CARE HOMES FOR OLDER PEOPLE
Harrias House Hedgerley Lane Beaconsfield Bucks HP9 2SD
Lead Inspector Christine Sidwell Announced 7th November 2005 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Harrias House Address Hedgerley Lane, Beaconsfield, Bucks, HP9 2SD Telephone number Fax number Email 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 Beaconsfield Housing Society Limited Mrs Ellie Bailey Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Harrias House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 29th March 2005 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. Harrias House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the report of an announced inspection, which took place on the 7th November 2005. Care plans, medication records, recruitment files and other records were examined. Care practices were observed. A tour of the building including the kitchens was undertaken. The staff on duty were spoken to. Most residents were also spoken to on the day. Eight residents, seven families, two general practitioners and two other healthcare professionals returned the comment cards which were distributed prior to the inspection. What the service does well: What has improved since the last inspection?
The written care plans have improved since the last inspection and there is now more information available to guide carers. Residents now have low surface temperature radiators in their rooms and the water outlets in their rooms have thermostatically controlled valves to minimise the risk of scalding. Harrias House Version 1.10 Page 6 The training programmes have improved since the last inspection although there is still more work to be done to ensure that carers have their skills updated. The recruitment processes have improved although the files are not yet complete. Funding for carers to achieve the National Vocational Qualifications in Care has been identified and staff are to commence this training in January 2005. The manager has now registered with the Commission for Social Care Inspection and is undertaking the National Vocational Qualifications In Care and Management at Level 4 A fire risk assessment has been completed and standards of cleanliness in the kitchen have improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harrias House Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Harrias House Version 1.10 Page 8 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 standard(s) 3, 5 and 6 The homes pre-assessment and admission policies work well and give staff and residents the confidence that the home can meet their needs. The opportunity to stay for a trial period and for respite care give potential residents an opportunity to assess the care that they receive before deciding to move to the home on a permanent basis. EVIDENCE: New residents are admitted following a pre-assessment. There was evidence in the files that these had been undertaken and of care manager’s assessments where the resident is sponsored by the local authority. The pre- assessment documentation for self-funding residents is comprehensive. A plan of care is developed from the information collected at the pre-assessment. Residents have a trial period in which to assess whether they would like to move to the home on a permanent basis. The home does not take people for intermediate care but does provide respite care for residents who may need temporary support whilst a family member is away.
Harrias House Version 1.10 Page 9 Harrias House Version 1.10 Page 10 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 standard(s) 7, 8, 9 and 10 The care plans have improved since the last inspection and now contain more information to enable carers to meet resident’s needs. There is good communication with local healthcare providers and resident’s healthcare needs are met. Medication is managed well and residents receive their medication in a safe and timely manner. The staff treat residents with respect and courtesy. EVIDENCE: The home uses the standex system of care planning. Four care plans were selected at random for inspection. All had good initial assessment documentation and care plans for everyday living. The short-term care plans for specific short-term needs are in need of development. However considerable improvements in the care planning documentation have been made since the last inspection. There was evidence in the care plans that residents have access to the Primary Healthcare team and to the services of the local hospitals where necessary. Two general practitioners returned the comments cards distributed prior to the inspection and both said that the home communicated clearly with them and that their specialist advice was incorporated in the care plan. The visiting district nurses also confirmed this. No residents have pressure damage and none seen by the inspector appeared dehydrated. One resident appeared to be very slight. It is recommended that
Harrias House Version 1.10 Page 11 nutritional assessments are undertaken and that residents are weighed regularly. There was evidence that residents have access to chiropody, optical services and hearing tests as necessary. There are medication policies and procedures. Records are kept of medication entering and leaving the home. The home uses a dossette box form of medication administration, prepared by the local pharmacist. Three residents self medicate. There are policies and procedures to cover this. The residents were happy with the medication procedures. The staff were seen to treat the residents with courtesy and dignity. All care is given in resident’s own rooms and visiting professionals confirmed that they could see residents in their rooms. There are no shared rooms. Harrias House Version 1.10 Page 12 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 standard(s) none These standards were not assessed at this inspection but will be assessed at the next unannounced inspection. EVIDENCE: Harrias House Version 1.10 Page 13 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 standard(s) 16, 17 and 18 The home’s complaints and protection policies are well understood and should protect residents and give them confidence that their concerns would be listened to. EVIDENCE: There are complaints, protection of vulnerable adult and whistle-blowing policies in place. All residents are on the electoral register. The contact numbers for the local advocacy services are in the home. The home has not received any complaints within the last year and neither has the Commission for Social Care Inspection. All the residents who returned the comment cards said that they knew who to speak to if they were unhappy with their care. All but two of the family members who returned the comment cards said that they were aware of the homes complaints policy but that they had not had cause to make a complaint. Harrias House Version 1.10 Page 14 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 standard(s) 19, 24, 25 and 26 The home is well decorated and provides a comfortable home for residents. Residents are able to personalise their rooms, maintaining their own individuality and memories. Resident’s safety has now been enhanced by the provision of thermostatically controlled valves at the water outlets and by low surface radiators. EVIDENCE: There is a programme of routine maintenance. Two sides of the outside of the house have been painted this year and resident’s rooms are painted as and when they become empty. The lounge has been redecorated. A gardener has been appointed and a number of residents said that they enjoyed walking in the gardens. The fire officer last visited in May 2005 and his recommendations have been implemented. There are no CCTV cameras. A number of resident’s rooms were seen. All were spacious and furnished with resident’s own furniture. They are carpeted. There are no double rooms although some rooms are large enough for a married couple to use them if they wished. Rooms are individually lit and have plenty of natural light. The old storage
