Latest Inspection
This is the latest available inspection report for this service, carried out on 21st September 2008. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Merrimans, 3 (Adult Respite).
What the care home does well Merrimans provides a spacious and well maintained facility for people receiving respite care. The home is clean and comfortable. The service offers flexibility and choice to people. People spoken with clearly indicated that they liked staying at Merrimans and they generally enjoyed the company of other residents and staff. People talked of their daily and social routines and how they continued with these during their period of respite care. The support needs of people are well documented in their care plans. What has improved since the last inspection? Improvements have been made to safety in the home, these improving security to the front door and ensuring that fire doors are working efficiently. People`s dietary likes and dislikes are documented and good photographs have been made available to assist people with menu choice. What the care home could do better: The recording of complaints and concerns must be reviewed to ensure that these are logged as required. CARE HOME ADULTS 18-65
Merrimans, 3 (Adult Respite) West Drayton Road Hillingdon Middlesex UB8 1JZ Lead Inspector
Ms Susan Woolnough-Singh Key Unannounced Inspection 21st September 2008 19:45 Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 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.V362023.R01.S.doc Version 5.2 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.V362023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Merrimans, 3 (Adult Respite) Address West Drayton Road Hillingdon Middlesex UB8 1JZ 01895 259324 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.V362023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th September 2007 Brief Description of the Service: Merrimans is a purpose built home constructed in the 1970’s and is situated on a busy road close to Hillingdon Hospital and public transport links. Following an extensive modernisation programme carried out over the past year, the home can now offer accommodation in two separate units and this means that people can be cared for in groups that are compatible with their needs. The home provides respite care for up to nine people with learning disabilities, physical disabilities and/or sensory disabilities. There are nine bedrooms, four on the first floor and five on the ground floor. The ground floor bedrooms are most suitable for people with physical 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. All of the bedrooms have en suite facilities and in total the home has four standard bathrooms, two assisted showers and one assisted bathroom. There are also two separate toilets on each floor. There are communal rooms on both floors and these are large, airy and have been refurbished to a high standard. There is a kitchen and dining room on each floor. The ground floor activity room is part of the conservatory area which leads out into the large enclosed garden with lawns and spacious patio areas. There is a passenger lift connecting the ground and first floors. People staying in the home continue to attend their day centres, colleges and clubs whilst staying at Merrimans. They remain with their registered General Practitioners. 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 bi monthly. There are approximately 76 people on the current list who come for regular respite care. The staff complement is currently supported by about 20 agency staff but has also begun recruiting permanent staff to support the team. The home accepts emergency placements both from their existing wait list and others referred by Hillingdon Social Services for whom there is often no background information. The majority of these placements are for people with challenging behaviour who have high needs.
Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 5 Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The Quality Rating for this service is two star. This means that people who use this service experience good quality outcomes.
