We carried out a review of the data available to us about Merrimans Respite Care Unit on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Merrimans Respite Care Unit, you can give feedback on this service.
About the service
Merrimans Respite Care Unit provides short term accommodation and personal care over 2 floors for up to 9 adults with a range of needs including physical and learning disabilities in order to give their carers a break from their caring responsibilities. At the time of the inspection, around 70 people accessed the service. There were 7 people using the service on the day of the inspection.
People’s experience of using this service and what we found
The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.
Right support:
Risks to people’s safety and wellbeing were appropriately assessed and mitigated. There were systems for monitoring the quality of the service, gathering feedback from others and making continuous improvements. People were supported with their medicines. Staff were trained in the administration of medicines and had their competencies assessed. They followed the procedure for the safe administration and recording of medicines. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used. People's needs were assessed before they started using the service and care plans were developed from initial assessments. People and those important to them were involved in reviewing their care and support plans.
Right care:
People's support focused on them having as many opportunities as possible for them to gain new skills and maintain their independence. The staff supported people in a person-centred way and respected their privacy, dignity and human rights. Records indicated people’s needs were met in a personalised way and they had been involved in planning and reviewing their care. Relatives’ feedback highlighted the staff were kind, caring and respectful and had developed good relationships with people who used the service. The provider worked closely with other professionals to make sure people had access to health care services. People’s nutritional needs were assessed and met.
Right culture:
Staff were responsive to people’s individual needs and knew them well. They supported each person by spending time with them and listening to them. They ensured that each person felt included and valued as an individual. People were engaged in meaningful activities of their choice. They were consulted about what they wanted to do and were listened to. Staff told us they were happy and felt well supported. They enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had procedures for recruiting and inducting staff to help ensure only suitable staff were employed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
The inspection was prompted in part due to whistleblowing concerns received about staffing levels. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Rating at the last inspection
The last rating for this service was good (published 29 August 2019). At this inspection, the service remains good.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
• Bedrooms in the designated care setting had en-suite bathrooms to help promote good infection prevention and control practices.
• The designated care setting was uncluttered and clean. The area had its own equipment and an arrangement had been made to safely provide, meals, snacks and drinks to people.
• The designated care setting had access to outside space so people could spend time in fresh air.
• The designated setting would provide tailored person -centred activities to people in their own bedrooms.
• There were cleaning schedules in place with daily record sheets and monthly infection control which were audited by the management team.
• The designated care setting was clearly identified. The unit was not physically separate from the rest of the home but the doors in between were closed and accessed by key-codes. Arrangements for entry and exit were safe.
•Staff breaks were managed appropriately to support social distancing and to ensure adequate staff cover in the unit.
We were assured of the provider's safe management of infection, prevention and control. However, the service was not suitable for the purposes of a designated setting because, plans had not been agreed to confirm a designated staff team and some repair works to maintain good infection control were not yet completed.
Further information is in the detailed findings below.
Merrimans Respite Unit provides short term accommodation and personal care over two floors for up to nine adults with a range of needs including, physical and learning disabilities in order to give their carers a break from their caring responsibilities. At the time of the inspection 79 people accessed the service. There were eight people using the service on the day of the inspection.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
Staff were responsive to people’s individual needs and knew them well. They supported each person by spending time with them and listening to them. They ensured that each person felt included and valued as an individual. People were engaged in meaningful activities of their choice. They were consulted about what they wanted to do and were listened to.
People who used the service and their relatives were happy with the service they received. Their needs were met in a personalised way and they had been involved in planning and reviewing their care. People said that the staff were kind, caring and respectful and they had developed good relationships with them.
The provider worked closely with other professionals to make sure people had access to health care services. People received their medicines safely and as prescribed. People’s nutritional needs were assessed and met.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People's needs were assessed before they started using the service and care plans were developed from initial assessments. People and those important to them were involved in reviewing care plans. Risks to their safety and wellbeing were appropriately assessed and mitigated. There were systems for monitoring the quality of the service, gathering feedback from others and making continuous improvements.
Staff were happy and felt well supported. They enjoyed their work and spoke positively about the people they cared for. They received the training, support and information they needed to provide effective care. The provider had robust procedures for recruiting and inducting staff to help ensure only suitable staff were employed.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (Published 1 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merrimans Respite Unit on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
There are two floors in the service and sections of the building can be separated depending on the needs of the people staying in the service.
At the last inspection, 6 and 10 November 2014, the service was rated Good.
At this inspection, 7 and 18 January 2017, we found the service remained Good.
Why the service is rated Good.
We received limited verbal feedback from people using the service and so we carried out observations to see how they were being supported and cared for. We observed positive interactions between the staff and the people using the service and we contacted relatives after the visit.
Relatives were happy with the way in which the service was run.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
People had a range of needs and communicated in different ways to the staff team. Staff had a good understanding of people’s personal preferences, likes and dislikes.
People using the service were protected from the risks of harm because the risks had been assessed and reviewed to ensure people were supported safely. The staff were aware of these and had training in order to help keep people safe. The environment was safely maintained and people received their medicines appropriately.
