Princess Christian Residential and Nursing Care Home

Princess Christian Residential and Nursing Care Home (referred to as Princess Christian in this report) is a care home providing accommodation, personal care and nursing care for up to 96 people. The service provided care to people with long term health conditions, people living with dementia and people at the end of their life. At the time of our inspection, 83 people were living at the service.

The service is divided into three separate living areas, depending on people’s needs and dependency. We inspected all three living areas as part of this inspection.

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

People received an outstanding service in relation to the food they were provided with. There was a strong emphasis on the importance of eating and drinking. This ensured people continued to eat and drink, despite having health conditions which may make this element of their day to day living difficult. People regained their independence with their food and drink through staff input and where people were provided with a modified meal this was presented in a way that ensured it looked the most appetising it could.

Innovative and inventive practices were in place to meet people’s holistic needs from well trained staff who were happy in their role. This had resulted in exceptional outcomes to some people in relation to their health and well-being, including someone being able to walk again and another person to regain their independence at mealtimes.

The service had a creative way of training clinical staff which meant they did not spend a long time trying to recruit nurses into the service. The service was accredited by a national body to run courses to support clinical staff to achieve the necessary qualifications.

There were champions within the service who actively supported staff to provide outstanding care when people were at the end of their life. This meant people were enabled to live well until they die. As an outcome of their work, Princess Christian was invited to roll out their good practice to other services within the borough.

People’s lives were improved by staff. People’s well-being was promoted through the staff’s consistent and high level of care.

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

There were sufficient staff to care for people and people felt cared for in a respectful, kind and supportive way. People felt safe living at Princess Christian and told us they received the medicines they required.

People lived in an environment which was suitable for them and promoted independence through the use of signage and equipment. The environment was well-maintained and clean, housekeeping staff working continuously in ensuring the environment was neat and tidy.

People told us staff were kind and caring and they could make their own decisions. People said there were things for them to do and they had access to an outside space. Where people had individual communication requirements, staff were aware of these.

People’s care plans contained good information for staff, although we found some that required additional information. The shortfalls we found were addressed immediately. The impact to people was low as clinical and care staff knew people’s needs very well. Those people at the end of their lives were provided with care in line with the Gold Standard Framework for end of life care.

The culture within the service was positive, people and their families felt the service was well-managed. People, their families and staff were supported to be involved in the service and staff told us they enjoyed their jobs.

The registered manager knew people well and was always looking for ways to improve the service. He worked well with external agencies to provide suitable and good quality care for people.

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 service was Outstanding (report published 21 January 2020).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We 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.

Follow up

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

Princess Christian Residential and Nursing Care Home (“Princess Christian”) is a residential care home registered to provide personal and nursing care up to 96 people. They have changed the purpose of some rooms so now have a maximum capacity of 92. Care was provided to people aged 65 and over at the time of the inspection. Many people were living with dementia. The service was supporting 82 people during the inspection.

The service operated in three nursing units: Bisley where people living with complex dementia lived; Knaphill a nursing unit for people who were needing palliative care and end of life care and, Pirbright where people with nursing and less complex dementia needs lived.

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

Everyone described Princess Christian in outstanding terms. People, relatives, professionals and staff described how the service was safe, effective, caring, responsive and well led to the best that it could be and was always looking to improve further. The values of caring, compassion, communication, competence, commitment and courage ran through the service and were continually measured to ensured good outcomes for people. This was achieved by the service’s quality assurance process, audits and listening to the views of everyone and acting on this.

The service had been nominated for several care awards and accredited for its end of life care, quality assurances and training of staff.

One person said, “This is a very good home. The care for my late husband was outstanding and they have looked after me every bit as well. At the end they made sure there was someone with him all the time, he was never left alone. I have nothing but praise for the home, the manager and the staff. It’s a lovely home, very well run.”

A relative said, “The registered manager has created and oversees a very caring and committed team. His visibility around the home encourages relatives to approach him and prevent any problems” and another said, “It is a brilliant care home”.

The care of each person was very personalised which meant they had the support needed and as desired. Every aspect of people’s care was planned around the person that is, meeting their health needs, goals and desires. One relative said, “I am also impressed that they like to understand the background and particular personality of each person.” This included food, medicines management and activities.

Staff worked in partnership with people, relatives and professionals. People were supported to have absolutely maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. When acting in people’s best interests, staff searched for ways to ensure the person had the life they would want to live should they have cognitive control. For example, a person living with advanced dementia who used to work as a carpenter was given a set of safe tools and observed to sit happily with these ‘working’ away at his latest project.

The leadership and governance of the service was very robust and passionate about supporting the staff to excel. The staff team led by the registered manager were highly trained and put this into practice. Creative ways had been put in place to recruit staff, retain staff and train staff to the accepted standard.

