Queen Elizabeth II Infirmary

The Queen Elizabeth II infirmary provides residential care to a maximum of 11 people. Accommodation is provided in single rooms, with shared living and dining facilities. The service currently has eight people in residence.

People’s experience of using this service and what we found

People were protected from the risk of harm from preventable risks. Risks to people's health and wellbeing had been assessed and reviewed. Support that people needed to eat and drink was provided in a safe way. The environment was safe and clean. The service continued to follow safe infection prevention and control measures to ensure people were protected from risks of COVID-19. Visiting was allowed to people at the home and the registered manager explained how this was planned with people’s families.

Rating at last inspection and update

The last rating for this service was Good (Published on 25/01/2019).

Why we inspected

This was a targeted inspection that considered areas of safe and effective due to concerns received about pressure area care and awareness of procedures to raise safeguarding concerns. Based on our inspection of these areas we found that the service was taking steps to learn from improvements required to ensure people remained safe and that care was effectively delivered.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Members of the senior management team and the board of governors attended personally to assist on site during times of staff shortage, including to help care for residents and support with day to day managerial and administrative functions. Staff told us they wanted to acknowledge their appreciation and sustain the sense of community and continuity within the home.

There was a designated staff member COVID-19 champion who was sharing information to help support, remind and encourage all staff, including regarding COVID-19 vaccination.

The service ensured that visitors to the home were carefully screened so that they do not present a risk to people in the home. Their temperatures were checked at the door. Personal protective equipment (PPE) including face masks, disposable gloves and aprons were provided for visitors before entering the home. Social distancing was observed. This was aimed at preventing and controlling the spread of infection.

Staff had a good understanding of infection prevention and control measures. They had been provided with infection control training and regular updates. The home had enough and appropriate PPE.

This inspection took place on 9 and 15 November 2018 and was unannounced. At our previous inspection on 20 April 2016 the service was meeting all the regulations that we reviewed and was rated as good.

At this inspection we found the service remained Good.

At the time of our inspection a manager was employed at the service and was undertaking the registration process with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission 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.

There was an organisational policy and procedure for safeguarding people from abuse. Care staff also had the contact details of the London Borough of Islington, which is the authority where the service is located, if any concerns needed to be raised although none had arisen. The members of staff we spoke with said that they had training about protecting adults from abuse, which we verified on training records and each of the staff we spoke with was aware of how to keep people safe.

Potential risks to people using the service were considered, including individual risks and common risks such as the risk of falls and those associated with people’s healthcare needs. The instructions for staff about how to minimise risks were clear and updated regularly.

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. There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards [DoLS] to ensure that people who could not make decisions for themselves were protected.

People were supported to maintain good health. The provider had cancelled the regulated activity of nursing since the previous inspection and any nursing care needed was provided by the local community nursing service. A local GP was available to visit the home if required, although people usually attended the local practice when they needed to. People using the service told us they felt that their healthcare needs were effectively met and gave us examples of how this had been supported by care staff.

People using the service and relatives that we spoke with believed that staff were caring and paid attention to people’s needs. The care plan system had undergone improvements which had been helped by the introduction of a computerised data base which helped to identify when updates and reviews of people’s care were needed.

We observed that communication between people using the service, relatives, visitors and staff was engaging and relaxed. Care staff we spoke with expressed commitment to their work and believed they were respected and that their views taken seriously by the provider.

The provider used a range of methods to monitor the effectiveness of the service. These included document reviews to conversations with people using the service, relatives, the staff team and visits from members of the board of trustees.

At this inspection we found that the home was meeting the regulations that we looked at.

This inspection took place on 20 April 2016 and was unannounced. At our previous inspection on 2 May 2014 the service was meeting all of the regulations that we reviewed.

At the time of our inspection a registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission 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.

The staff of the service had access to the organisational policy and procedure for safeguarding people from abuse. They also had the contact details of the London Borough of Islington, which is the authority where the service is located. The members of staff we spoke with said that they had training about protecting adults from abuse, which we verified on training records and each of the staff we spoke with was able to describe the action they would take if a concern arose.

Risks to people using the service were considered and common risks such as the risk of falls and those associated with people’s healthcare needs were included. Any risks associated with people’s individual circumstances were also given attention and responded to. The instructions for staff about how to minimise risks were clear and were updated regularly.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA appropriately in the small number of cases where people were thought to require assessment. The service had the necessary guidance relating to DoLS and had applied this correctly.

People were supported to maintain good health. Registered nurses were on duty at the service throughout each day and night and a local GP was available to visit the home if required, although people usually attended the local practice when they needed to with staff support if necessary. Staff and people using the service told us they felt that healthcare needs were effectively met.

Everyone we spoke with using the service and relatives praised staff for their caring attitudes. The care plans we looked at showed that attention was given to how staff could ascertain each person’s wishes in order to maximise opportunities for people to make choices.

Communication between people using the service, relatives, visitors and staff was open and respectful. Staff talked about the people they cared for with dignity and respect and knew their responsibilities in providing effective care.

The staff team communicated effectively and there was trust in approaching senior staff and the registered manager to raise anything of concern and to discuss care practices. The views of staff were respected as was evident from conversations that we had with staff.

