Inspection on 02/02/07 for Harrias House

This inspection was carried out on 2nd February 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Harrias House 03/07/08

Harrias House 04/07/07

Harrias House 17/02/06

Harrias House 07/11/05

Harrias House 29/03/05

Harrias House 06/12/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Harrias House Hedgerley Lane Beaconsfield Bucks HP9 2SD Lead Inspector Chris Schwarz Unannounced Inspection 9:25am 2 February 2007 nd X10015.doc Version 1.40 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 Harrias House DS0000022976.V310954.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 Older People. 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. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harrias House Address Hedgerley Lane Beaconsfield Bucks HP9 2SD 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) 01494 674204 hh.manager@ukonline.co.uk Beaconsfield Housing Society Limited Elinasi Bailey Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th February 2006 Brief Description of the Service: Harrias House provides care for 17 service users. It is situated on the edge of Old Beaconsfield and is an elegant building with extensive grounds. It provides welcoming and homely care for the older person. The rooms are spacious and can be personalised. There is an experienced care team. Fees range from £452 to £579 per week. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of a day and covered all of the key standards for older people’s services. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Fifteen replies were received, all expressing satisfaction with care provision at Harrias House. Specific comments and findings are mentioned under each relevant section of the report, but indicated a well run, caring and responsive home which is effectively meeting the needs of older people. Information received since the last inspection was also taken into account when planning this visit. The inspection consisted of discussion with the manager and some of the trustees who were visiting, a tour of the premises, examination of some of the home’s required records, opportunities to speak with staff and interviews with five service users. Feedback was given to the manager at the end of the visit. A key theme of the inspection was assessment of how the home meets needs arising from equality and diversity. The manager, staff and service users are thanked for their hospitality and cooperation during this inspection visit. What the service does well: Information about the service is contained within a statement of purpose and service users guide so that prospective service users and their families have the necessary information to help make a decision about moving into the home. Contracts are in place, setting out the terms and conditions of residency so that service users know what to expect and their rights. Assessment is undertaken of prospective service users to ensure that needs are identified and that the home is able to meet these needs. Care plans are in place for each service user, ensuring that needs are identified and can be met by staff. Health care needs are being met, to ensure that service users stay well. There is good regard for service users’ privacy and dignity and they are treated with respect, ensuring that care is provided sensitively and appropriately. Social, religious, cultural and recreational needs are well met, providing service users with continuity and stimulation. Contact with family, friends and the local community is enabled, maintaining important social links. Service users have opportunities to exercise choice and control over their lives, where able, to Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 6 retain independence. Meals and mealtimes are well managed, ensuring that service users’ nutritional needs are met. Complaints are effectively handled using the organisations’ complaints procedure, to ensure that views of service users and their representatives are listened to. There are adult protection procedures in place to ensure that the risk of harm to service users is reduced. A safe, clean and attractive environment has been created, providing service users with pleasant and well maintained surroundings. The number and skills mix of staff is sufficient to meet the needs of service users, ensuring that they are in safe hands at all times. There is effective management at the home, ensuring continuity and that the home is run in the best interests of service users. Quality assurance measures are sufficient to monitor standards of care, ensuring that service users receive the support they require. The home does not manage service users’ finances. Due regard is generally shown toward health and safety to ensure that the risk of accidental injury to staff, service users and visitors is minimised. What has improved since the last inspection? What they could do better: Medication needs to be better managed, ensuring that medication practice is safe, follows good practice and that an accurate record is maintained of medicines administered to service users. The home needs to be more thorough in recruiting staff, to ensure that service users are supported by appropriately vetted carers. An induction needs to be in place for all new staff, to ensure that staff have the necessary skills and knowledge to meet care needs. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 7 The home needs to carry out fire drills at least every six months, to ensure that staff and service users are adequately rehearsed in evacuation procedures. Electrical wiring of the premises needs checking and certifying as safe every five years, to reduce the risk of fire at the home. 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. