Margaret Thatcher Infirmary

People who use the service are known as ‘pensioners’ and they usually move into the Royal Hospital Chelsea onto the long wards. Pensioners could then progress to the three wards within the infirmary if they are assessed to need more care due to frailty and healthcare needs. One of the wards specialises in providing care to people living with dementia.

We found the following examples of good practice.

There were robust procedures in place to ensure visitors could enter the home safely, with checks made at the entrance gate and a requirement to provide a negative lateral flow device (LFD) COVID-19 test before entering the home. There was a designated testing area, along with designated visiting areas and vast open spaces throughput the grounds. The provider also had face recognition software for staff access into the main building.

Relatives were given information about visiting and were kept updated about any changes in visiting guidelines in the home. Relatives were supported to become essential care givers in line with current guidance. This ensured people would be able to have a visitor even if the home was advised to restrict visits in the event of a COVID-19 outbreak.

We saw the provider took a person centred and risk based approach to visiting, which had helped facilitate a special visit for a person during an outbreak. The provider worked closely with the family and the relevant health and social care professionals, including public health colleagues to ensure the visit could go ahead in a safe way.

The service was taking part in regular COVID-19 testing for people and staff in line with current guidance. The provider was aware of recently updated testing guidance and had discussed this with staff to ensure they were all aware of the new testing regime and how they needed to report their test results. The provider also provided staff with polymerase chain reaction (PCR) tests to take home, so if they developed COVID-19 symptoms away from work, they could access a test without delay.

The home was very clean, hygienic and free from odour. The provider had arranged professional deep cleaning across the home from an external cleaning contractor when there were positive cases to support the housekeeping team.

Staff were confident about the actions they had to take if there were new positive cases of COVID-19 in the home. Staff had discussed the recent outbreak and had a good understanding about outbreak management protocols to follow, with clear guidelines in place. One staff member said, "We know so much more now, we have less fear and anxiety now. We feel everybody has learned from this. We all know how important this is as we don’t want to take anything home to our family."

Senior staff carried out regular IPC audits, which included reminders in daily handovers, observations and spot checks across the home to help ensure staff understood their responsibilities and were following best practice. A senior staff nurse said, "We have posters around the wards, discuss it in handovers and supervision and practice handwashing regularly. We will address with staff directly if we observe any issues."

Staff were positive about the support they received and told us they had been kept regularly updated with any changes throughout the pandemic. Staff had access to an employment assistance programme and helplines if needed, with a focus on staff wellbeing. Staff also had access to the provider's online portal, which provided daily and weekly updates, which staff told us they found helpful.

The provider had organised a wellbeing event for people and staff, which included keynote speakers as part of the wellbeing programme. Staff told us they felt listened to by the senior staff team and were always available if needed. One staff member said, "They provided one to one sessions for us with a counsellor, about how we are feeling and what support we need. They wanted us to be as open as possible about this. I feel they have done everything they could to help us feel protected."

The Margaret Thatcher Infirmary provides accommodation for up to 68 people who require nursing or personal care within the Royal Hospital Chelsea, the home of the Chelsea Pensioners. At the time of our inspection 58 people were living in the infirmary. The organisation also provided personal care to approximately 30 people who were living in the Royal Hospital Chelsea, known as the long wards. This was through their domiciliary care service. People who use the service are known as ‘pensioners’ and they usually move into the Royal Hospital Chelsea onto the long wards. Pensioners could then progress to the three wards within the infirmary if they are assessed to need more care due to frailty and healthcare needs. One of the wards specialises in providing care to people living with dementia.

People’s experience of using this service

People and their relatives were extremely positive about the caring and compassionate nature of the staff that supported them. One relative said, “The staff are wonderful and go over and above what I would have expected. They have built up a wonderful rapport with all the pensioners.”

People praised the support they received from their Captains of Invalids. They were responsible for people’s social welfare and wellbeing and people respected and trusted them due to a shared experience of military life.

People benefitted from an excellent variety of activities, events and trips out that were available to reduce social isolation, give meaning and purpose and enhance their wellbeing. People had an overwhelming sense of pride representing the Chelsea Pensioners.

The provider was externally recognised as providing outstanding care at the end of people’s lives. Relatives praised the care and support both they and their family members received at this sensitive and emotional time.

People had access to an on-site medical centre and GP, including a range of health and social care professionals. This ensured people received effective care and immediate referrals if their health deteriorated and also to help manage any long term health conditions.

People were cared for by dedicated and passionate staff who felt appreciated and privileged to support people who had served their country. Staff spoke positively about the working environment and the support they received to help provide high standards of care. One staff member said, “This is our own village in Chelsea and is a wonderful community. Listening to the stories of the pensioners is the best thing about working here.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this inspection was Outstanding (published 29 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Margaret Thatcher Infirmary provides accommodation for up to 100 people who require nursing or personal care. At the time of our inspection 81 people were living in the infirmary. The organisation also provided personal care to approximately 20 people who were living in the Royal Hospital Chelsea, known as the long wards. This was through their domiciliary care service. People who use the service are known as ‘pensioners’ and they usually move into the Royal Hospital Chelsea onto the long wards. Pensioners could then progress to the four wards within the infirmary if they are assessed to need more care due to frailty and healthcare needs.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us staff were kind and compassionate and knew how to provide the care and support they required. Staff were committed and motivated, and understood the importance of getting to know people and understand their personal histories. All staff showed concern for people’s health and welfare in a caring manner, with enough time given for positive relationships to be developed.

