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Inspection on 02/08/05 for Kingsdowne Residential Home

Also see our care home review for Kingsdowne Residential Home for more information

This inspection was carried out on 2nd August 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents and relatives stated that the home provides a very good quality of care; for example one resident said, "I think it would be difficult to find a home where there was better treatment". A relative stated, "The quality of care is very good and there is always a welcoming attitude." The food provided is nutritious and nicely presented, and residents have plenty of choice.

What has improved since the last inspection?

New furniture has been purchased throughout the home and the lounge has been redecorated. A new awning had been installed in the patio. One bedroom and the staff room have also been redecorated. The residents and visitors were very complimentary about the appearance of the home.

What the care home could do better:

The manager must monitor the incidence of falls in the home to see if any lessons can be learnt and take steps to reduce these. Better recording of administration of medicines is necessary. The following maintenance issues must be addressed; the fly screen in the kitchen must be kept clean and the window frames repainted; the conservatory roof must be repaired. In relation to staff recruitment, it is not acceptable for CRB clearance from only previous employers to be used for new staff. New CRB`s have to be obtained before staff can start work at the home. In addition to the above, the manager must make sure that the care provided at night time to residents is of at least as good quality as that provided during the daytime. The portable electrical appliances in the home have to be tested. Any fire doors that are to be kept open, must be fitted with an appropriate device that ensures that the door closes in the event of the fire alarm being activated, and the water supply must be tested to exclude the presence of legionella bacteria.

