Inspection on 03/01/07 for The Infirmary

This inspection was carried out on 3rd January 2007.

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

The Infirmary 05/01/06

The Infirmary 16/09/05

The Infirmary 25/02/05

The Infirmary 02/07/04

Similar services:

Henry Nihill House

Birchwood

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Spring Lane Care Home

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

CARE HOMES FOR OLDER PEOPLE The Infirmary Sutton`s Hospital in Charterhouse Charterhouse Square London EC1M 6AN Lead Inspector Ms Edi O’Farrell Unannounced Inspection 3rd January 2007 10:25 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 The Infirmary DS0000032213.V287258.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. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Infirmary Address Sutton`s Hospital in Charterhouse Charterhouse Square London EC1M 6AN 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) 0207 253 9521 0207 251 3929 charterhouseec1@aol.com The Governors of Sutton`s Hospital in Charterhouse Ms Geraldine Ann Hales Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing procedures must be confined to residents admitted to the 10 beds within the registered Care Home - The Infirmary. 05/01/06 Date of last inspection Brief Description of the Service: The Infirmary is registered as a care home with nursing for up to 10 people. It is located within the historic site of Sutton’s Hospital in Charterhouse. Access is through the gatehouse located in Charterhouse Square, near to the Barbican. The site is home to a community of Brothers, who meet the criteria laid down by the Governors. The Brothers of Charterhouse have been able to access the services of the Infirmary together with other occasional external residents, both male and female. So far there have been five external residents but this number may increase during 2007. Stay can be either for full time residential care, or for short stays. The latter is usually following, or to avoid, hospital stays. Personal and nursing care is provided on a 24-hour basis. The Infirmary staff also have a watching brief in relation to the health and personal care needs of the other Brothers living on the site. Of the ten single bedrooms in The Infirmary, eight have ensuite, assisted showers; the remaining two rooms have access to an adjacent bathroom with assisted bath. The Infirmary is self-contained with a small kitchen, diningcum-sitting room and the quiet area of St Brunos Chapel. There is a large lounge on the ground floor and Brothers are encouraged to take their meals in the Great Hall situated in the main building. Suttons Hospital In Charterhouse believes that every brother has the right to live their life with privacy and dignity, independence and choice. Charges are £595 per month for Brothers and £150 per day for others. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this, unannounced, inspection took place on a weekday from mid morning to mid afternoon. It lasted just over four hours. During the visit we spoke to two Brothers, the Matron, one member of staff, and the visiting Physiotherapist. We looked round the home, including some occupied and some vacant bedrooms. We checked assessments, care plans, and daily logs, and compared these to the care being provided. We indirectly observed staff carrying out their duties, and how they related to the Brothers. Prior to the visit we reviewed the information we already had about this service. This included reports that have to be sent to us on a monthly basis by the Master, and previous inspection reports. It also included the information that the Matron and Master had provided in our pre-inspection questionnaire. We received two completed postal surveys from friends/relatives of the Brothers, and one from the visiting GP. We used all the above information to plan the site visit. We left a form with the Matron for her to let us know how she felt the inspection went. We generally use the term service users to describe people who use social care services. There are therefore parts of this report where that term is used, as our system pre-populates those sections. Wherever possible we have used the terms used by the service, such as Brother, Matron, and Master. We thank all who contributed to the inspection. What the service does well: Dignity, privacy, respect, and individuality are given a high priority. There is a focus on the retention of independence, and care and support only being given to the level agreed by each Brother. Every attempt is made to support short stay Brothers in moving back to their flats as soon as possible. Care planning, including nursing care, is systematic and holistic. Social and spiritual needs are given as high a priority as personal and health care. This is best practice in the care of older people. There is a calm and welcoming atmosphere. Every attempt is made to make the service as homely as possible. All bedrooms are single, with eight having ensuite, walk-in, showers. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 6 Brothers describe the staff as ‘caring’, and ‘seeing to every need’. They feel that the food is extremely good, as one put it ‘if you don’t like this food, you will not like any’. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. The Infirmary DS0000032213.V287258.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 The Infirmary DS0000032213.V287258.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Needs are assessed prior to admission. Every effort is made to ensure stays are as short as possible. EVIDENCE: Since the last inspection the number of Brothers permanently living in The Infirmary has reduced to four. The remaining six rooms have been used for short stays. We have judged the two standards in relation to the specific circumstances of this service. Staff already know the men who are admitted to the Infirmary. They have been living on the site in individual flatlets, having met the criteria for joining the community. They then use the residential services of the Infirmary when their health requires it. This may be to avoid, or following, hospital stays, or where clinical observation is needed. They are fully involved in the decision making, and know about the service from the Brother’s Handbook. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 9 The two most recently admitted men were spoken to, and their case records checked. Their needs had been fully assessed prior to admission. This included medical and nursing reports being provided. The information had been used to develop individual care plans. Both men reported that staff were very attentive to their needs and wishes. They felt that the care was exactly what they needed. They felt that they had full information on which to make the decision to move into the home. Some possible changes to the criteria for admission to the home were being looked at. We asked the Matron to contact us when any changes had been agreed. This was to discuss any changes that might be needed to documentation, such as the Statement of Purpose. Information provided since the last inspection in the monthly reports (Regulation 26 reports) that were sent to us demonstrated that every effort was made to keep stays as short as possible. The care plans seen were focused on strengths and the promotion of independence. The Infirmary DS0000032213.V287258.