A relative said, “Princess Christian is lovely; everyone is approachable and friendly. The registered manager always speaks when he sees us. It’s a place full of smiles and we are confident [our relative] is happy here.”

Rating at last inspection

The last rating for this service was Good (published 31 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the full report by selecting the link for Princess Christian Residential and Nursing Care Home on our website at www.cqc.org.uk.

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. Summary reviewed.

A registered manager was in post. 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.

Princess Christian Residential and Nursing Home provides accommodation and personal care for up to 96 people. On the day of our visit there were 88 people living at the service.

People and their relatives told us they felt the service was safe. Relatives told us that staff were very kind and they had no concerns in relation to the safety of their family member. Staff had received training in relation to safeguarding and they were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse. The provider ensured that full recruitment checks had been carried out to help ensure that only suitable staff worked with people at the home. Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

Staff had received training, regular supervisions and annual appraisals that helped them to perform their duties. New staff commencing their duties undertook induction training that helped to prepare them for their roles. There were enough staff to ensure that people’s assessed needs could be met. It was clear that staff had a good understanding of how to attend to people’s needs.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way. People were not prevented from doing things they enjoyed as staff had identified and assessed individual risks for people. The registered manager logged any accidents and incidents that occurred and discussed these with staff so lessons could be learnt to help prevent a repeat of these.

Staff supported people to eat a good range of foods. Those with a specific dietary requirement were provided with appropriate food. Regular discussions took place between the chef, staff and people to ensure the food provided was nutritious and what people liked to eat.

People had access to external healthcare services and professional involvement was sought by staff when appropriate to help people maintain good health.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private. People took part in a variety of activities that interested them. People’s relatives and visitors were welcomed and there were no restrictions of times of visits.

Documentation that enabled staff to support people and to record the care they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded. People and their relatives were involved in their care. People were able to continue following their hobbies and interests through the meaningful activities that were provided at the home.

If an emergency occurred or the service had to close for a period of time, people’s care would not be interrupted as there were procedures in place for events such as flood, fire and failure of utilities. There was an on-call system for assistance outside of normal working hours.

A complaints procedure was available for any concerns. This was displayed at the service. Complaints received had been addressed and resolved within the stated timescales set out in the provider’s complaints policy.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff.

People, relatives and associated professionals had been asked for their views about the care provided and how the home was run. Regular staff meetings took place.

Staff informed that they felt supported by the registered manager and they had an open door policy and were approachable.

We saw that systems were in place which had improved the effectiveness of cleanliness and infection control. This had included an additional member of housekeeping staff to assist with daily cleaning.

Each relative told us that cleanliness and maintenance was good. One relative told us 'It seems cleaner.' Another relative said 'It's always been ok.' Another person told us 'You can't fault the cleanliness.'

Relatives were also positive about the maintenance and confirmed that maintenance issues seem to be 'Dealt with promptly'. One relative told us 'It's lovely here, nice and modern and well maintained.'

We noted that improvements had been made to maintenance systems, including checklists and audits which were up to date.

In our previous visit we asked the provider to note that the system for verbal complaints was not robust but we did not make a compliance action. We reviewed these arrangements with the registered manager and saw that this had been strengthened so that verbal comments and complaints were monitored and appropriate action taken and recorded.

To help us understand people's experiences we used our Short Observational Framework for Inspection (SOFI) tool as part of our observation methods. The SOFI tool allowed us to spend time observing interactions and identify the type of support people received and whether people using the service had positive experiences. We also spoke with seven staff, reviewed records and carried out observations throughout the visit.

People told us that their consent was always obtained before carrying out any personal care and we saw that staff obtained consent and explained what they were doing when they helped people.

One person told us that staff were 'Very patient' and a relative told us 'No where is perfect but I think this is. ' However there were some negative comments about care from some relatives.

We saw that some cleaning routines were not always followed and not all staff knew what to do to protect people from the risk of infection. We also had concerns that some of the environment was not adequately maintained.

We noted that appropriate recruitment checks took place which meant that staff were suitably skilled and fit to practice.

People were made aware of the complaints system and saw that written complaints had been investigated.

To help us understand people's experiences we used our Short Observational Framework for Inspection (SOFI) tool as part of our observation methods. The SOFI tool allowed us to spend time observing interactions and identify the type of support people received.

Responses from people we spoke with were mainly positive about the nursing care. One relative told us 'The nursing care is excellent here.' However, there were some negative comments, particularly in relation to lack of activity and stimulation for people. One person told us that there was 'Nothing to do.' Another person explained that language could be a barrier as many staff did not speak English as a first language. Despite this people told us that care staff were polite and helpful and that they felt safe with them.

People told us that they thought that the staff were well trained and that care was mainly good. One person commented that 'The care is excellent.' However, another person told us that staff were not consistently good as people could be 'Left for long periods.'

People told us that there had been improvements, such as regular residents meetings and improvements to the menu.