Inspection on 04/07/07 for Harrias House

This inspection was carried out on 4th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harrias House 03/07/08

Harrias House 02/02/07

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 Barbara Mulligan Unannounced Inspection 4th July 2007 10:30 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.V338603.R02.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.V338603.R02.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 manager@harriashouse.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.V338603.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2007 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, and well-maintained grounds. It provides a welcoming and homely residence for the older person. Each bedroom is spacious and can be personalised by the occupant. The home requires potential service users to be mobile and personal bathing is undertaken by a visiting qualified carer who visits the home on a weekly basis. The Beaconsfield Housing Trust, which manages the home, has an active board of trustees who take an interest in the home. There is an experienced care team. Fees range from £452 to £579 per week. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken on Wednesday July 4th 2007 at 10:30am. The visit consisted of discussions with the registered manager, the staff team, service users and a visiting relative, a tour of the premises and an examination of the homes records, policies and procedures. The inspection officer was Barbara Mulligan. The registered manager is Elinasi Bailey. Twenty-six of the National Minimum Standards for Older People were assessed during this visit to the home. Twenty of these are fully met, five almost met and one has been assessed as not applicable. As a result of the inspection the home has received four requirements. The inspector would like to thank the registered manager, the staff team, service users and visiting relatives for their cooperation and assistance during this visit. Service users and relatives/representatives, both those interviewed and those who responded to the survey expressed a high level of satisfaction with the care received from support staff. Positive comments made about the service include, “ You will not find a happier home” and “the girls are so kind and help me a lot” and “ the atmosphere is always cheerful and friendly”. Comments made about the food were positive and include,” the food is always good here” and “its just like home cooking” and “I know you will enjoy your meal we eat well”. The manager is able to demonstrate a good recognition of the equality and diversity needs of staff and service users and the evidence seen and comments received, indicate that this service does meet the diverse needs [e.g. religious, racial, cultural, disability] of individuals within the limits of its Statement of Purpose. The inspector would like to thank the service users, the staff team and the registered manager for their cooperation and help during the inspection. What the service does well: Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. Healthcare support for service users is good. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 6 Service users feel that they are treated with respect and dignity. The home provides a pleasant and comfortable environment in which service users live. Individuals are encouraged to personalise their rooms with their own personal belongings. One relative stated “this is a beautiful, beautiful home”. The staff team are motivated, committed and respond to service users in a respectful and appropriate manner. Service users spoken to said that the staff are “very helpful and always happy” and “all the girls are lovely and very kind”. Service users confirmed that they were encouraged to participate in activities as they choose. There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. Meals are of a good standard and always presented in an appealing way. There is good support for the home by the provider organisation, with effective monitoring and quality assurance systems in place. What has improved since the last inspection? What they could do better: All medicines must be transported via an appropriate, lockable trolley. Care staff must receive formal supervision at least six times a year. All gas appliances must be serviced on annual basis. Harrias House DS0000022976.V338603.R02.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. Harrias House DS0000022976.V338603.R02.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.V338603.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. Potential service users receive a thorough needs assessment undertaken by staff trained to do so ensuring that the home can meet all the care needs requirements of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care of four service users was case tracked, including those most newly admitted to the home. The registered manager or the deputy manager completes the initial needs assessment for potential service users. Four completed needs assessments were examined. The records show that all service users had been visited at home or in hospital prior to their move to the home and an assessment of their needs has been undertaken. These are fully completed and provided sufficient details of the type of support each person requires. All assessments seen are signed and dated. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 10 The assessment tool covers past medical history, mobility, mental state, history of falls, dietary preferences and allergies, medication, general health and social needs and relationships. 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. The assessment documentation demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not offer intermediate care. Harrias House DS0000022976.V338603.R02.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. 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, however these need to include further detail in the action plan to ensure that service users needs are identified and can be met by staff. Healthcare support for service users is good, which means that their health and well-being is promoted and protected. The medication policies and procedures are clear and informative, but there is no consistent implementation of the policies, that could result in unsafe working practices. Service users feel that they are treated with respect and dignity and that their right to privacy is upheld ensuring personal care is delivered appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home uses the standex system of care planning and has worked hard to improve the written care plans. Four records were examined at random and these outline the support each individual requires and demonstrate that dependency levels are low at the home with minimal assistance needed from Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 12 staff with daily living tasks; risk assessments reflect this. The inspector was informed that a self-employed carer visits the home on a Saturday morning to bath service users and the homes care staff only undertake bathing on a needs only basis. There are some entries in the care plans that would benefit from further detail and this is a recommendation of the report. An example observed in three care plans records “assisted