This was an unannounced key inspection of Merrimans House; all of the key national minimum standards for younger adults were assessed. The inspection commenced on the 21st September 2008 (Sunday) at 16.40 until 18.30. The second visit to the home took place Wednesday 24th September. One the first day of the inspection Sunday evening, seven people were receiving respite care and four staff were on duty. We spoke with four people who were receiving respite care about their experience of the home. We toured the building and looked at records relating to peoples plan of care, staff recruitment and health and safety. What the service does well: What has improved since the last inspection? What they could do better:
The recording of complaints and concerns must be reviewed to ensure that these are logged as required. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 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.V362023.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs assessed prior to being offered respitre care. EVIDENCE: We looked at the care files of four people who use the service. The London Borough of Hillingdon had assessed peoples care needs prior to a service being offered. One person said that he/she arranged his or her own respite care. He/she knew how many weeks were available and booked the care by phoning the home directly. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care needs of people who use the service are reflected in their care plans. People are able to make decisions about their daily lives whilst at Merrimans House. People are able to take risks as part of an independent lifestyle; risks had been assessed. EVIDENCE: We looked at the care plans of four people who use the service, whom we were able to talk with during the inspection. People have a care plan that covers their routines, likes and dislikes, medical information and attendance at a day service and evening social clubs. There was sufficient information on the care plans to inform staff of peoples needs during their short stay. A night care
Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 11 plan is also in place. A summary of the care plan is completed on a six monthly basis. When we spoke with people who use the service it was apparent that they were able to make their own decisions. (Please see the standards on Lifestyle 11 – 17). We saw that risk assessments were on the care files. These included a moving and handling assessment, general assessment for household activities and a behavioural risk assessment. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12, 13,14 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People spoken with indicated that they enjoyed their respite stay at Merrimans House. There is flexibility and people are able to continue with their routines and make choices. The home provides freshly cooked and varied meals, which people confirmed they liked. EVIDENCE: We spoke with four people who were staying at Merrimans House. All confirmed that they were able to continue with the routines they had at home and really liked staying at Merrimans House. One person said they would like more respite care. Three of the people spoken with said they travelled independently and continued with their usual daily schedules and social life whilst at the home. Two people indicated that they liked all the staff but did
Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 13 not feel so confident with agency care staff, as they do not know them well. Two people liked the facilities available especially ‘Freeview’ television which they were enthusiastic about. One person spoken with said that he/she really liked the modernisation of the home. We looked at the kitchen and storage areas. The kitchen and storage area were clean and well stocked; we noted that ample fruit and vegetables were available. We looked at the menu, which is varied. An alternative to a written menu is available; this is in the form of a menu book of photographs of the most commonly cooked dishes. The photographic menu was well presented and gave a clear idea of the dishes available. Staff at the home do the cooking and people said they liked the food. People’s likes and dislikes are recorded. One person spoken with has special dietary requirements he explained how these are being met. People also confirmed that they could use the kitchen to make snacks if they wished. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive the personal and health care support they need during their period of respite care. Personal autonomy is encouraged and supported. There are policies and procedures in place for the safe storage and administration of medication. EVIDENCE: Information on how people’s health care needs will be met whilst they receive respite care is contained in the care plan. This includes basic information such as emergency numbers, information on medication, and any medical attention required whilst stating in the home. One person was receiving the services of the District Nurse at the time of the inspection. Information is contained on the care plan on the level of personal care required and support needed. We noted that one person has quite specific needs and these were noted on the care plan.
Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 15 Procedures are in place for the storage and administration of medication. We checked the medication cabinet and the medication administration records. A system is in place for the storage of any medication classed as a controlled drug. There is a system for booking in medication; the policy states that medication must be in the prescription containers and not pre dispended the person’s home. A medication risk assessment had been completed. Two people are to manage and administer their own medication. Staff monitor this be examining the Medication Administration Record. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure. The recording of complaints needs to be reviewed to ensure that peoples concerns are appropriately logged. Guidelines and training are available for staff in the protection of vulnerable adults. EVIDENCE: A complaints procedure is available this is available in the foyer area. Parents and carers are given a copy of the complaints procedure. People when asked said they knew how to make a complaint and would normally talk a member of staff. We received a complaint on the first day of the inspection. One person raised a concern, which was discussed at length. We raised the concern with the Team Leader on duty at the time of the inspection. In discussion with the Team Leader it was ascertained the home was aware of the complaint and thought it had been resolved internally. The complaint was then referred by the Team Leader to London Borough of Hillingdon Social Services. On the second day of the inspection Wednesday 24th September a Service Manager from Hillingdon Social Services was investigating the complaint at the home. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 17 We looked at the complaints record, which is kept in the home. An entry with regard to the initial concern being raised by the person using the service had not been made in the complaints record. A record of the initial conversation with regard to the concern should have been recorded under the complaints procedure. We were able to see from the Annual Quality Assurance Assessment that policies, procedures and training for staff in the protection of vulnerable adults are in place. Staff have received training in the protection of vulnerable adults. The Registered Manager has undertaken training in investigating allegations. We looked at the system for the management of personal finances. Some people are able to manage their own money. We saw the record of transactions where money is kept on behalf of people during their stay. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,26,27,28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A homely, comfortable, clean and safe environment is offered for people who use the service. EVIDENCE: The home has received extensive re-modernisation and refurbishment. The furnishing and fitments are of a high quality and the rooms are decorated in light colours and look very attractive. Most of the bedrooms have en suite facilities and in total, the home has four standard bathrooms, two assisted showers and one assisted bathroom. There are also two separate toilets on each floor. There are communal rooms on both floors and these are large, airy and have been refurbished to a high standard. There is an activity room, kitchen and dining room on each floor. The activity room on the ground floor in the conservatory area leads out into
Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 19 the large enclosed garden with lawns and spacious patio areas. There is a passenger lift connecting the ground and first floors. Safety issues were identified at the last key inspection these had now been rectified. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided with the training they require to enable them to work effectively with people who use the service. The recruitment policies, and practice, ensure that staff that work in the home are competent to do so and meet all of the necessary requirements. EVIDENCE: The staff establishment consists of the Registered Manager, two team leaders and five part time residential workers and three night staff. There is an administrator, part time housekeeper and a vacancy for a handy person. The number of staff on duty is dependent on the number of people booked in for respite care. Agency workers are employed at Merrimans House. The London Borough of Hillingdon commissions work with an external employment agency that are based at the Civic Centre; they supply regular agency staff. A recruitment process is in place to ensure that selected staff have a Criminal Records Bureau Checks and a PoVA First Check. We looked at the personnel
Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 21 file of one member of staff who had most recently joined the staff team required pre-employment checks were on file and two references. The Information provided on the Annual Quality Assurance Assessment stated that five staff had obtained NVQ Level 2 and three staff was working towards this. The skills for care induction programme is in place for new staff. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the experience to manage the home for the benefit of people who use the service. Areas have been identified in the Annual Quality Assurance Assessment to improve the service. Health and safety in the home is assessed and monitored. EVIDENCE: The Registered Manager has experience in the management of residential services for people with learning disabilities and has the Registered Manager Award. The Annual Quality Assurance Assessment provided to the Commission for Social Care Inspection sets out how standards for the service are being met
Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 23 and identifies areas for improvement. The AQAA informed us that annual surveys are sent out and regular parent/carer meetings are held. We received telephone feedback from a professional external to the home. This person commented that the staff are working very well together and people who previously could not be accommodated due to behaviour management issues, can now access the respite care available. There are systems in place for the monitoring of health and safety. The London Borough of Hillingdon provides the home with a premises management logbook. The staff are provided with mandatory training by the London Borough of Hillingdon. A record was available for weekly fire alarm tests incorporating an evacuation. Premises and work place risk assessments were complete. The fire alarm system had been serviced in July 2008. Information on the Annual Quality Assurance Assessment indicated that staff had received training in infection control. There are policies and procedures in place for working safely; equipment and facilities are serviced regularly. Improvements in safety have been made since the last inspection. All of the safety issues relating to the security of the building had been addressed. An additional lock had been fitted to the front door. The fire doors had an alarm mechanism fitted. This could be activated as necessary and would depend on the risks assessed for individual people using the service. A gate had been fitted to the foot of the external fire escape. The locked is released when the fire alarm is activated. The chair by the garden wall had been removed. Blender valves had been fitted to the taps producing water assessed as too hot. Bedroom 3 had also had a blender valve fitted. Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 24 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 3 2 2 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x 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 3 3 3 x 3 x 3 x x x 3 Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 25 N0 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 YA22 Regulation 22 (1) Requirement The internal procedure for recording concerns and complaints needs to be reviewed. Timescale for action 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Merrimans, 3 (Adult Respite) DS0000032534.V362023.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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