People were spoken with and treated in a respectful and kind way and staff respected their privacy and dignity, and promoted their independence. People also had the support of Captains of Invalids, who were responsible for people’s social welfare and well-being. People felt comfortable speaking with them due to their military background. Where appropriate, people and their families were involved in decisions about end of life care and staff were aware of the importance of respecting people’s wishes and providing support at this sensitive time. Care for people at this stage of their life had been recognised as outstanding.

People had direct access to healthcare services as there was an on-site GP and physiotherapist, with regular visits from other healthcare professionals, such as occupational therapists, chiropodists, audiologists and speech and language therapists. We saw if staff had any concerns about people’s health, immediate referrals were made with appropriate follow up meetings.

People were supported to follow their interests and were encouraged to take part in a comprehensive range of activities and programmes to increase their well-being and reduce social isolation. There were a number of events held within the service along with day trips, including opportunities to travel overseas. The provider also had the use of volunteers to support people with activities and events. People were able to be ambassadors of the Chelsea Pensioners, and supported to represent them at official events throughout the world.

There was a real sense of a unique community spirit throughout the service with all the amenities, public gardens, tours and a museum that people could volunteer in that was open to the general public. The provider’s values were embedded throughout the service and understood by all.

People were involved in planning how they were cared for and supported. An initial assessment was completed from which detailed care plans and risk assessments were developed. Care records were person centred and developed to meet people’s individual needs and reviewed if there were any significant changes. People and their relatives were actively encouraged to express their views and were involved in making decisions about their care and whether any changes could be made to the support they received.

People knew how to make a complaint and were able to share their views and opinions about the service they received. The provider listened to all complaints and made sure people were confident their complaints would be taken seriously. When issues were highlighted we saw action was taken. There were also surveys in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

There were effective quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. The registered manager followed a regular cycle of quality assurance activities and learning took place from the result of the audits. Quality assurance processes included obtaining and acting on the views of people in order that their views could be used to drive improvements throughout the service.

The service promoted an open and honest culture and the registered manager and senior staff team were transparent in their discussions with us during the inspection. The registered provider focussed on their core values and staff were dedicated and knew what was expected of them, feeling privileged to be able to care for people who had served in the British Army.

Staff spoke highly of the support they received from management and were confident they could raise any issues or concerns, knowing they would be listened to and acted upon. The strength of leadership throughout the service contributed to the outstanding level of care, attitude of staff and quality of life for people using the service.

Staff were aware of people’s dietary needs and food preferences and provided support to those who required it during mealtimes. There was a good variety of choice available and people had the opportunity to feedback about the food they received. People also had the choice to visit the on-site café or licensed bar.

There was a comprehensive induction and a 12 month probation period for new staff. Staff members also took part in a training programme to support them in meeting people’s needs effectively. New staff shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were listened to during the supervision they received.

People who required support with their medicines received them safely from staff who had completed in-depth training in the safe handling and administration of medicines, which was refreshed annually. Staff training in this area included observations of their practice to ensure medicines were given appropriately and with consideration for the person concerned. Staff completed appropriate records when they administered medicines and these were checked after each medicines round on the same day to minimise medicines errors. More thorough checks were carried out on a monthly basis and findings were discussed at quarterly governance meetings.

The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. Sufficient numbers of staff were employed to keep people safe and meet their needs, being able to spend enough time with them to know them well.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent. The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and application.

There were robust systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and the correct action to take if abuse was suspected. Appropriate safety checks of the building, equipment and maintenance systems were undertaken to ensure health and safety for people and staff was maintained.

People’s risks were managed and care plans contained appropriate and detailed risk assessments which were updated regularly when people’s needs changed. We saw accidents and incidents were closely monitored by the registered provider and discussed at quarterly meetings.

People who lacked capacity had input from multi-disciplinary professionals ensuring the service being provided was in their best interest and their human rights were being respected.

Staff had been trained in what to do in a medical emergency and would contact the emergency services if and when required.

The dietary requirements for all people staying at the MTI were recorded as part of the assessment and care plan records.

Staff undertook mandatory training set out in the provider's training policy on an annual basis. This included safeguarding and what to do in a medical emergency. All staff attended team meetings and received annual appraisals where their performance would be discussed and targets set for the coming year.

The service conducted audits to monitor the quality of the service it was providing. Regular feedback questionnaires were completed. Records showed that there had been no incidents at the service in the last two years.

We looked at the complaints log and the complaints made had been dealt with appropriately with records in place to show what actions were taken.