/01/09. The Summary was also in picture format, which is commended. The review meeting had been attended by the resident, two relatives, the care manager, the key worker, and a speech therapist. The care plan had space for people to sign it, but no-one had. The Manager said that the link worker, key worker, resident and/or their representative, and the Manager, should all have signed the care plan. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: An advocate has appointed to support the resident. The Manager reported that the speech therapist uses a talking map to help communicate with the resident and ascertain his wishes. This is also commended. Collective residents meeting are held quarterly. Concerning risk taking, the FACE risk profile dated April 2008, had not been reviewed in September 2008 as the form indicated it should be. A new risk assessment however was undertaken at Merchiston House in October 2008 but no member of staff had signed it to demonstrate that they had read and understood the contents, as the Hillingdon procedure required them to do. The file contained a behaviour support plan and a transition plan, which is commended. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a good range of educational, recreational and social activities. Community links are maintained and developed. Residents are provided with a satisfactory diet. Evidence: Residents are encouraged to participate in the running of the home. The home routines are flexible. Independence is supported and encouraged by for example a member of staff accompanying initially a resident to the shops, or on public transport. The intention is to support residents towards a return home or a move into supported living. Each resident has an individual activity timetable. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Outside activities include going bowling, visiting a public house, going to the theatre. There has been a trip to Brighton. One resident attends a day service twice a week. Interests include horticulture and dog walking. One resident used to attend College last year to do pottery. Now he is interested in cookery. We examined a sample menu which was for four weeks, and in a picture format. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good personal care in the way they require and prefer. Residents physical and emotional health needs are being well met. Residents are protected by the homes policies and procedures concerning medication. Evidence: The care plan examined contained details of how the resident wishes to be supported in his personal care needs. Key workers and link workers are used to provide this support. In terms of health, nurse support is provided from the CTPLD. A speech therapist is also available. Residents existing GPs are used. Residents are supported to attend hospital visits, and dentists. The residents weight chart we examined contained only two entries, dated 17/06/08 and not again until 02/02/09. None of the residents are able to administer their own medication. We examined the homes medication storage, and medication records including records of medication returned to the pharmacist unused. In one case medication had been given without an Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: initial appearing in the record. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well protected by the homes complaints procedure and by the homes Safeguarding Adults procedures. Evidence: We examined the homes complaints record and noted that no complaints had been recorded in recent times. No complaints have been received by us. The home has a complaints procedure that is printed in a picture format. London Borough of Hillingdon have a corporate Safeguarding Adults policy that applies in Merchiston House. LBH train the staff in the policy, and according to the homes Manager are in the process of bringing the training up to date for all the homes staff. During the last year one strategy meeting has been held. we checked the records of cash held by the home on behalf of a resident who we selected at random. Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a reasonably safe and comfortable environment but one that is not very homely. The home is sufficiently clean and hygienic. Evidence: We toured the home in the company of the Manager and saw all areas including a bedroom, with the permission of the resident concerned. Each resident has a single room, but sometimes of a strange shape, as a double room has been sub-divided into single rooms. None of the bedrooms are en-suite. The bedrooms do not contain a table one can sit at to eat or pursue a hobby. The room we saw did not contain a lockable private space for the resident. The premises were reasonably clean but some kitchen units were damaged but the kitchen is otherwise clean and bright. We found that freezer temperatures were being recorded as positive readings. This was because the thermometer reading being used was the room temperature reading, not the ice-box reading. The thermometers being used were not ideal for the purpose as they gave two readings, internal and external. The laundry doubles up as a storage facility for staff lockers and for staff files, which is Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: not ideal. There are no fire evacuation route signs in the laundry. The hot water supply is such that it takes a very long time for hot water to reach the hot tapes at wash hand basins in the toilets, which is an infection control concern. Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are now well supported by an effective staff team who have been skillfully recruited and who have undergone substantial training. Evidence: The Manager explained that last summer, the home was operating with a large number of staff vacancies and hence a high dependency on temporary agency personnel. This issue had been compounded by staff on long-term sick leave, and a London Borough of Hillingdon freeze on recruitment. Since then a new Manager and a new Deputy Manager have started, and 3 support workers, 1 senior support worker, and 1 night support worker have been recruited. Current staff vacancies are for 2 support workers, a part-time senior support worker, and 20 hour night support worker. We examined a current staff rota that demonstrated that 2 or 3 support workers are on duty each shift throughout the week, one of them being shift leader, with the Manager or Deputy being on duty in addition. At night 1 member of staff is awake, and another sleeping in. We examined a staff recruitment file and found that all appropriate checks had been undertaken. Probationary periods were being followed, and a full induction had taken Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: place. There are currently 6 support staff employed, and all have NVQ level 2 in care, and 2 are undertaking level 3 at present. Performance and development plans are undertaken on each employee but a training and development plan for the year ahead was not available. Care Homes for Adults (18-65 years) Page 23 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home. Residents and relatives views are taken into account. The health and safety and welfare of residents is well promoted and protected. Evidence: The Registered Manager is no longer working at Merchiston House but a new Manager commenced in November 2008. He is not yet the Registered Manager. He has a foundation degree in Intellectual and Developmental Disabilities from the University of Kent, and he intends to undertake the Registered Manager Award. Quality Assurance is undertaken by surveys being sent to residents and their relatives. We examined the homes fire certificate, first aid box, and health and safety weekly checklist. We found that fridge and freezer temperatures temperatures were not being accurately recorded but this is dealt with under premises and environment. Care Homes for Adults (18-65 years) Page 24 of 30 Care Homes for Adults (18-65 years) Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose must be kept under review so that the information contained within it is up to date, and the information quoted must accord with that required in Schedule 1 of the Regulations. Otherwise prospective residents and their representatives may not receive all the information they need. 01/05/2009 2 6 15 Residents or their representatives must sign care plans where possible. This is to demonstrate that they have been consulted on and have agreed to the contents. 01/03/2009 3 24 23 The operating temperatures 01/03/2009 of fridges and freezers must be accurately measured and recorded. Suitable equipment and training must Care Homes for Adults (18-65 years) Page 27 of 30 be provided to ensure this happens. Residents and staff may be in danger of food poisoning otherwise. 4 26 23 All bedrooms must be provided with a lockable storage space, unless this is inappropriate, in which case the reasons must be recorded in the care plan. This is to provide security and privacy for the resident. 5 26 23 Residents bedrooms should contain a table they can sit at, unless it is recorded in their care plan that this would be inappropriate. This is so they can eat a meal at table in their bedroom, or use the table to pursue a hobby. 6 37 9 The Manager must apply to the CSCI to become the Registered Manager of the care home. This is to confirm that he is a fit person for the position. 01/05/2009 01/05/2009 01/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 That work to create an individualised care plan for new residents should be started during the pre-admission phase, and be based upon the assessment information provided. The first version of the care plan should be Care Homes for Adults (18-65 years) Page 28 of 30 available, to be added to in the light of experience, during the first two weeks of a new residents stay. This is so that residents needs can be met almost straight away. 2 9 That FACE risk profiles should be reviewed and updated, and that risk assessments of residents should be signed by all staff who need to be aware of their contents. That residents weight is measured and recorded monthly. Any gaps should be explained. As the building is old fashioned, without en suite facilities, and without a shower for residents use, it is recommended that the provider considers finding more modern and suitable premises. 3 4 19 24 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - 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. You have been warned!