Care Home: The Infirmary

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What the care home does well The services ethos is for residents to maintain as much independence as possible and to maintain as much control over their lives as possible. The service has developed a statement of purpose and service users guide. Potential residents are comprehensively assessed prior to admission. The service is able to provide intermediate care to residents who require it. The service develops individual plans with residents and these are regularly reviewed. Residents are supported to access a range of healthcare services. Where appropriate residents are encouraged to manage their own medication. Personal care is provided in a flexible manner and residents dignity and respect are promoted. Residents are able to engage in a range of social and community based activities according to their abilities and interests. Residents told us that the meals provided are of a high standard. The home has an open culture and listens to the views of residents. Care staff demonstrate a good understanding of safeguarding issues and protect people who use the service. People who use the service benefit from a range of private and shared accommodation that is maintained to a very high standard. Staff receive regular core training and are supported to undertake NVQ level qualifications. Residents told us that staff are excellent. The service has sound recruitment procedures that promote the safety and well being of people who use the service. The manager is suitably qualified and experienced and promotes an ethos within the service that is open and transparent. Residents are encouraged to manage their own finances. New staff receive an induction and are regularly supervised. The home carries out and records a range of health and safety tests. What has improved since the last inspection? Since the last inspection the service has received a specialist pharmacy inspection and complied with its recommendations. What the care home could do better: No requirements or good practise recommendations were made as a result of this inspection. Key inspection report Care homes for older people Name: Address: The Infirmary Sutton`s Hospital in Charterhouse Charterhouse Square London EC1M 6AN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lea Alexander     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: The Infirmary Sutton`s Hospital in Charterhouse Charterhouse Square London EC1M 6AN 02072539521 02072513929 charterhouseec1@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Governors of Sutton`s Hospital in Charterhouse care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Nursing procedures must be confined to residents admitted to the 10 beds within the registered Care Home - The Infirmary. Date of last inspection Brief description of the care home 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 24Care Homes for Older People Page 4 of 25 Over 65 10 0 Brief description of the care home 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, dining-cum-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. 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: One inspector carried out this inspection over the course of a day. We met with the registered manager and spoke with staff on duty. We also spoke privately with three people who use the service. In addition we sampled a range of documentation relating to the running of the service including residents personal files and staff personnel files. We examined key national standards and examined the services progress in complying with requirements made at an earlier inspection. At the time of this inspection the service had nine residents, with one vacancy. The service generally uses the term Brother to describe people who use the service, and the Manager is referred to as Matron. Care Homes for Older People Page 6 of 25 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has developed a comprehensive statement of purpose and service users guide and puts a high value on responding to individual needs for information, reassurance and support. All new residents receive a comprehensive needs assessment prior to admission. Evidence: The service has revised and updated its statement of purpose and service users guide. We looked at these documents and found them reflective of the service being offered. We examined the personal files of two residents. These evidenced that each was assessed by the home prior to their moving in. The service provides intermediate care, and at the time of this inspection three residents were being assessed as to whether they could return to their independent accommodation within Charterhouse, or whether they needed to move permanently to Care Homes for Older People Page 10 of 25 Evidence: the Infirmary. 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. Residents receive personal and healthcare support using a person centred approach with support provided based upon rights of dignity and respect. Residents are supported to access healthcare services, and have access to the aids and equipment they need. The home has sound medication practises and procedures. Evidence: We examined the personal files of two residents. We also spoke with residents, the Matron and care staff on duty. We were able to evidence that each resident has clearly laid out individual plans that include information on a range of health, personal and social needs. These plans are regularly reviewed and updated. The service has arranged for a local GP to visit once per week. Residents have the choice of registering with this GP or continuing to see GPs from other practises whom they may already have registered with. In addition a physiotherapist visits the service once per week and runs an excercise group that all residents can attend as well as Care Homes for Older People Page 12 of 25 Evidence: providing 1:1 sessions. A local chiropodist also visits the service regularly. For each person who uses the service an assessment the risk of falls had been completed. Since the last inspection a specialist pharmacy inspector has visited the service. We spoke with the matron who told us that they had found this very useful, and that as a result the services medication practises and procedures have been revised. At the time of this inspection a number of residents were managing and administering their own medication. We examined the available medication records. These evidenced that service keep Medication Administration Records (MAR) for all residents medication. Where residents are self medicating, the MAR sheet is annotated as such and staff do not complete. Where staff do offer assistance with medication the MAR sheet is appropriately completed. We examined the MAR sheets and available medication for one resident. Medication in tablet form was pre loaded into blister packs by the dispensing pharmacy. Other preparations such as drops and inhalers were also available. All medications were stored inside a locked cabinet. We found that all the available medication was recorded on the MAR sheet, and that that the MAR sheet had been completed and was in good order. As a result of the pharmacy inspection the service now maintains records of medication received as well as disposed of. We examined these records and found them to be in good order. Residents are encouraged to manage their own medication wherever possible. One of the residents we case tracked is currently managing and administering their own medication. This was clearly identified in their individual plan and was subject to a risk assessment. Sampling of personal files along with discussion with residents and staff evidenced that Individual plans are reflective of residents needs with regard to personal care and their personal preferences. People who use the service who receive assistance with personal care told us that staff promote their dignity and treat them with respect whilst providing this assistance. 