CARE HOMES FOR OLDER PEOPLE Kingsdowne Residential Home 37 Dury Road Hadley Green, Barnet Hertfordshire EN5 5PU Lead Inspector Tom McKervey Unannounced 2 August 2005 @ 09.30 am 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. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kingsdowne Residential Home Address 37 Dury Road, Hadley Green, Barnet, Hertfordshire EN5 5PU 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) 020 8449 0675 020 8440 8220 John Nicholls for The Kingsdowne Society Janette Higham PC Care Home only 18 Beds Category(ies) of OP Old Age registration, with number of places Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16 February 2005 Brief Description of the Service: Kingsdowne Residential Home is a registered care home for eighteen older people of either gender. The home is situated in the Hadley Green area within approximately ten-minute walk to shops and other amenities in Barnet High Street. The accommodation comprises of sixteen single bedrooms and one double bedroom. The home has large dining and lounge areas and a conservatory. There are extensive grounds, with a front paved garden, used as a car park for staff and visitors. There are also very attractive back and side gardens, accessible via a ramp for wheelchair users. There are adequate toilet and bath facilities on the ground and first floor. The laundry room and the office are also on the ground floor. All indoor communal areas are accessible to service users. Besides wide stairs with rails, a lift is provided for accessing the first floor. The staff turnover is very low with some working at the home for a number of years, and the manager, Ms Janette Maria Higham, has been in post for over eleven years. The aim of the home is “to meet residents’ expectations and achieve the greatest quality of life that is possible, whilst encouraging residents to maintain their independence”. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed in seven hours, forty-five minutes. The registered manager was present during the inspection, and fully assisted with the process. The inspection included a tour of the premises, speaking to four individual residents, three visitors and several staff. Service users’ case files and documents pertaining to the running of the home were also examined. Prior to the inspection, nine comment cards were sent to the inspector from service users, twelve from relatives, and nine from professionals connected to the home. What the service does well: What has improved since the last inspection? New furniture has been purchased throughout the home and the lounge has been redecorated. A new awning had been installed in the patio. One bedroom and the staff room have also been redecorated. The residents and visitors were very complimentary about the appearance of the home. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 6 What they could do better: 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. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 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 Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 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) 2, 3, 4 & 5. Standard 6 does not apply. There is good information and trial visits available to enable service users and their representatives to make decisions about the suitability of the home to meet their needs. EVIDENCE: Four case files of the most recently admitted residents were sampled. They contained signed contracts of the terms and conditions of the service, including the fees charged. The case files contained thorough assessments by social workers where appropriate, and by the manager of the home. There was evidence that the care was reviewed annually by care managers. The inspector spoke to four residents and three relatives who confirmed that they were able to visit the home prior to admission. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 9 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 & 10 Service users’ assessed needs are identified in good care plans, which support staff to meet their needs appropriately. The staff provide very good care, in a manner which meets the expectations and wishes of the residents. There is a need for more accuracy when recording the administration of medicines, and the incidence of falls in the home needs to be monitored to ensure that the health and welfare of residents is protected. EVIDENCE: Four care plans were examined. These included assessments, goals of care and action guidelines for staff to meet service users’ needs. There were also appropriate risk assessments recorded. The plans were reviewed on a monthly basis. There were records of visits by health professionals, including the G.P, chiropodists, dentists and district nurses. Residents’ weights are recorded monthly. There were two residents with pressure sores, but the district nurse who was in attendance, informed the inspector that these were well on the way to recovery. Although there was good recording of falls and risk assessments were in place about this, there was no monitoring of this important issue to detect any patterns, so that falls could be minimised. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 10 The medication standard was examined. There was a record of one resident administering their own insulin, prepared by the district nurse. Controlled drugs were securely stored and accounted for. There was a medication profile for each resident. There was a mistake noted in the record of administration of medicines, and a requirement is made to address this. It is also recommended to write the date of opening on liquid medication. Residents who were spoken to, stated that they were generally well cared for and that staff addressed them by their preferred method and supported them with personal care discreetly and with dignity. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 11 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) 12, 13,14 & 15 Service users’ experiences in the home match their expectations through a range of social and religious interests and needs. They are provided with wholesome food in a pleasant environment. However, spot checks need to be made at night time, to ensure that all residents are able to go to bed at the time of their choosing, and that their personal care is attended to appropriately. EVIDENCE: The inspector noted that more leisure activities were now being provided, including keep fit, and an entertainer visits the home once a month. The residents who were spoken to, stated that they were free to join in the activities or not, as they chose. There was evidence in the residents’ records that they were supported to attend religious services. The visitors’ book showed that residents received frequent visits from friends and relatives, three of whom the inspector spoke to. They stated that there was open visiting and they were always made welcome. The majority of the residents who were spoken to, stated that they had a wide range of choice about their lives in the home, including the time of rising and going to bed and about meals. However, a concern was expressed to the inspector that at night time, some residents might be coerced into going to bed Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 12 earlier than they wished, and that their personal care might not be attended to as diligently as during the day time. A requirement is made for the manager to carry out spot checks in regard to this issue. The inspector was invited to join a group of residents for lunch, which is the main meal of the day. The meal was well cooked and attractively presented. The dining room provided a pleasant and comfortable environment. The menus indicated a good variety of wholesome food, including fresh fruit. Special diets were also catered for. Service users stated that they could have hot or cold drinks and snacks on request at any time. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 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 & 18 Service users are confident that their concerns are addressed appropriately and there are good systems in place to ensure they are protected from abuse. EVIDENCE: A copy of the home’s complaints procedure was pinned to the residents’ notice board. There were no complaints recorded in the log for the past twelve months. Residents and relatives spoken to, stated that they were very satisfied with the service, but they were confident that any complaints would be dealt with appropriately. A copy of the placing authority’s policy and procedure of protecting vulnerable people from abuse was available. The home’s own policies and procedures are satisfactory. During discussion with the inspector, it was evident that staff were aware of abuse issues and that training in this subject was provided. However, note the judgement and requirement made in relation to Standard 14 above. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 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, 20, 23, 24 & 26. Residents live in a generally well-maintained, clean and comfortable environment. EVIDENCE: A tour of the premises was carried out. The building has an attractive appearance with cultivated gardens, plants and flower tubs. The building was generally well maintained, however, there were two broken panes of glass on the conservatory roof. In the kitchen, the fly screen was dirty and the window frames needed to be repainted or replaced. A requirement is made regarding these issues. All the bedrooms were visited. They were very attractive and comfortably furnished. Service users stated that they were very appreciative of the accommodation provided. There was evidence of personal items in the bedrooms. The standard of cleanliness was very good and there were no offensive odours at the time of the inspection. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 15 Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 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 There are sufficient numbers of competent staff available to meet service users’ needs. However, service users are potentially at risk because some staff do not have current CRB clearance. EVIDENCE: The staff rotas showed that there is normally four care staff on the early shift and three on the afternoon/evening. There are two staff at night time. The home also employs a maintenance person, an administrator, and cleaning and cooking staff. Service users and relatives stated that there were sufficient staff available to meet residents’ needs. Eight staff have achieved a care qualification equivalent to NVQ level 2. Staff records showed that staff were generally properly recruited, with references and Criminal Records Bureau, (CRB) checks obtained. However, there were instances were new CRB checks had not been carried out for staff who had CRB clearance from previous employers. A requirement is made regarding this issue. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 17 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, 36, 37 & 38 The home is being managed properly and there is good leadership and guidance given to staff to support them in meeting residents’ needs. However, some health and safety issues need to be addressed to protect residents, staff and visitors to the home. EVIDENCE: The manager holds a City and Guilds Advanced Management for care qualification and has been running the home for over eleven years. The manager is responsible to a board of trustees and is supported by an administrator who deals with day-to-day correspondence and bookkeeping. All the required policies, procedures and documents were available for inspection. The residents, staff and visitors spoken to were complimentary about the manager. It was evident from observations that the manager and the whole staff group work as a team, and there was a relaxed atmosphere in the home. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 18 The inspector saw an audit of the service, which included the views of the residents, which had been carried out in the past year. There was a high level of satisfaction expressed. There was evidence from discussion with the staff and an examination of records, that the staff have received regular supervision. Health and safety training has been provided for staff at induction. Records showed that fire training had been provided and drills carried out. Fire alarms were tested weekly and equipment had been serviced. It was noted that two fire doors that link the dining rooms were wedged open. A requirement is made to comply with fire regulations. There were certificates of safety for gas and electrical installations, which were in order and the temperatures of fridges and freezers were monitored daily. The water supply had not been tested to exclude legionella and portable electrical appliances had not been tested in the last year. A requirement is made regarding these issues. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 x COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 20 No 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 8 Regulation 13(2) Requirement Timescale for action 30/9/05 2. 9 13(2) 3. 14 12(3) & (4) The registered person must monitor the incidence of falls in the home and implement systems to reduce these. The registered person must 30/9/05 ensure that the records of administration of medicines are accurate. This requirement is restated from the last inspection.Previous timescale of 31/3/05 not met. The registered person must carry 30/9/05 out spot checks at night time to ensure that all residents are able to go to bed at the time of their choosing, and their personal care is attended to appropriately. The registered person must ensure that the fly screen in the kitchen is cleaned. The registered person must ensure that the window frames in the kitchen are repainted or replaced. The registered person must replace the broken glass in the roof of the conservatory. The registered person must ensure that all staff have current CRB checks before starting 30/9/05 4. 5. 19 19 23(2)(d) 23(2)(b) 31/12/05 6. 7. 19 29 23(2)(b) 9,17,19 Sch 4 30/10/05 30/9/05 Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 21 employment at the home. 8. 38 13(4)(c) The registered person must 30/10/05 ensure that the water supply is tested to exclude legionella and portable electrical appliances are tested The registered person must 30/10/05 ensure that all fire doors that are to be kept open, are fitted with a suitable device that will be activated in the event of a fire. 9. 38 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 9 Good Practice Recommendations The registered person should record the date of opening on liquid medication. Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 22 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 Kingsdowne Residential Home 20050802 Kingsdowne X00015 UN Stage 4 S10459 V240472 G59.doc Version 1.40 Page 23 - 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. 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