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards 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 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the service is contained within a statement of purpose and service users guide so that prospective service users and their families have the necessary information to help make a decision about moving into the home. Contracts are in place, setting out the terms and conditions of residency so that service users know what to expect and their rights. Assessment is undertaken of prospective service users to ensure that needs are identified and that the home is able to meet these needs. Intermediate care is not provided. EVIDENCE: A statement of purpose and service users guide are in place, providing prospective service users with good information about the home. A sample of care files showed that contracts are in place for each person outlining what they may expect of the service and their obligations. An assessment of care Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 10 needs had been carried out in each case by either the manager or deputy manager, and provided sufficient details of the type of support each person requires. Service users spoken with during the inspection confirmed that they had opportunity to visit before moving in and were supplied with enough information to help them make a decision about moving in. Encouragement had been given to personalising their rooms to help them settle in. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Care plans are in place for each service user, ensuring that needs are identified and can be met by staff. Health care needs are being met, to ensure that service users stay well. Medication needs to be better managed, ensuring that medication practice is safe and follows good practice. There is good regard for service users’ privacy and dignity and they are treated with respect, ensuring that care is provided sensitively and appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were in place for service users outlining the support they require. Each of the files examined showed that dependency levels are low at the home with minimal assistance needed from staff with daily living tasks; risk assessments reflected this. Documentation was up-to-date and included information about history of falls and ability to manage medication. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 12 Records showed that service users receive prompt attention to their health care needs. A doctor commented “Overall extremely impressed with the services provided for residents. Staff work extremely hard and are a pleasure to work with.” A second doctor was satisfied with overall care provided to service users and felt that the home communicated clearly and worked in partnership with the surgery, appropriately managed medication and demonstrated a clear understanding of service users’ needs. Two district nurses returned comment cards and were satisfied with overall care at the home and had not received any complaints. A relative commented, “Immediate action taken on health emergencies.” Medication is administered using a monitored dose system. Medicines were being kept securely on the premises and only administered by senior staff. Records of medication received into the home and retuned to the pharmacy were in good order. No controlled drugs were being used at the time of this visit. An unlabelled dossette pack was found in the cabinet with some tablets contained within it. The manager said this belonged to a service user who had come in for respite care. The dossette pack had been filled by a relative/carer which staff at the home were then administering from. It was pointed out that this practice is very unsafe, as staff at the home would be unable to verify what the tablets were and who they had been prescribed for. A requirement is made to address this, to ensure that better safeguards are in place. Some gaps were evident on medication administration records alongside prescribed dose times. A second requirement is made, to address this. Six service users returned comment cards. All indicated that they are happy living at the home and feel well cared for and that their privacy is respected. Staff knocked on doors before entering and were courteous and respectful when speaking with service users and their visitors. All bedrooms at the home are single therefore there are no issues with privacy whilst carry out personal care. Post is passed to service users and they may make and receive telephone calls in private; many had their own telephone lines installed. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Social, religious, cultural and recreational needs are well met, providing service users with continuity and stimulation. Contact with family, friends and the local community is enabled, maintaining important social links. Service users have opportunities to exercise choice and control over their lives, where able, to retain independence. Meals and mealtimes are well managed, ensuring that service users’ nutritional needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities co-ordinator works at the home part-time and those service users spoken with felt that there was enough to occupy them. Several service users said they like to spend time in their rooms but knew that activities were available and just came down for meals and to occasionally sit in the communal areas. A programme of activities was displayed in the hallway, as was information about local clubs and groups. The mobile library visits the home – dates of these visits were posted up for information, and a hairdresser also visits. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 14 Several visitors came to the home during the course of the inspection. Service users said that friends and family are welcome. A friend of a service user commented “I have the highest opinion of the kindness and care given at Harrias House and am always made to feel most welcome.” A relative commented “We are always warmly received in a pleasant, homely atmosphere. A camaraderie exists between carers, visitors and residents. It’s a pleasure to visit Harrias”. Service users confirmed that they are able to exercise autonomy and choice through, for example, personalising their rooms, choosing to be alone or in company, managing their medication where able and bathing unassisted where able. All service users completing comment cards were happy with meal provision at the home. A relative commented “Food is good and a lot is homemade.” The chef is experienced and orders good quality produce for the home. As well as three meals a day, service users additionally enjoy morning coffee and afternoon tea with freshly made cakes. Menus reflected a balanced, nutritious and wholesome diet and the menu for the day is displayed in the hallway each day. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Complaints are effectively handled using the organisations’ complaints procedure, to ensure that views of service users and their representatives are listened to. There are adult protection and whistle blowing procedures in place to ensure that the risk of harm to service users is reduced. