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Inspection on 05/01/06 for The Infirmary

Also see our care home review for The Infirmary for more information

This inspection was carried out on 5th 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.

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 staff in the home are good at ensuring the rights and choices of the Brothers are at the forefront of good practice. The service users benefit from a well-trained staff group, who have a good understanding of their care needs and have forged positive relationships with them. The home is being managed effectively by an experienced and competent manager, who is supported well by the senior staff and care staff. The manager provides clear leadership with all staff demonstrating an awareness of their roles and responsibilities.

What has improved since the last inspection?

As a result of the last inspection, the home has introduced an information pamphlet, which is a guide to making comments, complaints or suggestions about the service. This is readily accessible to both service users and their visitors. The home has developed links with the Adult Protection liaison officer within the local borough. The training for staff in adult protection will also be improved. Information is now accessible in the absence of the manager to show that all the relevant checks have been carried out as part of the recruitment and selection process. A training plan is available. The home is working towards 50% of the care team to have the recognised qualification of NVQ level 2.

What the care home could do better:

The area where the home could be doing better was discussed with the manager. The policy and procedure on the administration of medication needs to be reviewed and updated.

CARE HOMES FOR OLDER PEOPLE The Infirmary Sutton`s Hospital in Charterhouse Charterhouse Square London EC1M 6AN Lead Inspector Ms Pippa Treadwell-Smith Unannounced Inspection 5th 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 The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 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.V250384.R01.S.doc Version 5.1 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 490 4445 charterhousem@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.V250384.R01.S.doc Version 5.1 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. 16th September 2005 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 known as The Charterhouse. Access is through the Gatehouse located in Charterhouse Square; this is manned and provides a secure entry into the whole site. The Infirmary provides contemporary and purpose built accommodation all on one level. It is located on the first floor and there is access via a shaft lift. Generally all the service users are male and have been living as Brothers, the term used by the organisation, within Suttons Hospital in Chaterhouse prior to admission. The Infirmary provides personal care to those Brothers who are not able to be supported in their on-site flats. Short unplanned admissions to The Infirmary would occur following disacharge from hospital and on the recommendation of the GP for an acute illness. In addition the staff of the Infirmary have a watching brief in relation to the health and personal care needs of the Brothers living in their flats. Of the ten single bedrooms in The Infirmary, eight have ensuite with assisted showers; the remaining two rooms have access to an adjacent bathroom with an assisted bath. Although The Infirmary is self-contained with a small kitchen, dining-cum-sitting room and the quiet area of St Brunos Chapel, the service users have access to a large lounge on the ground floor and can 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. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in January 2006 and lasted about four hours. The focus of the inspection was to assess the remaining key standards, which had not been inspected at the previous unannounced visit in September 2005. The nurse-in-charge and the manager assisted with the inspection. A variety of records were looked at including policies and procedures, medication records and training documents. What the service does well: What has improved since the last inspection? As a result of the last inspection, the home has introduced an information pamphlet, which is a guide to making comments, complaints or suggestions about the service. This is readily accessible to both service users and their visitors. The home has developed links with the Adult Protection liaison officer within the local borough. The training for staff in adult protection will also be improved. Information is now accessible in the absence of the manager to show that all the relevant checks have been carried out as part of the recruitment and selection process. A training plan is available. The home is working towards 50 of the care team to have the recognised qualification of NVQ level 2. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 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. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 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.V250384.R01.S.doc Version 5.1 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): These standards were not assessed EVIDENCE: The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 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 the following standard(s): Standard 9 The systems for administration of medication are satisfactory. There are clear and comprehensive arrangements in place to ensure service users’ medication needs are met. Although a policy and procedure is in place, this should be updated. EVIDENCE: The administration of medication is undertaken by the nursing staff only. Discussions with the nurse-in-charge highlighted that the arrangements in the home to order, store and administer medication are in line with the code of conduct from the Nursing and Midwifery Council. The storage facilities are satisfactory and the MARS sheets were noted to be up-to-date and no gaps in recording. There is an assessment of competency for short stay service users who want to self-medicate. The disposal of medication continues to be with the local pharmacist rather than in the home as new legislation states. The manager confirms that the dispensing pharmacist is still happy to dispose of unwanted medication. Staff are clear about the seven day rule on retaining medication after the death of a service user although this is not reflected in the policy and procedure; which needs to be reviewed and updated. