Merrimans Respite Care Unit provides a respite service (short term accommodation and personal care) 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. 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 79 people accessed the service. There were nine people using the service on the first day of the inspection and one person on the second day.

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.

We used a number of different methods to help us understand the experiences of people using the service, because most of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with three members of staff, two people who were using the service, observed staff providing care and support to people and looked at some records.

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.

We were not able to speak in detail with people using the service, due to communication difficulties. Some people communicated to us through verbal communication and by none-verbal communication that they were being well looked after.

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.

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.