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users completing comment cards said that staff treat them well and they feel safe at the home. Fifteen comment cards were returned overall, from service users, health professionals, relatives and friends of service users. None had any complaints about the service. All service users completing comment cards said that they knew who to speak to if they were unhappy. A complaints procedure is in place, covering all required areas and has the upto-date contact details of the Commission. The Commission is not aware of any complaints by service users or their representatives. Adult protection procedures are in place at the home and training had been undertaken by staff. The Commission is not aware of any adult protection concerns for this service. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. A safe, clean and attractive environment has been created, providing service users with pleasant and well maintained surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large country residence located amongst walled grounds in Old Beaconsfield. Accommodation is on the ground and the first floor and all bedrooms are single and vary in size. Some have direct access to the gardens via a door and several have large bay windows overlooking the gardens. Each room that was looked at was clean, odour free and personalised by the service user. Bedrooms either had en-suite bathroom facilities or were close to communal facilities. Flooring was being replaced during the inspection to some of the bathrooms and was due to be completed the next working day. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 17 There was good regard for hygiene and infection control. The kitchen was clean and in good order and the laundry had appropriate facilities. A relative commented that the home is “very clean” and “gardens beatifically maintained.” Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The number and skills mix of staff is sufficient to meet the needs of service users, ensuring that they are in safe hands at all times. The home needs to be more thorough in recruiting staff, to ensure that service users are supported by appropriately vetted carers. An induction needs to be in place for all new staff, to ensure that staff have the necessary skills and knowledge to meet care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this visit, the manager was on duty plus a senior carer, two carers, a domestic worker, the chef and activities co-ordinator. The chair of trustees was also present at the home and two other trustees visited. Service users described sufficient levels of staff being available to them at all times and they have pendant alarms to summons help if need be. Four staff have attained National Vocational Qualification at level 2 or above and a further three have started their training. The manager has the Registered Managers Award but is also doing National Vocational Qualification level 4 in Care. Service users said that staff at the home were very good and used words such as “thoughtful”, “patient” and “marvellous” to describe them. A relative commented “Residents are treated with graciousness and dignity by staff. Could not be more happy with the care given by the manager of Harrias Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 19 House. Staff work really hard to make Harrias House a “caring home” for its residents.” At the last inspection in February 2006, four requirements were made regarding staffing practice. These covered recruitment, staff induction and training. The files of three carers were examined. One carer had started work prior to the last inspection and may have been one of the files examined at that time. The file provided evidence of most recruitment checks being taken up prior to starting work, except for the references. A “to whom it may concern” type of reference was on the file, dated three years previously to the date of application, and was not one of the referees indicated on the application form. If this was one of the files examined at the last inspection, the manager had not taken steps to acquire appropriate references and must now do this. Two other files, of staff commencing since the last inspection, were looked at. One had the full range of required checks and was satisfactory. The other file showed that the carer had been allowed to start work twenty days before a POVAfirst check had been returned. This is contrary to one of the requirements made in February 2006. The manager must ensure that service users are not placed at risk of potential harm through insufficient recruitment practices and the requirements that have not been fully complied with are repeated on this occasion. Failure to adhere to these could result in the Commission seeking to take legal action to ensure compliance. Files showed that staff had been given codes of conduct for working at the home and job descriptions were in place. The Skills for Care induction package had been used with new carers, although records had not been signed and dated as each section was completed. It is recommended that this is done, to prove competency, rather than leaving until the whole programme is completed. A written and signed induction programme was not in place for a senior member of staff who came to the home with a qualification. The manager still needs to demonstrate that practices and procedures at the home have been gone through with such staff and that they are competent to carry out the tasks in their job description. Some evidence was in place where staff had signed to show that they have read and understood certain policies at the home, but this is not sufficient. The requirement made at the last inspection regarding induction is therefore not being complied with and is repeated on this occasion. Records of mandatory training were examined for three staff. All had up-todate moving and handling training and Protection of Vulnerable Adults. One person had a first aid certificate and overall there are nine first aiders at the home. Two of the three had attended fire safety training; the third person had started at the end of November 2006 and should be completing this as part of the induction package. No staff had attended food handling and hygiene – this was attributed to carers having no involvement with meal or snack preparation Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 20 other then making drinks and biscuits, as the home’s chef makes all the meals and leaves supper items for staff to serve. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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, 33, 35 and 38 Quality in this outcome area is adequate. There is effective management at the home, ensuring continuity and that the home is run in the best interests of service users. Quality assurance measures are sufficient to monitor standards of care, ensuring that service users receive the support they require. The home does not manage service users’ finances. Due regard is generally shown toward health and safety to ensure that the risk of accidental injury to staff, service users and visitors is minimised, but some attention is needed to making sure that regular fire drills take place and that electrical wiring is checked for safety. This judgement has been made using available evidence including a visit to this service. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has a full time manager who is registered with the Commission and has completed the Registered Managers Award. Service users spoke favourably of her and also referred to some of the trustees by their first names, indicating regular contact with them. A service user and visitor satisfaction survey had been undertaken in October 2006 as part of a quality assurance system, supplementing the monitoring visits that are carried out by the trustees. It was noticed that one of the monitoring reports had been summarised of several visits between November 2006 and January 2007. If this format is to continue, a recommendation is made to include within the report the dates of visiting the service, in order that it is clear that visits have been carried out at least every month. The home was not managing the finances of anyone living at the home. Some service users manage their own money and others have arrangements with families and sponsors. A health and safety policy has been written for the home, which looked comprehensive. Policies were in place for a number of additional safe working practice topics including infection control, medication practice, contamination incidents and control of waste. Certificates showed that hoists had been serviced in September 2006 and water testing had been done in September 2006. The gas boiler had been serviced In December 2006/January 2007 and electrical wiring had been checked in June 2000. The Health and Safety Executive recommends that electrical wiring installation is checked every five years and a requirement is made for a new check to be carried out. Accidents were being recorded with action taken noted. Hot water was being tested and all recorded temperatures were below the safe maximum limit of 43° Celsius. Portable electrical appliances had been serviced in December 2006 and the home’s fire procedure and health and safety statement were displayed in the hallway, alongside evidence of employer’s liability insurance and the certificate of registration. The chef had up-to-date food handling training. The fire log showed that weekly testing of the alarm is undertaken regularly and the emergency lighting is checked. The alarm system had been serviced in November 2006 and a fire based risk assessment was in place for the premises. Drills had been conducted on 26 October 2005 and then 14 September 2006, which showed that these are not taking place at least every six months as required, to ensure that staff and service users are adequately rehearsed in evacuation procedures. A requirement is made to attend to this. A report titled “oil firing service report November 2006” recommended that the home’s oil storage tank be sited away from the building and advised that pressure devices had not been fitted correctly. At the time of the inspection, the manager was not certain what action was being taken by the trustees in Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 23 relation to this report and it is requested that information about what is being done to remedy matters is supplied to the Commission in a letter. Harrias House DS0000022976.V310954.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 2 Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Timescale for action Medication is only to be 15/03/07 administered from pharmacydispensed bottles or packets of medication or from a monitored dose system prepared by a pharmacist. Accurate records are to be 15/03/07 maintained of medication administered to service users. The recruitment files should 15/03/07 contain the information specified in Regulation 19, schedules 2 and 4 of the Care Homes Regulations 2001. Previous timescale of 30/04/06 not met. The references referred to in the report are to be obtained. Staff must not start work until a 15/03/07 Criminal Records Bureau (CRB) check has been received. If necessary a POVA first check must be undertaken and the staff supervised until a full CRB check is received. Previous timescale of 30/04/06 not met. All staff must complete an 15/03/07 induction programme. DS0000022976.V310954.R01.S.doc Version 5.2 Page 26 Requirement 2 3 OP9 OP29 13(2) 19 4 OP29 19 5 OP30 18 Harrias House 6 OP38 13(4) 7 OP38 23(4) Previous timescale of 30/06/06 and previously not met. A check is to be carried out of 01/06/07 the electrical wiring installation at the home by a qualified electrician and a safety certificate issued. Fire drills are to be conducted at 15/03/07 least every six months. 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 2 3 Refer to Standard OP30 OP33 OP38 Good Practice Recommendations The induction programme is to be signed and dated as each section is completed, to show competencies have been achieved. The dates of visiting the service are to be added to any report summarising monitoring visits by the provider over a period of time. The provider is to write to the Commission, outlining what remedial action is to be taken in response to the oil firing service report of November 2006. Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Burgner House 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford, OX4 2SU 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 Harrias House DS0000022976.V310954.R01.S.doc Version 5.2 Page 28 - 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!