This inspection took place on 21, 22 and 23 September 2016 and was unannounced on the first day. We told the registered manager we would be returning over the next few days. At our previous inspection on 29 May 2013 we found the provider was meeting the regulations we inspected.

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

The people living at the Margaret Thatcher Infirmary (MTI) known as Chelsea Pensioners reported that they were happy living at the home. Comments ranged from “very nice wouldn’t be anywhere else" and "Its first class here". Care plans were written with the person that included their consent for care and support.

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.

The people living at the Margaret Thatcher Infirmary (MTI) known as Chelsea Pensioners reported that they were happy living at the home. Comments ranged from: "I enjoy living here I have the privilege of living with very brave men" "I am cared for extremely well, I do need help that's why I moved into the MTI" " I cannot fault the care I receive here, the staff are excellent"

The Chelsea Pensioners we spent time talking with told us they were aware of the complaints procedure and would talk to the matron or deputy matron if required.