At this inspection we found that the home was meeting all of the regulations that we looked at.

At this inspection we sought to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The people we spoke with who used the service did not make specific comments about whether they felt safe. However, other comments people made showed that staff were trusted and people felt that their care was usually of a high standard. At the time of this inspection there were no safeguarding concerns. It should be noted that concerns have rarely arisen at this service.

The staff we spoke with said that they have training about protecting vulnerable adults from abuse and were able to describe that action they would take if a concern arose. Staff training had most recently taken place in April 2014.

During our visit we talked with staff about their understanding of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff demonstrated a knowledge and awareness of both of these areas, as well as knowledge of where to seek specialist advice when needed. Staff were also aware of the recent Supreme Court ruling which affects the range of issues covered by MCA and DOLS assessments. The manager informed us that they were due to attend a meeting within the next couple of weeks with the local authority who had invited services to a briefing about how the supreme court ruling may affect services. It was positive to note the manager's commitment to review how the service operated in light of what they will learn from the briefing.

Is the service effective?

We saw care plans were reviewed regularly by the nursing staff. At our previous inspection we had found that care plans were not always signed as being agreed by the person or someone acting on their behalf. At this inspection we found this had improved and all care plans we looked at were signed and dated as being agreed.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. At our previous inspection we had asked the manager and staff about the arrangements for implementing and acting upon the recommendations of safety and risk alerts, bulletins and notices. The manager and staff were not able to provide us with any examples of recent risk alerts and notices at that time but on this inspection we found this had improved significantly. The manager described the online notification system that the service had signed up to and staff were informed at staff team meetings and handovers about any alerts that were relevant to this service.

Is the service caring?

The three people we spoke with were mostly complementary about the way in which the service supported them. One said, "some staff are better than others, but they are all good enough, and some are far more than just good'. Another person told us 'I am so lucky to be here' whilst someone else said 'nurses are all wonderful and helpful.

The people who were using this service each had a personal care plan. We looked at the care plans for three people who had spoken with us. The care plans covered personal, physical, social and emotional support needs. The care plans also contained details of activities people took part in each day, contact with family and friends and other information about how people preferred to live their life. We found that what people had told us about their care and support matched was the service had written in their individual care plans.

Is the service responsive?

The service compiled risk assessments that covered people's day to day activities, physical care needs and other areas of support that were being provided. We found that these were reviewed and updated at regular intervals and sooner if changes were necessary.

People's care and treatment reflected relevant, up-to-date, research and guidance. For example, we found that the service had obtained an updated medicines formulary, which meant that staff now had access to current information, including the uses of different medicines and any potential side effects of them to look out for. We saw that policies and procedures had also undergone review.

People's religious, cultural and personal diversity was recognised by the service. The manager informed us that people using the service were of Christian faith although people were not required to actively practice this faith as a condition of residence.

Is the service well-led?

The staff we spoke with were positive about the range of training opportunities available to them. The provider kept records, which we viewed, showing which training staff had completed, when refresher training was due in core skills and plans to include additional training in specialised areas, for example, manual handling and record keeping. We were shown an example of the appraisal and personal development plans that had recently been introduced. We were unable to see those which the manager said were with the provider for approval as the appraisal process for this year had recently been completed. The format for appraisal and development covered relevant areas and showed that action had been taken in response to what we had found at our previous inspection.

The manager told us that the provider carried out a quality monitoring process each month. A person using the service told us 'I get a questionnaire at least every month' and another said 'they are always asking me about what I think'.

Each of the people using the service is matched with a trustee of the charitable trust that provided the service. The manager informed us that this added to the opportunities which people had to discuss the way in which the service supported them and trustees reported back to the quarterly trustee meeting about people's views. We saw the most recent available minutes of this meeting and found that people's views of the service were given priority and any action required as a result was discussed and monitored.

There were steps in place to ensure that people were protected against risks of receiving care or treatment that was inappropriate or unsafe. Staff we spoke with accurately described their responsibilities in managing foreseeable emergencies.

There were suitable arrangements in place for obtaining, storing, recording, handling, administering and disposing of medicines, and staff accurately described their specific responsibilities in handling medicines.

Staff felt supported by management in their roles. However, staff did not always receive appropriate on-going training and professional development. Managers told us that they had recruited some new staff recently and that there were plans to provide more training once they were in post.

People told us they were invited to comment on the quality of the services provided through residents' meetings and satisfaction surveys, and that their comments were listened to and acted upon. Staff told us their views were also invited and acted upon through regular supervision and staff meetings.

A personalised care plan was developed with each person using the service that reflected their needs. However, review dates were not always made explicit.

People who use the services were protected from abuse. All staff had successfully completed safeguarding training during autumnn 2012, and were clear about the local safeguarding policy, contacts, and their particular responsibilities.

All staff had received relevant training to manage emergencies and were clear about the policies and action they would need to take. We saw that call bells were answered promptly and were told by people using the services that this was normally the case, including at night.

Staff received appropriate training and development to carry out their role based on their annual appraisal and service needs.

There were a range of tools in place to monitor and evaluate the service provided and which were reported on regularly through a range of meetings and forums.