bathing”. Another entry records under hobbies and interests records “no known hobbies”. These are vague statements and would benefit from further detail. Several areas of care plans were not completed. The main areas left incomplete are oral care, interests and hobbies, social aims and objectives and emotional well-being. All areas of the care plans must be competed to ensure all the identified needs of service users are met. This is strongly recommended. There are many areas within the needs assessments and the care plans where Tipex has been used. This practice needs to be discontinued and is strongly recommended. Documentation is up to date and includes information about history of falls and ability to manage medication. The daily entries had been signed and dated. There was documented evidence of medical and other healthcare professional input. The inspector observed a short term care plan that had been put into place for one individual due to a change of circumstances because of illness. This is good practice and is to be commended. All care plans are stored in safe and secure areas and there is documentation to demonstrate that care plans are reviewed monthly. Records showed that service users receive prompt attention to their health care needs. Most service users are registered with two local GP Practices. Service users can register with their own GP if this is practical and agreeable to both parties. All have access to local NHS Services. The home does not admit service users who are not independently mobile. A domiciliary optical service visits the home on an annual basis and as needs require. Referrals for a hearing test go through the service users G.P. Weight monitoring was observed in the care plans and this is undertaken monthly. Chiropody services visit the home on a six weekly basis. Dental services are accessed privately on a needs only basis. During the previous visit the inspector observed an unlabelled dossette pack 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 that staff at the home were then administering from. A requirement was issued for medication to be administered from pharmacy-dispensed bottles or packets of medication or from a monitored dose system prepared by a pharmacist. On the whole this Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 13 has been complied with and there is a monitored dosage system in place. However, there were medicines for a service user, admitted initially for respite care and now admitted for long term care which were not contained within a monitored dosage system. It was explained to the inspector that whilst this individual had been living at home she had accumulated a large quantity of medicines and the home was using this. All entries on this individual’s medication record were hand written with no signatures. It was pointed out that this practice is unsafe and it is strongly recommended that all hand written entries are signed by two staff. The inspector observed a medicine round taking place during lunchtime. Medicines are transferred from the medication storage area to the dining room via a two shelved plastic trolley. During the medicine round medications are not kept within a lockable trolley and kept secure. This will be a requirement of the report. There are monitored dosage systems in place and it was observed that there is a large number of pharmacy-dispensed packets stored within a plastic Tupper-ware box. The inspector queried why there are so many pharmacy-dispensed packets and why these have not been included within the monitored dosage system. The registered manager stated that some of these are painkillers given on a needs only basis and others are medicines that must remain within the foil container. The home uses a local chemist to supply and deliver the homes medicines. There were no out of date medications held in the home and there is a returns procedure in place. There are no controlled drugs in use at the time of the visit, however Temazepam is in use and it is strongly recommended that this is stored and administered in line with the guidelines for controlled drugs. During the previous inspection it was identified that there were several gaps evident on medication administration records alongside prescribed dose times and a requirement was issued for improvement. It is pleasing to note that this has been complied with. Training records demonstrate that staff undertake an introduction to the administration of medicines during their induction programme and then go on to complete accredited safe handling of medicines training. Service users receive care from staff and health care professionals in complete privacy. Staff were observed during the inspection to knock on service users bedroom doors before entering. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans. Service users spoken to on the day of inspection said that 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 personal care is delivered. 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.V338603.R02.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Systems in the home ensure that where appropriate service users are supported to exercise choice and control over their lives. Individuals are able to receive visitors at the home and there are no restrictions imposed on visiting unless requested by the service user. Service users are encouraged to bring personal possessions in with them allowing personal space to reflect the character and interests of its occupant. The presentation and standard of food is good and meets the nutritional needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans show routines of daily living and include bathing, rising and retiring times. The routines in the home are flexible and service users confirmed that they had a choice as to when they get up and when they go to bed. Relatives and friends are welcome at any time and the visitors spoken on the day were able to confirm this. Religious observance is recorded in care plans and service users interests are recorded in the initial assessment. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 15 An activities co-ordinator works at the home part-time and those service users spoken with felt that there was enough to occupy them. The inspector interviewed the activities co-ordinator. She felt that it would be very helpful if the home obtained a life history of the individual to give staff information about previous leisure pursuits, hobbies and other interests. This is recommended. Two visiting relatives stated that the activities are varied and suited to each , individual. A programme of activities is 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. Examples of involvement in the home by local community groups and individuals are visits by mobile hairdressers, various visiting entertainers and a monthly church service. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. Family and friends are invited to participate in some of the social event organised. Service users and/or their families are encouraged to look after their own financial affairs whenever possible. If this is not practicable a chosen solicitor will be responsible for an individuals financial dealings. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. A visiting relative on the day of the inspection commented, “You will not find a happier home. The atmosphere is always cheerful and friendly”. When questioned about service users having access to their personal records, the inspector was informed that this could be facilitated if it was requested. Service users are offered three meals a day. The inspector had the opportunity to join the service users for lunch. Lunch was relaxed, unrushed and well organised. All meals seen were attractively presented and plentiful. Comments made by service users regarding the food include “ you always get a good meal here” and “ the food is very good, I enjoy meal times”. During discussions with service users it was confirmed that meals are always of a high standard and there are sufficient snacks and drinks available throughout the day. Comments made about the food were positive and include, “the food is always good here” and “its just like home cooking” and “I know you will enjoy your meal, we eat well”. The chef displays the day’s menu every morning. However, this does not include an alternative. In discussions with the chef and the service users it is apparent that there is always an alternative available, but service users were unable what this was. It is recommended that the alternative meal choice is displayed on the daily menu. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 16 The inspector was told that service users can take their meals in their rooms if they wish and this was the choice of several individuals on the day of inspection. The nutritional needs of service users are assessed and there is evidence of regular monitoring in all care plans seen. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 17 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. 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. However the recording of concerns needs to be improved. 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: The home has a complaints procedure, which is accessible to service users and their representatives. This is up to date and contains details of how the complainant can contact the Commission for Social Care Inspection. The home has a complaints record form that will be completed when a complaint has been received by the home. Each service user has a book in their bedrooms where each individual can record any concerns they may have. The inspector observed one book where three concerns were recorded. Although this is good practice there is nothing recorded in the book to indicate that the concerns have been dealt with appropriately. It is strongly recommended that all concerns contain evidence of the action taken and the outcome of each complaint. The registered manager stated that the home has not received any complaints since the previous report. The Commission has received no complaints about this service. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 18 A summary of the complaints procedure is included in the Statement of Purpose and Service Users Guide. The registered manager is aware of the POVA register and would submit staff for inclusion if it became necessary. The home uses the Bucks Multi Agency POVA policy and an organisational policy in conjunction with this. This includes guidelines for staff about the responsibilities of the staff, types and signs of abuse and what to do if you suspect abuse. Training records demonstrate that most care staff are up to date with POVA training and this forms part of their induction. The registered manager does not act as appointee for any service users. There are systems in place to look after small amounts of personal allowance or for the safekeeping of service users valuables. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 and 26. Quality in this outcome area is good. The standard of the environment within the home is excellent, providing service users with an attractive and homely place to live. The overall quality of the furnishings and fittings is good ensuring the safety and comfort of service users. Standards of cleanliness at the home are good meaning that service users live in an environment that is clean and hygienic, protecting their health, safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Harrias House provides care for 17 service users. 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. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 20 The local amenities include a village store, public house and an attractive green. The second floor of the home is accessible via a passenger lift. The front entrance of the home includes a reception area and this is welcoming and homely. Just past the reception there is a small seated area for the use of service users and visitors. Communal space consists of two lounge areas and a bright spacious dining area, which are both set in a homely and attractive fashion. The internal decoration of the home is of a good standard and there are personal touches around the home such as flowers, plants, books and pictures. The main kitchen is clean, spacious and well looked after. This is to be commended. However, a further smaller kitchen where staff make beverages and snacks would benefit from a new fitted kitchen. Cupboards and drawers are broken and work tops are worn. This is strongly recommended. Lighting in communal areas is domestic in character and sufficient to facilitate reading and other activities. The furnishings observed in communal areas are of good quality and suitable for the range of interests and activities preferred by service users. The gardens are large and well maintained. These are accessible to service users. There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. All radiators have low temperature surface covers and are thermostatically controlled. Emergency lighting is provided throughout the home. Hot water control valves are fitted to all hot water outlets accessible to service users. Laundry facilities are very spacious and sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The home has an infection control policy and the inspector observed this. Instructions are in place for the washing of soiled linen. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. Staffing numbers are adequate, and ensure that the assessed needs of the service users are met. There are effective recruitment procedures in place to ensure service users are protected from harm. Service users benefit from a staff team who are up to date with their training, to ensure that staff are competent to do their jobs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s staff rota demonstrates that there are adequate numbers of staff on duty at all times to ensure the needs of the service users are always met. This includes sufficient numbers of ancillary staff. The registered manager is extra to these numbers. There are no staff working in the home who are aged under 18 years of age and there are no members of staff under the age of 21yrs left in charge of the home. The home continues to support staff on NVQ training and at the time of this inspection two staff had obtained NVQ level 2 training and a further two staff were working towards NVQ 2 training. However a minimum ratio of 50 trained members of care staff has not yet been achieved. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 22 Following the previous inspection it was identified that the one carer had been allowed to start work twenty days before a POVA first check had been returned and a requirement was issued for improvement in this area. It is pleasing to see this has been complied with. A random selection of staff files were made available for inspection purposes, including those most newly recruited. All files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks have been obtained before they commence work. Following the previous inspection it was identified that there was no written and signed induction programme in place for a senior member of staff who came to the home with a qualification. A requirement was issued that all staff must complete an induction programme. The inspector was unable to assess this completely because there had been no new staff employed since the previous inspection. However the inspector was able to view a blank induction package and the registered manager stated this will be completed for each newly employed carer. Training records reflect that staff have received mandatory training and this appears to be up to date for all staff. However it is recommended that the training records are organised to make them easier to assess. There is specialist training available for staff, an example of this is falls prevention and management programme and dementia care. Staff confirmed that there are regular staff meetings. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The home operates various methods of quality assurance resulting in the home being proactive in identifying issues that may affect the well being of services users. Protocols and systems are in place to ensure service users financial interests are safeguarded. Staff are not regularly supervised, potentially leaving service users at risk of poor practice from staff. The homes health and safety procedures ensure the service users health, safety and welfare are protected and promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 24 The Beaconsfield Housing Trust, which manages the home, has an active board of trustees who take an interest in the home. The chairman and three of the trustees visit the home regularly. On the day of the visit the inspector was able to meet with the chairman and one member of the board of trustees who were visiting the home. The manager appears competent and sufficiently experienced to manage the home. She has completed her registered managers award. The registered manager feels that the staff team understand and can relate to the aims and purposes of the home. This is usually achieved through regular staff meetings, staff supervision and annual appraisals. The registered manager stated that service users satisfaction questionnaires are sent out to service users and their relative or representative on an annual basis. These are sent to the board of trustees. In addition to this there is a book in each service users bedroom where they can record their comments and concerns. These books are collected and looked at by the manager who will respond to each concern. The registered manager seeks Service users views informally on a daily basis. The manager does not undertake the role of appointee for any service users. Service users are encouraged to look after their own financial affairs where at all possible. 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. Service users have locked storage in their rooms if they wish to keep valuables with them and all residents have a key to their room door, which can be locked if they wish. The registered manager stated that she carries out informal supervision with care staff on an ad hoc basis. Formal supervision needs to be undertaken six times a year and should cover all aspects of practice, philosophy of care in the home and career development needs. All other staff must be supervised as part of the normal management process on a continuous basis. This will be a requirement of the report. A health and safety policy has been written for the home, which is detailed and comprehensive. Policies in place for a number of additional safe working practice topics including infection control, medication practice, contamination incidents and control of waste. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment that is reviewed annually. Following the previous report a requirement was issued Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 25 for fire drills to be conducted at least every six months. Records demonstrate that this has been undertaken since the last inspection. Evidence of mandatory health and safety training demonstrates that staff are up to date with this training. Service reports are in place for the maintenance of hoists and the lift. There are service certificates for the gas appliances dated 14/10/05. The registered manager was unable to locate an up to date certificate and it is a requirement of the report that a copy of the certificate is forwarded to the Commission. PAT testing was undertaken on 14/12/06 and Legionella on 08/09/06. Following the previous report a requirement was issued for a check to be carried out of the electrical wiring installation at the home by a qualified electrician and a safety certificate issued. It is pleasing to see that this was completed on 27/04/07. There are systems in place for water chlorination and kitchen hygiene. COSHH sheets are up to date and accurate. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 26 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 X X 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 3 3 3 X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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) Requirement The registered manager is required to ensure that all medicines are transported via an appropriate lockable trolley. The registered manager is required to ensure that staff receive formal supervision at least six times a year. The registered manager is required to ensure that upto service certificates are available for appliances in the home. Timescale for action 30/09/07 2 OP36 18 30/10/07 3 OP38 23 30/09/07 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 OP7 OP7 OP7 Good Practice Recommendations It is recommended that the care plans contain further detail to ensure It is recommended that the use of Tipex in care plans and other documentation is discontinued. It is strongly recommended that all areas of the care plan is completed. DS0000022976.V338603.R02.S.doc Version 5.2 Page 28 Harrias House 4 5 6 7 8 9 OP9 OP9 OP15 OP16 OP19 OP30 It is strongly recommended that all hand written entries on medication administration records are signed by two carers. It is strongly recommended that Temazepam is stored and administered in line with guidelines for controlled drugs. It is recommended that an alternative choice of menu is displayed on the daily menu. It is recommended that all concerns received by the home record the action taken and the outcome of the concern. It is strongly recommended that the kitchen used by staff for preparing beverages and snacks is replaced. It is recommended that training records are organised to make it easier to assess the training undertaken by staff. Harrias House DS0000022976.V338603.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 © 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 - 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. 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