Inspection on 26/07/06 for Harrison House

This inspection was carried out on 26th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Harrison House 21/08/07

Harrison House 07/03/07

Harrison House 16/12/05

Harrison House 24/08/05

Harrison House 10/12/04

Harrison House 01/07/04

Harrison House 12/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Harrison House Liverpool Road South Maghull Liverpool Merseyside L31 8BS Lead Inspector Mrs Trish Thomas Unannounced Inspection 10:00 24th and 26th July 2006 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 Harrison House DS0000005407.V295378.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. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harrison House Address Liverpool Road South Maghull Liverpool Merseyside L31 8BS 0151 526 0564 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) suep@parkhaven.org.uk Parkhaven Trust Mrs Claire Louise Burgess Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 24 OP. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 16/12/05 Date of last inspection Brief Description of the Service: Harrison House is a care home for 24 Older People. The home is situated on the Parkhaven estate and is surrounded by extensive and well-maintained gardens. Harrison House is owned by Parkhaven Trust and the registered manager is Mrs. Claire Burgess. The home block contracts six placements for respite beds with Sefton Social Services. In addition there are eighteen places in Harrison House for long-term residency. The home provides twenty-four hour care and social support, single accommodation, full board and a laundry service. The home is situated in a residential area, close to bus routes and with shops and restaurants in the general area. All permanent residents are registered with a G.P., (and those receiving respite care have temporary access to a G.P.). There are arrangements for referrals to be made to district nurses and paramedical services in accordance with need. There are three ground floor bedrooms with a passenger lift to upper floors, where the remainder of bedrooms are situated. Those who are admitted to the home on a permanent basis are encouraged to bring possessions with them to personalise their bedrooms. The home is furnished in a comfortable style and is maintained to good standards of hygiene. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two visits on 24th and 26th July 2006. The methods used during the inspection were, discussion with residents and staff, reading records compiled in the home, and touring the premises. The outcomes of the review of a recent complaint are included in the report. The registered manager Claire Burgess, senior Barbara Corker and maintenance manager Peter Bridgewater also provided information, which was requested, during the two visits. What the service does well: What has improved since the last inspection? What they could do better: Two requirements from the last inspection had not been met. These are repeated in this report with extended time limits given. The requirements relate to accident reporting and providing meals, which are to residents’ satisfaction. There are varying levels of satisfaction regarding the two services on offer. Care plans for permanent residents were comprehensive, had been regularly updated and the residents had no complaints about the support provided. In reviewing a complaint about the respite service, a care plan was read and was Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 6 found to lack detail and relevance to the resident’s assessment and ongoing needs. There was also a delay in contacting a G.P. when the resident’s condition (according to the home’s records) deteriorated. To ensure that respite residents’ health and personal care needs are met, care plans must be regularly updated regarding any improvement or deterioration in condition. Referrals to the respite service have resulted in admissions of residents whose needs are not within the registered category of the home. Staff said that two residents of the respite service had been transferred to a home, which provides a dementia service. They were said to be at risk in Harrison House, (due to the open staircase, staffing levels and lack of the knowledge and skills necessary to support people who have dementia). To ensure that residents are not placed at risk, the home must only admit those whose needs are within the registered category. Residents had some reservations about the activities on offer. One lady said few activities were arranged, another said she would like to go out more. Two residents said they were happy to remain in their bedrooms to read or listen to music. To meet the needs of all residents, activities must be provided which provide entertainment and stimulation for all levels of capacity, ability and preference. The home has been negligent in fire safety procedure. The fire exit from the main lounge was obstructed by building work. The home did contact the fire safety officer for authorisation of an alternative means of escape until the risks had been identified in the CSCI visit of 24th July 06. The fire roll call list was out of date, as one resident whose name was included on the list, was in hospital. Under the Care Home Regulations 2001, (Regulation 24), the home has a duty to protect residents from risk of fire by taking adequate precautions against the risk of fire including those, “ for evacuation in case of fire of all persons in the care home and safe placement of service users.” 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. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 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 the following standard(s): 3,4 The quality of this outcome was poor. This judgement has been made using available evidence, including a visit to the service. Residents have their needs assessed by social workers, prior to admission. The home does not always provide sufficient evidence, in their own initial assessments and care plans, that respite residents’ needs, will be met within the available service, facilities and skills. EVIDENCE: Harrison House is registered for 24 residents providing six respite beds for short-term placements, and eighteen places, which are a permanent home to those residents. The respite service, which is contracted with the Social Services Department, results in regular admissions and discharges to and from Harrison House. There is evidence that the home has accepted at least one resident for respite care, whose needs are not within the registered category of the home without having applied for a variation to the category and satisfying the Commission for Social Care Inspection, that the residents’ needs will be met. Some of the residents placed permanently, who have lived in the home for a number of years, have become more physically and mentally frail and the Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 9 home must demonstrate through continuous assessment, care planning, training and provision of equipment, that those residents’ ongoing, nonnursing needs are being met. Since the last inspection a number of staff have received basic training to support the mental health needs of some of the residents who live permanently in Harrison House. There are aspects of the building, which could present health & safety hazards to residents who are confused and not aware of risk. The home has a passenger lift and there is also an open staircase from the ground floor corridor to the upper floors where the majority of bedrooms are situated. The staircase would pose risks to residents who are confused due to its ease of access and lack of protection above banister level. The building therefore would not meet those residents’ needs regarding freedom of movement and safety. Those who live permanently in Harrison House, currently enjoy freedom of movement throughout the building and to the gardens, which are not secure having open access to the main road close by. Building construction in progress directly outside the lounge exterior doors, poses risks of trips and falls to residents who may attempt to leave by way of this exit, (which is also a means of escape in case of fire). Fire risks relating to this exit whilst building work is in progress are referred to elsewhere in this report. Evidence for this outcome was obtained through reading the initial assessments for residents referred for respite care, and for others who have been discharged, reading the care plan of one respite resident and by touring the premises. Current staffing levels in the home are adequate to resident numbers and the registered category, but there would be insufficient staff to meet the support needs of those requiring constant supervision, or for those requiring support for high mobility needs. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 The quality of this outcome was poor. This judgement has been made using available evidence, including a visit to the service. The effectiveness and quality of care plans is variable. Care plans for permanent residents are generally satisfactory. Shortfalls are apparent in the care planning process for residents of the respite service, and written communication methods lack detail. Access to medical treatment for residents has not been timely in all instances. EVIDENCE: The care plans of two permanent residents and a respite resident were read. Care plans for permanent residents, had been signed by the residents/representatives, and there were monthly review records. The outcomes of reviews had been addressed in action plans. There were records of G.P. and paramedical referrals. Risk assessments had been carried out with regards to moving and handling, risks of falls, managing medication and personal finance management. In a respite resident’s care plan, a number of shortfalls were evident. The initial assessment for the resident refers to diagnosed depression. There was no care plan or risk assessment to address the resident’s mental health needs other than to encourage the resident to Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 11 socialize and make eye contact. The care plan in place concentrated on the person’s personal care and mobility. This care plan had not been reviewed in response to a documented deterioration in the resident’s mental and physical condition during her stay, there was a delay in contacting the G.P., and records compiled by staff relating to this resident, lacked detail. All permanent residents are registered with local G.P.s and there is also temporary access to G.P.s for residents of the respite service. There were records of health care interventions on residents’ care plans. Other than as previously referred to, residents appeared to be receiving medical care as needed. The home has a procedure for managing residents’ prescribed medication and those assessed as fit to self-medicate are accommodated through provision of locked facilities. A member of staff who administers medication said she has attended a college course and holds a certificate in the “safe handling of medicines.” Medication is held in a locked trolley and the keys are held secure when not in use. Medication administration records were satisfactorily maintained other than when these had been handwritten. In instances where prescribed drugs are not pre-printed on the pharmacy MAR sheet, the writer should have a colleague check and sign the drug, time, dose and name of the resident for whom the medication is prescribed, to avoid error and risks to residents. Residents spoken with said that staff are respectful and they had no concerns regarding their privacy. Written comments from residents’ families say, “Thank you for all the care and attention,” “Kindness and patience is much appreciated.” Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 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 the following standard(s): 12,13,15. The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. The home is comfortable, has a pleasant and friendly atmosphere and visitors are made welcome. Further work will be necessary towards providing leisure and social activities for residents, which meet their expectations, preferences and capacities. EVIDENCE: A resident who commented on activities available in the home said, “I miss the day centre. I can’t concentrate here and don’t go out. I would like to go out.” Further comments include, “I miss having someone to go shopping for me.” “We just sit and watch television until it’s time for tea. The hairdresser comes once a week and sometimes there is bingo on a Saturday.” A resident was spoken with in her bedroom, she said, “I do as I please, I prefer my own company and like to do my own thing.” A resident who was sitting outside reading said. “I love reading and listening to music. My room is very comfortable and I spend a lot of my time there. I have all I need, I just do as I like. When my visitors come, we can talk in my room. There is no interference. The girls (staff) are there if I need them.” An activities coordinator is employed by Parkhaven Trust, who visits Harrison House twice a Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 13 week to supervise in-house social activities. Residents’ social and leisure preferences are recorded in their care plans, which also include activities diaries. In the care files, which were read, these documents had not been completed so it was not possible to fully assess the level of social stimulation on offer for individual residents. Two residents said there had been pizza for lunch and the crust was very hard and difficult to chew. Another resident said about the pizza, “I have never eaten such a thing, and I didn’t ask for it.” These comments were passed on to the cook. Others said the food was good and had no complaints. One resident said sometimes food was not to her satisfaction, but there had been some improvement recently. The menus were read and these provide a range of variety and choice for residents. There were no detailed records of the diets of diabetics and these should be recorded for each individual. Residents said, “We are served drinks throughout the day, and at night if you ask for one.” A resident was visited in her room and there was a cold drink beside her bed. She said the call bell cord is beside her and she can ask for a hot or cold drink whenever she wants one. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 14 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): 16,18 The quality of this outcome was good. This judgement has been made using available evidence, including a visit to the service. The home has a satisfactory complaints procedure, which is available to residents and their representatives, and there are procedures in place to protect residents from abuse. EVIDENCE: There has been a recent complaint against Harrison House, which was investigated by the registered providers, Parkhaven Trust. The investigation had been completed within agreed time limits and witness statements were provided to support the findings. Parkhaven Trust did not uphold the complaint, but identified shortfalls in record keeping in the home and have taken steps to improve this aspect of the service. A review of the complaint investigation was carried out by the Commission for Social Care Inspection and a visit to the service followed. As an outcome, a number of requirements are made in this report with regards to pre-admission assessments, care plans and reviews, meeting needs and record keeping. Reference was made to the home’s procedures manual and discussion took place with staff. The home has a procedure for protection of vulnerable adults and “whistle blowing” and staff have received related training. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 15 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): 19,26 The quality of this outcome was adequate. This judgement has been made using available evidence, including a visit to the service. The building is wellmaintained, comfortable and clean. There were risks to residents’ safety as a result of building work (construction of a conservatory) outside lounge exit. EVIDENCE: Harrison House is very homely and has a pleasant and relaxed atmosphere. Furnishings are domestic in style and residents’ bedrooms are highly personalised. There are pleasant views of the grounds from all aspects of the building. An improvement to facilities has been a recent single storey extension at the front of the building, which provides two extra toilets on the ground floor. A conservatory is being constructed at the rear, off the main lounge. The building work is taking place outside the lounge exit which gives access to the garden. This is also a fire exit. The builders had placed a plank, from the threshold to ground level outside, presumably to be used as a ramp by residents. The plank was not as wide as the exit and there was a drop of about eighteen inches on either side of it. The area where residents were Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 16 expected to congregate, in case of fire, was covered in rubble, and directly at the end of the ramp (plank) stood a stack of breeze- blocks to waist height, which would hamper the means of escape. Following discussions with the maintenance manager, a return visit was made to Harrison House on 26th July 06. The hazards referred to had been removed by the builders, and the doors had been locked to prevent residents using the exit until such time as building work is completed. A tour of the building was carried out and discussion took place with staff on duty. The home employs domestic staff and the building was clean and well organised. Cleaning materials were locked away when not in use. The home has COSHH and infection control procedures and staff receive relevant training. The tumble dryer was not in working order, as the door had fallen off. There had been a prolonged period of fine weather, and staff said that the laundry was drying without any problem. Staff said the dryer had been “reported”. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 17 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): Not assessed EVIDENCE: Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 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 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): 38 The quality of this outcome was poor. This judgement has been made using available evidence, including a visit to the service. The safety of residents was at risk, due to the fire escape from the lounge being obstructed. EVIDENCE: Following risks being identified, posed by building work in progress, the Fire Safety Officer visited on 24th July 06. On 26th July 06 a second CSCI visit was carried out to check that the fire officer’s recommendations had been implemented. Peter Bridgewater, maintenance manager, Parkhaven Trust, confirmed the following. The fire officer gave permission for the lounge exit to be out of commission and locked, to prevent residents from using it, until completion of the conservatory. The alternative means of escape authorised by the fire officer were, (i) from the front entrance and (ii) from the dining room external doorway. The manager, Claire Burgess, said that residents and staff had been informed of the temporary change in fire safety procedures. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 19 The fire roll call list was out of date. The name of resident who was in hospital, had not been removed from the list. This would provide incorrect information to fire officers, regarding resident numbers, in case of fire. Health & Safety maintenance certificates were read and were satisfactory. An incident referred to in a daily report was cross checked with accident records and no accident report could be found. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 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. 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 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 21 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 OP3 Regulation 14 (1) (d) Requirement Timescale for action 10/08/06 2. OP4 3. OP7 4. OP7 5. OP8 6. OP19 The registered person must ensure that a full assessment of residents’ needs is carried out in relation to the service available in the home, to ensure that the home has the services, facilities and training to meet those needs. 14 (1) (2) The registered person must admit residents whose needs are within the registered category of the home. 15(1) (2) The registered person must ensure that a care plan is formulated to meet the assessed needs of all residents and that the care plan is regularly reviewed. 17(1) The registered person must ensure that accurate records are maintained of the residents’ treatment/interventions (in accordance with Schedule 3). 13(1)(b) The registered person must ensure that residents receive necessary treatment from healthcare professionals without delay. 13(4)(a-c) The registered person must DS0000005407.V295378.R01.S.doc 10/08/06 10/08/06 10/08/06 10/08/06 25/08/06 Page 22 Harrison House Version 5.2 7. 8. OP19 OP38 23 (2) (c) 23 (4) (b) 9. OP38 23 (c) (iii) 10. OP15 16 ensure that risks to residents’ safety in the home and grounds are eliminated. The registered person must arrange for the tumble dryer to be repaired/replaced. The registered person must ensure that fire escapes in the home are free of obstructions and hazards. The registered person must arrange for the fire roll call list to be updated with regards to all admissions and discharges. The manager must consult with residents (including respite residents) as to their dietary preferences (including special diets) and make arrangements for meals to be provided accordingly. (Outstanding from last inspection, extended time limit given). The manager must instruct staff as to the information required in accident reports and monitor all such reports regarding the content. (Outstanding from the last inspection, extended time limit given). 28/08/06 28/08/06 28/08/06 28/08/06 3. OP38 17.Sch3 j 28/08/06 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 OP9 Good Practice Recommendations The registered person should ensure that handwritten MAR sheets are checked and signed by a second member of DS0000005407.V295378.R01.S.doc Version 5.2 Page 23 Harrison House 2. OP15 staff. The registered person should arrange for records of diabetic diets to be maintained for each individual who has diabetes. Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Harrison House DS0000005407.V295378.R01.S.doc Version 5.2 Page 25 - 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!