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Inspection on 24/03/09 for Kingsdowne Residential Home

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

This inspection was carried out on 24th March 2009.

CSCI found this care home to be providing an Excellent service.

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

The home consistently provides an excellent environment that is clean and homely, attractively decorated and well maintained. People who come to live in the home, first have their needs assessed to make sure that the home is suitable for them and they can bring their personal possessions with them. People who fund their care have a contract that shows what services they are paying for. The staff make sure that if someone is unwell, they are referred for treatment promptly and the home has good systems to ensure that medication is stored safely so that residents well being is protected. If anyone has any concerns about their care, these will be taken seriously and acted upon and residents are further safeguarded by staff being trained and aware of what constitutes abuse. There is a stable group of staff who have worked at the home for a long time. This ensures that the staff are familiar with the needs of the people who live in the home and provide a consistent approach, which reassures residents. The manager has been in post for a long time and involves the residents in the way she runs the home.

What has improved since the last inspection?

All residents have a written care plan that accurately reflects their current needs and all the staff have been trained in writing care plans. Staff now ensure that residents take their medication in their presence to prevent mistakes being made which could affect the residents wellbeing and staff have one to one supervisions with their line manager to monitor their performance and to support them in their role as carers.

What the care home could do better:

We have made no requirements for improvement at this inspection.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingsdowne Residential Home 37 Dury Road Hadley Green Barnet Hertfordshire EN5 5PU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: THOMAS McKERVEY     Date: 2 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Kingsdowne Residential Home 37 Dury Road Hadley Green Barnet Hertfordshire EN5 5PU 02084490675 02084408220 jan.higham@kingsdowne.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Kingsdowne Society care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Kingsdowne Residential Home is a registered care home for eighteen older people of either gender. The home is situated in the Hadley Green area of Barnet, within approximately a tenminute 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 car park at the front of the property. There are also very attractive rear and side gardens, which are accessible via a ramp for people who use wheelchairs. There are adequate toilet and bathing facilities in the home. There is a large kitchen and laundry room, and Care Homes for Older People Page 4 of 25 Brief description of the care home the staff room and main office are also situated on the ground floor. A passenger lift makes the first floor accessible. The staff turnover is very low and several staff have worked at the home for a number of years. The manager, Ms Janette Maria Higham, has been in post for many 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. The fees for the service are £539 per week. Following Inspecting for Better Lives, the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection .which took place over a period of five hours and was carried out as part of the Commissions inspection programme to check compliance with the key standards. We received a copy of the homes Annual Quality Assurance Audit, (AQAA), which is a self assessment by the management of the home. This focuses on how well outcomes are being met for people who use the service. It also gives some numerical information about the service. We have referred to the AQAA in various sections in this report. At the time of the inspection, there were sixteen people living in the home and there was one vacancy. At present, a double room is designated as a single. The inspection included a tour of the premises and speaking to the manager. Several Care Homes for Older People Page 6 of 25 individual residents and staff were interviewed about their experiences of living and working in the home. We also spoke to visitors who came to the home during the inspection. We sent out surveys to residents and staff prior to the inspection, six of which were returned by residents. Residents and staff records, and documents pertaining to the running of the home were also examined. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of this service can be confident that their needs will be thoroughly assessed and they can visit the home before deciding to move in. Good information about the service is provided, including what is covered by the fees. Evidence: At the time of this inspection, there was one vacancy. There is one room which can be used for double occupancy, but is usually used as a single room. Six case files were examined at random. They contained preadmission assessments, covering personal care, mobility, communication, psychological and physical needs and hobbies and leisure interests. The admission form also includes details about peoples culture and ethnicity and whether they practise their religion. The assessments indicated that the home was appropriate to meet peoples needs. All areas of the home, including the gardens, are accessible to anyone who has mobility problems. The case files of people who were privately funding their care, had signed contracts that included the terms Care Homes for Older People Page 10 of 25 Evidence: and conditions of the service and the fees charged. A letter is sent ot them each year advising them when the fees go up. Many of the people who were interviewed, said that they had spent time previously in the home on respite care and they liked it so much that they decided to stay. We noted that residents are given a Bill of Rights regarding independence, choice, respect and dignity. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home can be confident that staff make sure that they receive prompt health care treatment and intervention. Medication is stored safely and accounted for, which enables residents wellbeing to be safeguarded. Evidence: Five care plans were examined at random, including those belonging to people who had been admitted within the last two months. All the care plans were clear and easy to follow and included assessments, goals of care and guidelines for staff about how to meet the residents needs. There were written assessments for mobility, nutrition and pressure areas. Care plans had been reviewed by the manager about six weeks after the persons admission to the home. Most of the care plans were reviewed on a monthly basis by key workers and amended if necessary, but in two instances, the plans had not been reviewed in the past two months. We saw records of healthcare appointments by visiting professionals and where residents attended hospital outpatient clinics. There were records in the case files to Care Homes for Older People Page 12 of 25 Evidence: show that residents are registered with a G.P and the district nurse visits regularly to attend to wounds and administer insulin. At the time of this inspection, no-one was in hospital or in poor health and no-one had pressure ulcers. One resident who has a history of falls in the bedroom, has been given a cal alarm to wear round the neck to call for assistance. All residents weights are recorded monthly. We spoke to a district nurse who was attending during the inspection. She said that in her view the care was excellent and the staff knew the residents very well. She also said that staff were very diligent in carrying out any tasks she advised. At the time of the inspection, no residents were self-medicating. We assessed the medication standards and found no discrepancies in the recording of administration of medicines and there was safe storage of medication stock. This included controlled drugs which were stored separately and securely. There was a record of the medication received and any that was returned to the pharmacy. There is a photograph of each resident at the front of the MAR sheet and any allergies are highlighted in the care plan. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident that they are able to choose how they spend their leisure time. Appropriate, stimulating activities are provided and visiting is unrestricted for friends and relatives. The catering is of high quality with a nutritious and varied menu offering a range of choice Evidence: We spoke to several residents individually and in small groups about their lifestyle in the home. They all said how happy they were about the activities provided which they did not feel pressurised to attend. We saw several residents reading books and newspapers in quiet areas of the home, and some were sitting in their rooms watching television or listening to the radio. There is an activities coordinator who leads art and craft groups. A particular activity at this time was supporting residents to plant seeds, which we saw on window sills. There were daily records kept of how residents spend their time. This included attending church services. We spoke to four visitors who told us that they can visit their relatives at any time and can see residents privately in their rooms if they prefer. They all said the home was Care Homes for Older People Page 14 of 25 Evidence: excellent and they were satisfied that their relatives were safe and well cared for. Two relatives described the home as a happy place. The AQAA states that residents are asked to choose the colour scheme in their bedrooms. The maintenance person told us that they had recently repainted a bedroom because the resident did not like the original colour scheme. The dining room is quite spacious and provides an attractive area to enjoy meals. The menus showed a good variety of wholesome food and special diets were catered for. We observed the cook going round and asking residents what they would like to eat that day. Residents told us in our surveys, that alternatives to the menu were always available on request. They also said they could have hot or cold drinks and snacks at any time. Records are kept of the temperatures of the fridges and freezers and of the food actually eaten by the residents. We joined a group of residents for lunch. The meal consisted of meat and two vegetables and gravy and there was a choice of ice cream or sponge and custard for dessert, all of which tasted very good. The meal was also hot and well presented. Two residents were observed being supported to eat by staff. The staff sat beside the person and engaged them in conversation during the meal, which was unhurried. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that any concerns will be taken seriously and that the staff are trained in, and are aware of how to protect people from abuse. Evidence: The residents that we spoke to, said they were very satisfied with their care, and had no concerns or complaints. They said they were confident that complaints would be addressed promptly. The complaints procedure is displayed on the notice board in the dining room, and includes contact details for the Commission, should anyone wish to raise concerns directly. As part of the inspection process, we sent questionnaires to residents, eight of which were returned, some with comments which were very positive about their experience of living in the home. The comments were very complimentary about the manager and the staff. There were no complaints recorded since the last inspection and the manager told us there were none outstanding. The manager and deputy are accredited as trainers in adult protection and the prevention of abuse. Staff records showed that they had attended this training. The staff who were spoken to, were very knowledgeable about their responsibilities regarding reporting suspected abuse. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they live in a comfortable, safe and well maintained home and they can bring their personal possessions with them when they move in. Evidence: A tour of the home, including several bedrooms was carried out. The overall appearance of the home is very attractive and the grounds are well maintained. All areas of the home are easily accessible, including the gardens, where a ramp is provided for wheelchair users. Grab rails are well positioned in toilets and bathrooms for people with problems with mobility, and there are several hoists available. There is a handyperson employed for maintenance and minor repairs, and a gardener comes once a week. There are several spacious areas, including a conservatory, for residents to sit in comfortable armchairs, as well as private areas for them to receive visitors in private. The residents can summon help with call alarms that they can wear around the neck. I saw records of weekly fire alarm tests and regular fire drills. The service records of hoists and the lift were available for inspection. The communal lounges and dining areas are pleasant and bright with comfortable domestic-style furniture. The dining tables had tablecloths and flowers which made the room look very attractive. There is a well equipped kitchen and laundry. There is a passenger lift to the upstairs bedrooms, which are tastefully decorated and there were plenty of personal Care Homes for Older People Page 17 of 25 Evidence: possessions and family photographs on display in the rooms. There is a dedicated team of cleaners who keep the home very clean and tidy. The home smelled fresh and pleasant at the time of the inspection. Staff have been trained in infection control and alcohol gel, disposable gloves and aprons for carrying out personal care, are provided to prevent infection. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident that sufficient numbers of staff are available to meet their needs and their welfare and best interests are safeguarded by thorough recruitment procedures. Evidence: The duty rota gave an accurate record of the staff actually on duty during the inspection. The normal staffing levels are; four care staff on the early shift and three on the afternoon/evening. There are two staff on waking duty at night. At the time of the inspection there were only three staff on the morning shift as there were only thirteen residents. The staff to whom I spoke, said they were satisfied with the level of staffing available. The residents also confirmed that there were always sufficient staff available to meet their needs and they responded promptly when called to assist. The staff includes a deputy manager, three senior carers and thirteen care staff. The home also employs a maintenance person, an administrator, and cleaning and cooking staff. The team has been together for a considerable time, and at the time of the inspection, three staff were on maternity leave. The manager informed us that regular staff cover these absences but agency staff are used to cover occasionally. Two new care staff had started since the last inspection. Their records were examined and we were satisfied that proper recruitment procedures had been followed including Criminal Care Homes for Older People Page 19 of 25 Evidence: Records Bureau checks and references. The staff we spoke to, demonstrated a sound knowledge of the residents and their role as carers. They had an obvious commitment to providing a good quality of care. The staff records showed that they had undertaken a lot of training, including mandatory health and safety subjects. Two people, including the manager, hold a certificate in dementia care from Barnet College. According to the AQAA, thirteen care staff have attained National Vocational Qualifications at level 2 or above, which meets the required standard of at least 50 of staff having this qualification. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be confident that the home is well managed by an experienced and skilled manager, who provides clear leadership for the staff sensitively and efficiently. People who live in the home can also be confident that the installations and equipment in the home are regularly serviced to ensure their health and safety. Evidence: The AQAA was discussed with the manager to clarify some of the content. The AQAA provided good information about the residents and staff and what steps were taken to improve the service where necessary. The registered manager has been running the home for fourteen years. She holds a City and Guilds Advanced Management in Care qualification. The manager and her deputy, hold a certificate in dementia care, awarded by Barnet College. The manager is responsible to a board of trustees who carry out monthly monitoring visits in the home. The reports of their findings were Care Homes for Older People Page 21 of 25 Evidence: available for inspection at this visit. The Trustees also hold six weekly meetings to discuss the progress of the service. The manager is highly regarded by the residents and visitors who were spoken to and was confirmed in the surveys we received. Staff said that the manager was very supportive and approachable in her dealings with them and sets high standards for the care of the residents. The manager sent her annual AQAA to the Commission within the required timescale. This document, along with completed questionnaires from residents, was used as part of the inspection process. Meetings are held regularly with staff and residents to discuss the running of the home, at which people are able to air their views. This was confirmed by the residents and the staff I spoke to. The home has a good record of responding to and complying with, any requirements and recommendations that were made at previous inspections. In discussion with the staff, and looking at their records, it was evident that they have regular supervision sessions with their line managers, which staff said thy valued as an opportunity to discuss their work and identify training needs. All records that were examined were well structured and easy to follow. This included how any money held on behalf of residents was managed and accounted for. Relatives who were spoken to, confirmed they were happy with how they were invoiced for expenses incurred by residents for hairdressing and other purchases. According to the AQAA, all policies and procedures have been reviewed and updated as necessary within the last two years. A fire risk assessment of the premises has been carried out recently. The home provided evidence of seeking quotes to adapt or replace some fire doors which do not meet required standards. There were current service records available for fire alarms, electric, water and gas installations and a current employers liability certificate was on display. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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