As on previous inspections people’s care records continued to be informative and guided staff on how to care and support people appropriately. People’s health and nutritional needs were assessed to ensure staff understood how to support people when they visited the respite service.
People had access to a range of different leisure and social opportunities both in the service and in the community. The staff supported them to do as much for themselves as they could.
Some people were able to make a complaint if they were unhappy and they also had the support of their relatives who could also represent their views.
Relatives and staff were happy with the way in which the service was run. The service was appropriately managed. There were comprehensive systems for monitoring the quality of the service. The registered manager and staff team listened to and learnt from the feedback of others to make changes and improve the service.
The service met the relevant fundamental standards that we assessed and provided a positive, caring respite service which offered a break for both the person using the service and for their relatives and carers.
Further information is in the detailed findings below.
Adults Social Health and Housing - The London Borough of Hillingdon (known as Merrimans) provides a respite service (short term accommodation and personal care) for up to nine adults with physical and learning disabilities in order to give their carers a break from their caring responsibilities. People are allocated a number of nights per year which is arranged through social services. This number can vary depending on the needs of the person and their carer (usually a relative). At the time of the inspection 87 people accessed the service. There were nine people using the service on the first day of the inspection and seven on the second day.
The service was last inspected on 25 and 26 October 2013 and at the time was found to be meeting of all the regulations we looked at.
This inspection visit was unannounced.
The service had a registered manager who was still in post but now working in another position with the same provider. A new manager started working in the service in September 2014 and they had started the process to register as the manager of Merrimans. They will be referred to as the acting manager in this report. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People and their relatives told us they felt safe whilst using the respite service. Staff were aware of what to do if they needed to report anything of concern and had received training on safeguarding people from abuse.
Staffing levels were flexible and there were enough staff on duty to meet people’s needs. Staffing numbers were increased where necessary to ensure people’s safety. Recruitment checks were carried out before new staff started working in the service.
Staff had undertaken training on the Mental Capacity Act 2005 (MCA) and were aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). The safeguards informed staff to support people in making decisions where possible about their lives and assess if restrictions needed to be put in place for their safety. We saw that staff ensured people were given choices and the opportunities to make decisions during their stay at the service. This included what food they ate and how they spent their time whilst using the service.
Arrangements and checks were in place for the management of people’s medicines whilst they stayed in the service.
The staff team considered and assessed people’s nutritional needs by making sure they received a choice of food and drinks that met their individual needs.
Staff received training, one to one support through supervision meetings and appraisals. Staff also received specialist training if this was required to support people with their healthcare needs.
Staff were caring, and treated people with dignity and respect. Care plans were detailed and informed staff how to support people safely and appropriately.
Throughout the inspection, we observed that staff cared for people in a way that took into account their diversity and right to make choices about their lives.
There was a clear management structure at the service and people, staff and relatives told us that the management team were approachable and supportive. Many staff had worked in the service for several years and they showed an understanding of people’s individual needs.
There were effective systems in place to monitor the quality of the service so that areas for improvement were identified and action taken to address these.
We looked at support plans for four people using the service. We saw the plans detailed people's health, social and personal care needs and how identified needs would be met during their stays. Plans were updated regularly and, where possible, people were involved in reviewing the care and support they received. Where people did not have the capacity to consent to their care, the provider acted in accordance with legal requirements.
The provider had policies and procedures for safeguarding people using the service. Care workers understood the procedures and were trained to identify possible abuse. A member of staff told us 'I'd always tell a senior if I had any concerns.'
The provider also had systems in place to identify the training needs of people working in the service. Training was provided and regularly updated to make sure people had the skills they needed to support people using the service.
There were procedures to monitor the quality of services provided. The provider carried out regular audits and people using the service were asked for their views on the care and support they received.
People and their representatives were encouraged to be involved and express their views about the service. We observed people being supported to make choices and independence was encouraged. People were supported to go out in the local community. People's privacy and dignity was maintained and people's cultural and religious needs were respected.
Care records clearly detailed people's needs and how these should be met. Any identified risks had been assessed to ensure that people were kept safe whilst their independence was promoted. We observed positive interactions between staff and people who used the service and one person told us, "the people here are lovely".
The service was well maintained, clean and warm. Health and safety audits were being completed and all the required health and safety certificates were in place. For example, gas safety certificates were in place and fire safety equipment had been serviced at regular intervals.
The service was adequately staffed and there was a complaints management system in place that was comprehensive and accessible to all.
People who could not communicate verbally indicated that they were happy by smiling and laughing. We observed that people were happy with their surroundings and were comfortable in the presence of staff. A relative told us that 'It's home from home' and 'a lifesaver'.
During our visit we observed and found people were receiving care and support that met their individual needs and preferences. A relative said 'I am quite involved in the care plans, reviews and updates'.
We observed that people using the service had choices in all aspects of their daily living. Their privacy and dignity were respected. Staff were seen treating people with consideration and respect. One relative said 'it's very safe; it's the most important thing to me. I have peace of mind'. Another said 'I don't worry about my family member once I have dropped them at the home'.
We heard people laughing and joking with the staff on duty.
We saw that people and their representatives were supported to give feedback on the quality of the service provided.