Harrias House Version 1.10 Page 15 heaters have now been replaced and all bedrooms have low surface temperature radiators. Thermostatically controlled valves have been provided to all water outlets in resident’s rooms. The home was clean and had no offensive odours. There are separate laundry facilities and the washing machines have the capacity to launder at 65C to reduce the risk of infection. Harrias House Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The homes staffing levels are sufficient to meet the needs of the current residents. They will need to be monitored regularly if resident’s dependency levels increase to ensure that they continue to meet their needs, particularly at night. The recruitment policies and procedures should protect residents from being cared for by unsuitable carers but need to be implemented carefully and with attention to detail if they are to fully protect residents. The training that carers receive has improved since the last inspection although not all staff have had the required mandatory training as yet to ensure that they have the skills necessary to care for residents. EVIDENCE: The staffing levels comprise the manager, deputy manager and two carers in the mornings, three carers in the afternoons and evenings and one carer awake at night, with one asleep on the premises who can be woken if necessary. The residents spoken to said that the carers were available when they needed help although one said that the night carer was very busy. There is sufficient domestic and catering staff to keep the home in a clean and tidy condition. The numbers of care staff meet the recommendations of the Residential Forum whose guidance has been adopted by the Department of Health. The night staffing levels are sufficient whilst the residents are needs care low but must be kept under review if any resident’s dependency increases. Harrias House Version 1.10 Page 17 Currently no staff hold National Vocational Qualifications in Care but funding has been secured for three carers to commence the course in January 2006 and for a further three to commence in June 2006. Four recruitment files were selected at random and examined. There is an improvement since the last inspection although not all files have copies of the required documentation yet. The inspector agreed to send the home a checklist of the documentation required and copies of the Department of Health’s guidance on the Protection of Vulnerable adults. An additional visit will be undertaken to ensure that all documentation is complete. The training programmes have improved since the last inspection. All senior carers have undergone medication training. Six members of staff have undertaken people handling awareness training, nine have attended fire awareness training and a number have attended protection of vulnerable adults training recently. Although the levels of training offered have improved there is a need to ensure that all staff complete an induction programme and have basic training with annual updates where applicable. Harrias House Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38 There is an open and inclusive management style in the home which gives residents confidence that their wishes would be respected. The home’s lack of a health and safety policy and systematic approach to risk assessment does not protect residents. EVIDENCE: The home has an experienced manager who is now registered with the Commission for Social Care Inspection. There is an open ethos in the home and the residents spoken to said that they felt able raise any issue with the manager or their carers and felt that their views would be respected. There are clear lines of accountability in the home and the staff spoken to say that they feel able to speak to the manager or any member of the committee. The quality assurance programme is in development. A resident’s satisfaction survey is undertaken and evidence was seen that action is taken as a result of the survey. There is a need to develop a systematic approach to the internal
Harrias House Version 1.10 Page 19 audit of care practices and processes such as recruitment to ensure that the standards set by the homes own policies and procedures are met and that all relevant legislation is complied with. At the last inspection a requirement was made that a Health and Safety policy was agreed. A start has been made on this but it is not yet in place. This must be written and agreed by the committee. The fire risk assessment has now been completed. Staff have first aid training and there is a staff member with first aid training on all shifts. The kitchen was inspected and found to be clean and tidy. The refrigerator temperatures had been taken and cleaning schedules had been established. Food temperatures had been recorded at the point of delivery. Accidents are recorded in an accident book. The manager said that staff would in future be undertaking the induction programme run by Buckinghamshire County Council training services. Harrias House Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 2 x x x x 2 Harrias House Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement The improvement in care plans should be maintained and care plans written to meet the short term care needs of residents. Copies of staff members passports and birth certificates must be kept on file. This is an unmet requirement from the December 2004 inspection and a new timescale has been set. Staff must not start work until a 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. All staff must complete an induction programme All staff must have foundation training with annual updates of mandatory topics. This is an unmet requirement of previous reports and a new timescale has been set. A health and safety policy must be agreed and risk assessmnets should be undertaken to ensure safe working practices. This is an unmet requirement of previous reports and a new
Version 1.10 Timescale for action 31.03.06 2. 29 19 31.12.05 3. 29 19 31.12.05 4. 5. 30 30 18 18 31.03.06 31.03.06 6. 38 13 31.01.06 Harrias House Page 22 timescale has been set. 7. 33 24 A system of internal audit of quality of care should be developed and implemented. 31.03.06 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. Refer to Standard 8 Good Practice Recommendations Service users should be weighed regularly and appropriate action taken if there is significant change. Harrias House Version 1.10 Page 23 Commission for Social Care Inspection there is significant changeCambridge House, Smeaton Close 8 Bell Business Park, Aylesbury Buckinghamshire HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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