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 10 The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 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 the following standard(s): These standards were not assessed EVIDENCE: The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 12 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 There is a clear and comprehensive complaints procedure in place to ensure that concerns from service users and relatives are listened to and acted upon. Arrangements are in place to ensure the protection of service users through training and updated procedures. EVIDENCE: Since the last inspection the home has introduced a pamphlet on how to make comments, complaints or suggestions about the service. The pamphlet is comprehensive and accessible to both service users and visitors. As part the last inspection there has been contact between the home and the adult protection liaison offer of the London Borough of Islington. This has resulted in the home receiving a copy of the local procedure on adult protection and the opportunity for further training. The manager has confirmed that following the training, which is scheduled in the next few weeks, the policy and procedure on adult protection will be revised. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 13 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): These standards were not assessed. EVIDENCE: The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 14 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): 28, 29 & 30 The staff have a good understanding of the service users’ support needs through access to a range of appropriate training and development opportunities. The service users are protected by the home’s recruitment and selection process. EVIDENCE: There has been a delay in reaching the minimum ration 50 of the staff team with NVQ level 2. One member of staff has completed the training and three more are awaiting verification of their evidence. The delay has not been of the home’s making but rather problems with getting a consistent service from the training organisation. An NVQ assessor was visiting a member of the care team on the day of the inspection. There were other dates logged when she would visit other members of the care team. The nurse-in-charge confirmed that qualified staff are able to maintain the requirements of the Post Registration Education Profile (P.R.E.P). A notice board at the nurses stations shows the training available and in particular for nurses. Staff confirmed that supervision is regular and training needs are discussed as part of this meeting. The home has a training plan, which ensure that mandatory topics are attended first. There is an in-house induction programme and the manager confirmed that she is trying to access external courses for the Skills For Care induction and foundation training. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 15 The home has policies and procedures in relation to equal opportunities and a recruitment and selection process. The equal opportunities policy needs to be reviewed and updated. Discussions with the manager and an inspection of recruitment records shows that the recruitment and selection of new staff follows good practice and regulatory requirements. The inspector did recommend that references should be requested on the previous employer’s letter headed paper. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 16 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): 31, 33 & 35 The home is being effectively managed by an experienced and appropriately qualified manager. The views of service users are sought on an individual basis and acted upon. The policy and procedure for handling service user’s monies is designed to protect the service users. EVIDENCE: The manager has a relevant nursing qualification and is engaged on an NVQ level 4 management training course. She has also been updating her P.R.E.P requirements. The size of The Infirmary and the staffing levels ensures that service users have individual staff attention. This means that there is individual consultation between the staff and the service users. There are informal discussions with the other Brothers at meal times in the main dining room. The Care The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 17 Committee holds reviews of the overall service through the use of anonymous satisfaction surveys but this is not specific to The Infirmary occupants. The manager confirmed that consideration is being given to gaining the views of the short stay service users. There is regular contact with a local GP who has responsibility for the Brother in The Infirmary. The home has a policy on the handling of service users’ monies. This includes staff keeping receipts so that a balance sheet can be maintained. The manager confirmed that the Clerk to the Brothers would assist where possible, along with family and friends. The staff with Charterhouse do not take responsibility for service users financial arrangements. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 19 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 OP9 Regulation 13(2) Requirement The policy and procedure for the handling of medication in the custody of the home should follow the guidelines from the Royal Pharmaceutical Society. Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP29 Good Practice Recommendations It is strongly recommended that policy on equal opportunities is reviewed and updated. The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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 The Infirmary DS0000032213.V250384.R01.S.doc Version 5.1 Page 21 - 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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