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health, person, social, and spiritual, needs are set out in care plans, and are met. Some changes to medication policy and procedure are needed. EVIDENCE: We case tracked the two people who had most recently moved into the home. This included speaking to them, checking their care records, comparing this to the care being given, and discussions with the Matron. We also had a short discussion with the Physiotherapist, and indirectly observed staff interacting with the men. We had planned to carry out a sample audit of medication. This was not possible due to the current system. The assessments, care plans, and daily records, were of a good standard. It was particularly positive to see that social and spiritual needs, wishes, and interests were included, along with more basic health and personal care needs. Daily reports included not only information about the care that had been given, but also about activities and well being. This demonstrated best The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 11 practice in the care of older people. Where needs had changed, these had been incorporated into care plan reviews. Care plans were being signed by staff but not by the Brothers. We discussed this with the Matron, who reported that this was being discussed. As this was work in progress we have not set a requirements, but will check on progress at the next inspection. Care plans were based on identified needs, and followed through from preadmission information. This meant that complex medical problems were being correctly and comprehensively addressed. The physiotherapist is contracted for three hours per week, but confirmed that if more time was needed then this was allocated. This time is for both the Infirmary, and the other members of the community. Daily reports showed that staff followed the advice she provided for such things as moving and handling. It was not possible to carry out a medication audit, as amounts received were not recorded on the medication administration charts. This meant that it was not possible to compare the stock with amounts given. As the home had no arrangement for a visiting pharmacist to carry out regular checks we have arranged for one of our specialist pharmacist inspectors to carry out a separate inspection. The Matron welcomed this as a means of further improving the service. Following that visit we will send a separate report to the Matron. Any Requirements set must be implemented in the set timescales. This is Requirement 1. Both men spoken to felt that staff treated them with respect, and that the care they received was what they wanted. The care plans, and daily records, demonstrated that staff were very aware of the strengths of each person, and how to build on these. Staff were, indirectly, observed speaking to the men, and there was an obvious warm and mutually respectful relationship. The Infirmary DS0000032213.V287258.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Brothers follow the lifestyle that they wish. EVIDENCE: The people living in the Infirmary had access to all activities and resources available on the site. This included taking meals in the main dinning hall, if they wished. They attended services in either the main chapel, or the small chapel within the Infirmary. As many were clergymen, spiritual needs and wishes were of prime importance. Wishes, needs and preferences were well documented in care plans, and activities reported in the daily logs. The two people spoken to were very happy with their routine, and the facilities. They enjoyed having daily conversations with staff, and visitors. They confirmed the details held in their case files about their chosen daily routines. As on previous visits meals were reported to be of a very high standard. As one person put it ‘if anyone didn’t like the food here then they’d be impossible to please.’ The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Brothers are listened to and protected from abuse. EVIDENCE: The Brothers were clear how they would raise any concerns. They found the Matron and staff very approachable to do this with. The monthly reports (Regulation 26) sent to us have been informative about any concerns raised. Staff had accessed the LB Islington Adult Protection training, and were aware of their responsibilities The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Brothers live in a safe and well-maintained environment. EVIDENCE: We toured the premises, including both empty and occupied bedrooms. We discussed some redecoration needs; such as wheelchair scuff marks on doorways, with the manager. She reported that these were due to be repainted, so we did not set a requirement. We will check on this at the next inspection. The two people spoken to were both very happy with their rooms. They appreciated having their books, tapes, and small pieces of furniture around them. One was waiting for final confirmation of his contract before bringing additional possessions in. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 15 Since the last inspection an assisted bathroom has been installed. This includes a chair-assisted bath, shower, disabled-access wash basin and toilet. This means that there is now a choice of bath or shower for most Brothers using The Infirmary service. Ventilation to the surgery has been improved by the addition of a sky-light. All parts of the home were very clean and the member of staff responsible is to be commended. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A competent, and well trained, staff team meets the Brothers’ needs. EVIDENCE: We looked at the staffing rota prior to the visit, and discussed staffing levels with the Matron during the day. We checked staff recruitment, training, and supervision files. We looked at the records that staff made of the care they deliver. We, indirectly, observed staff carrying out their duties, and also asked two people how they felt the staff treated them. Staffing was based on the assessed needs of the people living in the home. This included health and personal care needs, and, the many, hospital appointments that they had to attend. There was a good skill mix of staff, with a staff nurse on duty at all times. The care records demonstrated that they had an excellent appreciation of good quality care for older people. Recruitment records were comprehensive, with all required checks having been carried out. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 17 Supervision of care staff met the standards, and there were yearly appraisals. These included a self-appraisal by the staff member, and an action plan for the coming year. The training programme had resulted in three more care staff achieving NVQ2 since the last inspection. This meant that the home had achieved above the required standard. The Infirmary DS0000032213.V287258.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Brothers using the infirmary access a well-managed service. EVIDENCE: The manager had submitted her Registered Manager’s Award portfolio for verification, and was awaiting the outcome. Her approach to the inspection, and the systematic record keeping seen during our visit demonstrated a commitment to a high quality service. She also demonstrated a sound knowledge of good practice in the care of older people, for example, automatically talking about a particular situation as affecting the well being of the person. Comments from people living in the home were: ‘She’s a joy, always got a twinkle in her eye’. ‘She’s always there to talk to’. The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 19 The needs and wishes of the people who lived in the Infirmary were central to how the home was run. Their views were regularly used to help to improve the service, for example, concerns about the environment. People living in the Infirmary either manage their own finance, or have made private arrangements with friends or solicitors. Health and safety records were sampled. Theses were up to date and in order. The Infirmary DS0000032213.V287258.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 4 X X 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 4 X X 3 The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 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 OP9 Regulation 13(2) Requirement Following the specialist pharmacist visit all Requirements set must be implemented within the agreed timescales. Timescale for action 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 The Infirmary DS0000032213.V287258.R01.S.doc Version 5.2 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. 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!