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. Residents are able to enjoy a full and stimulating lifestyle. The routines and activities of the service are person centred, individualised and diverse. Evidence: As well as the services availabe within the Infimary, Brothers also have access to other facilities within the community. Most choose to take their meals within the Great Hall. There is also a chapel with daily services, and music recitals and lectures regularly take place in the Great Room. Where residents require assistance with accessing activities within the community staff are available to provide this. The Infirmary also organises its own activities, for example a social evening with wine had taken place the night before this inspection. The Infirmary also has its own small chapel. During our visit to the unit we observed family and friends visiting people who use the service. Our discussions with people who use the service evidenced that residents are supported and enabled to maintain contact with family and friends. Discussion with residents, the Matron and care staff and our own observations of practise during our visit evidenced that people who use the service are supported to Care Homes for Older People Page 14 of 25 Evidence: excercise choice and control over their lives. All food is prepared in the kitchens attached to the Great Hall. Residents can choose to eat in the Great Hall or at the Infirmary either in the dining area or in their own room. People who use the service told us that the meals provided were excellent. 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. The service has an open culture that allows residents to express their views. Staff demonstrate a sound understanding of safeguarding issues and their responsibilities. Evidence: We spoke with the Matron and residents. We also looked at the services complaints log. No complaints have been received since the last inspection. Residents who we spoke to told us that they were extremely happy with the service provided and that they had no complaints. They also told us that they knew how to make a complaint should they have any concerns. There have been no safeguarding issues or referrals since the last inspection. We spoke with a member of staff on duty. They were able to demonstrate a good understanding of safeguarding issues and their responsibilities should they have any safeguarding concerns. 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. The physical environment of the Infirmary provides for the individual requirements of the people who live there. The home offers a range of private and shared accommodation that is maintained to a very high level. Evidence: The Infirmary is located within the historic Charterhouse setting. Within the Infirmary there are ten bedrooms. There is also a surgery/consultation room, laundry rooms, a lounge and dining area with kitchen attached. There is a large day room which also acts as a library and reading room. There is also a piano and a range of daily newspapers and other reading materials are available. There is a physiotherapy area equipped with excercise equipment. Each resident has their own bedroom that they are able to personalise with their own belongings and possessions. Eight bedrooms have ensuite bathrooms with adapted showers. Two bedrooms do not have ensuite facilites, and these are adjacent to a bathroom with specialist shower and bath adaptations. The walls inside the Infirmary decorated with photographs of royal visitors and professional portraits of past and current residents and staff. Artwork from residents also decorates walls - these take the form of cartoons of events or discussions within the community and abstract paintings and collages. Care Homes for Older People Page 17 of 25 Evidence: The premises extremely well maintained and comfortable. We found the Infirmary to be very clean and hygenic and free from offensive odours. The Infirmary also has accommodation available for visiting family and friends to utilise. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has plentiful staff available at all times to support residents. Staff are supported to undertake external training and qualifications. People who use the service report that they know the staff team well. Evidence: At the time of this inspection the service employes three nurses and seven care staff. Domestic staff are also employed by the service. In addition there are five bank nurses and two bank care staff. The Matron told us that the service is in the process of recruiting additional care staff. The service also uses regular agency staff when permanent or bank staff not available. Residents that we spoke to told us that staff were excellent, and that they felt they were very well looked after. All permanent healthcare assistants have successfully completed NVQ level 3. Bank staff are also supported to undertake NVQ training. We examined the personnel records for two staff members. These evidenced that the service obtains two satisfactory references and a Criminal Records Bureau (CRB) for new recruits. The service also provides details of their employment terms and conditions to new recruits. Care Homes for Older People Page 19 of 25 Evidence: In the last year the service was evidenced as having provided food hygiene training, first aid training, moving and transferring, infection control and diabetic foot management. Dementia care training has also been provided to staff. The training records we saw evidenced that permanent members of staff were evidenced as receiving three days paid training each year. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is suitably qualified and experienced and is highly competent to run the service. They are an excellent role model for other employees. The service has an ethos that is open and transparent. The AQAA completed by the service contains excellent information and is supported by appropriate evidence. All of the working practises within the home are safe, and there are comprehensive records of regular health and safety checks. Evidence: The Matron has obtained their Registered Managers Award (RMA), and the deputy matron is currently studying for NVQ level 4 During our visit to the home we formed the view that people who use the service benefit from the ethos, leadership and management of the home, and that the service is run in the best interests of people who use the service. People who use the service commented that the matron was fantastic, and promoted an excellent atmosphere and environment within the service. Care Homes for Older People Page 21 of 25 Evidence: Discussions with the Matron and residents, and sampling of personal files evidenced that all residents are independent with finances. Some receive assistance from family or friends in managing their finances. The finance department within the community can also provide assistance if required. All residents encouraged to write a will and make arrangements for enduring power of attorney should their cognitive abilities deteriorate. Each of the staff members we case tracked was evidenced as receiving a minimum of six supervisions in a year. The service displays its current insurance certificate and has obtained appropriate cover. We examined fire records relating to the Infirmary. This evidenced that maintenance department carry out weekly testing. The Infirmary is on a circuit with the entire Charterhouse site. Fire alarm call point tests are carried in rotation. All Infirmary call points are tested in order as part of the cycle, with the outcome recorded. Our sampling of personnel files also evidenced that new members of staff received an induction. 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 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) Care Quality Commission (CQC). 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. 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