Inspection on 04/01/06 for Kingsdowne Residential Home

This inspection was carried out on 4th January 2006.

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.

Other inspections for this house

Kingsdowne Residential Home 24/03/09

Kingsdowne Residential Home 15/04/08

Kingsdowne Residential Home 25/04/06

Kingsdowne Residential Home 02/08/05

Kingsdowne Residential Home 16/02/05

Kingsdowne Residential Home 23/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kingsdowne Residential Home 37 Dury Road Hadley Green Barnet Hertfordshire EN5 5PU Lead Inspector Tom McKervey Unannounced Inspection 4th January 2006 10:00 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 Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kingsdowne Residential Home Address 37 Dury Road Hadley Green Barnet Hertfordshire EN5 5PU 020 8449 0675 020 8440 8220 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) The Kingsdowne Society Mrs Janette Maria Higham Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 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 a 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 stairways with rails, a lift is provided for accessing the first floor. 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 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 DS0000010459.V269758.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed in four hours, forty-five minutes. The registered manager was present for the majority of the inspection, and fully assisted with the process. Because the manager had to leave to attend the funeral of a service user, feedback about the findings of the inspection was given later by telephone. The inspection included a tour of the premises, speaking to eight individual residents, two visitors and several staff. The district nurse and the music and movement therapist who were visiting the home, were also spoken to. Residents’ case files and documents pertaining to the running of the home were also examined. What the service does well: What has improved since the last inspection? There have been improvements in the recording of medication and residents have more choice about when to go to bed. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 6 New windows have been installed in the kitchen, and a bedroom has been redecorated. Criminal Records Bureau clearances have been obtained for new staff. The water system and portable electrical appliances have been tested and appropriate devices have been fitted to ensure that fire doors close automatically when the fire alarm is activated. 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 DS0000010459.V269758.R01.S.doc Version 5.0 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 Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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): 2, 3, 4 & 5. Standard 6 does not apply Prospective service users and their representatives are able to have trial visits to assess the suitability of the home to meet their needs, and no one is admitted without a needs assessment being carried out. Contracts of the terms and conditions of the service must be provided for all residents, including those on respite care, to ensure their rights are safeguarded. EVIDENCE: Since the last inspection, two service users had been admitted for respite care. Both residents were self-funding. However, no contracts had been provided, which should detail the terms and conditions of the service to be provided. The manager stated that contracts are not normally provided for users of respite care. A requirement is made to address this. One of the new residents and their relative were spoken to. They were very happy with the service in general, although there was an issue regarding the telephone, which is addressed later in this report. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 9 The service user said that they had visited the home prior to moving in. During the inspection, a relative of a prospective service user was being shown round the home. The case files of the new residents showed that they had been assessed by the manager prior to admission. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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 residents are treated with dignity and respect. However, they need to be consulted about how often they would like to have baths, and professional advice should be obtained about reducing the incidence of falls in the home. Some medication issues need to be addressed. 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. However, the care plans were not being reviewed on a monthly basis. A requirement is made regarding this. There is clear record in each file of visits by health professionals, including the G.P, chiropodists, dentists and district nurses. The district nurse was interviewed during the inspection process. She was very complimentary about the staff in their caring roles. The bath book indicated that full baths were only provided once a week, and this was confirmed in discussions with some residents, who expressed a wish Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 11 to have baths more frequently. This is a reasonable request and a requirement is made about this. There were no residents with pressure sores at the time of the inspection. Following the last inspection, the incidence of falls was monitored, but not in a manner where patterns were clearly identified. There was a record of one or two residents having frequent falls. The manager said that the G.P had been informed with a view to refer this matter to the “Falls Clinic” for advice, but this had not happened as yet. A requirement is made about this matter. The medication standard was inspected. The controlled drugs stock tallied with the register and the administration of medicines records were in order. However, staff signatures on the MAR sheets were not very recognisable and a requirement is made to address this. A requirement is also made that the medication procedure must state that medication must be retained for seven days after the death of a resident. Previous requirements at the last inspection about medication had been complied with. Residents who were spoken to, stated that they were generally well cared for and that staff addressed them appropriately and supported them with personal care discreetly and with dignity. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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 Residents expressed satisfaction about the range of activities available. The majority are also happy with the meals provided. However, specialist advice should be sought on behalf of residents who do not eat full meals, and mealtimes need to be more flexible to comply with individual residents’ wishes. EVIDENCE: During the inspection, a music and movement session was taking place, attended by a group of residents. An entertainer also visits the home once a month, and a clothes sale is held each quarter. The residents who were spoken to, stated that they were free to join in the activities or not, as they chose. Several residents were observed reading newspapers and doing crosswords. One resident was out for a walk. There was evidence in the residents’ records that they were supported to attend religious services. The menus showed a good variety of wholesome food and fresh fruit was available. Special diets were also catered for, and the residents said that they could have hot or cold drinks and snacks on request at any time. The record of food actually eaten by the residents was not up to date, and the inspector was concerned that two residents appeared to only eat sandwiches, almost exclusively. The manager said that staff try to persuade these residents to eat full meals but they usually decline. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 13 In discussion with one of these residents it emerged that they had been used to eating their main meal in the evening, rather than lunchtime, when they didn’t feel hungry. The manager is required to arrange mealtimes to suit the wishes of all the residents, and in the meantime, to refer those residents who do not eat balanced meals to the dietician for advice. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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 residents indicated a high degree of satisfaction with their care, and have a very good relationship with the staff. There are good systems in place to protect residents from abuse. The complaints log needs to include response times and better telephone facilities should be provided for relatives to contact residents. EVIDENCE: The complaints procedure was available on the residents’ notice board. There were no complaints recorded in the log for the past twelve months. However, the complaints log needs to include the date of the complaint and the date of response as evidence that complaints are addressed within reasonable timescales. The residents who were spoken to, stated that they were very satisfied with the service and spoke highly of the staff. A relative complained that they could only contact a resident who was on respite care, via the pay-phone. The manager stated that telephone outlets are provided for private use in the bedrooms, but this would not be normally installed for users of respite services. It is recommended that the manager explore options for relatives to be able to telephone residents via a hand-held mobile phone. 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. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 15 Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 16 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 environment for the residents is homely, very clean and well maintained. EVIDENCE: A tour of the premises was carried out. The building appeared attractive and the grounds were well maintained. It was noted at the last inspection that there were two cracked panes of glass on the conservatory roof. However, the manager stated that this had been inspected by a surveyor who was satisfied that the roof was safe. In the kitchen, new double glazed windows have been recently installed, which has greatly improved the kitchen environment. The home was very clean and attractively decorated throughout and there were no offensive odours. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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): 27, 29 & 30 There are sufficient staff on duty to meet residents’ needs. However, the staff rota does not always accurately identify the staff actually on duty. Staff receive training appropriate to their roles and responsibilities. However, recruitment procedures are not thorough, which could put the residents at risk. EVIDENCE: The normal staffing levels are four care staff on the early shift and three on the afternoon/evening. There are two staff on duty at night time. The home also employs a maintenance person, an administrator, and cleaning and cooking staff. The rota however, did not give an accurate record of the staff actually on duty; for example, someone was off due to sickness, but the person covering the absence was not entered on the rota. A requirement is made regarding this matter. The records of a new member of staff contained a Criminal Records Bureau clearance, but references had not been taken and there was no proof of their identity. A requirement is made for these documents to be obtained. In discussion with staff, they described the various training courses they had undertaken in the past year. This included the mandatory subjects, e.g. fire, health and safety and food hygiene. Training in adult protection had also been provided. The residents who were spoken to, said that they were very confident in the staffs’ ability to care for them. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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): 32, 35 36 & 38 There is a relaxed and friendly atmosphere in the home and the staff morale is high. Regular staff supervision takes place. The residents’ personal finances are properly accounted for. Some health and safety issues need to be addressed to protect residents, staff and visitors to the home. EVIDENCE: There was a relaxed atmosphere in the home during the inspection, and there was an obviously good relationship between the manager, staff and residents. The staff said how much they enjoyed working at the home and this is reflected in the very low turnover of staff and the length of time people worked there. There were records of regular staff supervision. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 19 At the time of the inspection, only one of the residents managed their own financial affairs; the remainder being managed by relatives. Two residents’ personal financial records were examined. There was a good record of how their money was accounted for when purchases were made on their behalf for toiletries, clothes, hairdressing etc. The records included income and expenditure, for which receipts where obtained. The fire log showed that fire alarms were tested every week and drills were carried out. Devices had been installed on two doors in the dining area, which close when the alarm sounds. Requirements made at the last fire safety inspection by the LFEPA had been complied with. However, a designated fire exit near the laundry did not have a proper opening device and a requirement is made to address this. The electric wiring system in the home is more than five years old. The manager said that she had been trying to obtain a quote to have the system tested but without success. A requirement is made for this matter to be attended to. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 3 X 2 Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5(1)(a) Requirement The registered person must provide a contract of the terms and conditions of the service for all residents, including those on respite care. The registered person must consult and comply with residents’ wishes in relation to the frequency of bathing. The registered person must ensure that care plans are reviewed monthly. The registered person must seek specialist advice about prevention of falls for those residents particularly at risk. The registered person must amend the medication procedure to state that medication must be retained for seven days after the death of a resident. The registered person must ensure that staff signatures are clear on the MAR sheets. The registered person must seek advice from a dietician about those residents who frequently do not eat full meals. DS0000010459.V269758.R01.S.doc Timescale for action 28/02/06 2 OP8 12(3) 28/02/06 3 4 OP7 OP8 15(2)(b) 13(1)(b) 28/02/06 28/02/06 5 OP9 13(2) 31/03/06 6 7 OP9 OP15 13(2) 13(1)(b) 28/02/06 28/02/06 Kingsdowne Residential Home Version 5.0 Page 22 8 OP16 9 OP27 10 OP29 11 OP38 12 OP38 The registered person must 31/03/06 amend the complaints log to include the date of the complaint and the date of response. 17 Sch(4) The registered person must 28/02/06 ensure that the staff rota clearly reflects the actual people on duty each shift. 7,9,19 The registered person must 28/02/06 obtain two references and proof of identity for a specific member of staff. 23(4)(c)(ii The registered person must 31/03/06 i) provide an appropriate device for opening the fire exit near the laundry area. 13(4)(c) The registered person must 31/03/06 ensure that a survey of the home’s electric wiring system is carried out. 22(4) 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 OP16 Good Practice Recommendations The registered person should provide better telephone access for relatives to contact residents. Kingsdowne Residential Home DS0000010459.V269758.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office 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 DS0000010459.V269758.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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