Archived: Princess Marina House

Princess Marina House is situated on the south coast, in Rustington, West Sussex. It is an exceptionally large, purpose built, detached property spread over two floors. It has communal lounges, dining rooms and gardens. It is owned by The Royal Air Force (RAF) Benevolent Fund and is a home that offers respite and short breaks for serving and former RAF personnel and their families, however, will also accommodate personnel from other services. Princess Marina House can accommodate 50 people and is registered to provide care for up to 30 people, for adults over 18, some of whom are living with physical disabilities or dementia and who may require support with their personal care needs. On the day of the inspection there was one permanent resident who lived at the home and 16 people who were staying at the home for a short break. People could fund their own care and stay or have their stay subsidised by the RAF Benevolent Fund.

The RAF Benevolent Fund had conducted research and consulted with people across the country to identify what people required and expected of the fund. As a result, a respite at home service was implemented in 2016 for people who lived in their own homes, to reduce the risk of social isolation. This provided support for people, some of whom required support with their personal care needs, and offered a respite service to them and their permanent carers. On the day of the inspection there were six people receiving this service.

During the inspection we inspected both the home as well as the respite at home service.

The home and respite at home service had the same registered manager. 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.

People, who stayed at the home and those that used the respite at home service, received a service that was extremely responsive to their needs. People who used both services had access to a wide and varied range of activities and stimulation to meet their social and emotional needs. People were complimentary about the entertainment provided within the home, they told us, “There is always some form of entertainment. Every day you can get to the village on their bus” and “There are trips out and even when there are only two of us, they still take us out. There is plenty of entertainment”. People who used the respite at home service were supported to access the local community and partake in activities that they enjoyed. A relative of a person who used the service told us, “They do respond to all their needs. They pick my relative up and return them”.

The home and the respite at home service was extremely well-managed by both the provider and the registered manager. The registered manager strived to continually improve the service provided and welcomed feedback and used this to drive improvements and change. There were quality assurance processes in place to enable the registered manager to have oversight of the home and of the respite at home service, to ensure that people were receiving the quality of service they had a right to expect. People, relatives’ and staff were extremely complimentary about the leadership and management of the home and of the respite at home service. One person staying at the home told us, “The manager is on the ball. It’s beautifully run”.

People told us that they received a service that they valued and that had a positive impact on their lives. Comments from people staying at the home, included, “The service here is first class, it’s like coming on holiday” and “This place is the jewel in the crown. I would recommend it”. Positive comments continued from people and relatives who used the respite at home service. A relative told us, “Princess Marina does a marvellous job”.

Staff worked in accordance with peoples’ wishes and people were treated with respect and dignity. It was apparent that staff knew peoples’ needs and preferences well. Positive relationships had developed between people and staff. One person staying at the home, told us, “The staff are very friendly, they think a lot about me. They are polite with me, like asking if they could make my bed. I like to be happy and have a laugh and a joke with them all”. People and relatives who used the respite at home service were equally as positive. A relative told us, “The carers are so caring and are so interested in our past life” and “They are so good at talking to my relative. They get them to open up, where I can’t”.

People who stayed at the home and those that used the respite at home service were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff who had undertaken the necessary training to assure their competence and enable them to recognise concerns and respond appropriately. Peoples’ freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented.

People who stayed at the home and those that used the respite at home service, received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were safe systems in place for the storage, administration and disposal of medicines. A relative of a person who used the respite at home service, told us, “They give them their medication at lunchtime and they have never missed any”. The building and equipment were adapted to meet peoples’ needs. People who required assistance with their mobility had access to appropriate equipment to aid their independence.

People who stayed at the home and those that used the respite at home service were asked their consent before being supported and staff had a good awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. People and their relatives’, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. Care plans documented peoples’ needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current.

People who stayed at the home and those that used the respite at home service had their health needs assessed and met. People had access to medicines and healthcare professionals when required. Peoples’ privacy and dignity was respected and maintained. People within the home had a positive dining experience and told us that they were happy with the quantity, quality and choice of food. One person told us, “The meals are absolutely fabulous”. People who used the respite at home service, who required support with their eating and drinking, were supported appropriately. One person told us, “When they are here, they puree my food”.

The provider, management team and staff strived to ensure that people who stayed at the home and those who used the respite at home service, had access to high quality care. This was evident and embedded in their practice.

At the time of our visit there were two people using the service permanently and 21 people there for short stays, two of whom had no support needs and were accompanying their less able partners. We spoke with one person living there permanently and seven people using the service for a short stay. We also spoke with three staff, the team manager and the registered manager. We observed care practices and reviewed a selection of records. Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

Is the service safe?

People we spoke with told us that they felt safe in the service and one person said, 'I feel really secure. I couldn't wish for better'.

Care plans included information on how to maintain a safe environment for people using the service. The risks people were likely to face in daily living had been assessed and were reviewed regularly for those using the service permanently. Up to date guidance for staff was provided on the actions required to minimise the risks while maintaining people's well-being safely.

The service had policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The manager told us that there was no one subject to DoLS at the time of the inspection but relevant staff had received training to understand when an application should be made and how to submit one.

Procedures for the safeguarding of vulnerable adults were robust. We saw that staff received annual training on the subject and those we spoke with told us that they would not hesitate to report suspected abuse or concerns of poor practice in order to protect people's safety.

From our discussions with staff and the evidence seen we found that staff received the appropriate training, supervision and support to care for people safely.

Quality assurance systems were in place to ensure that lessons were learnt from the outcome of service reviews and events such as accidents and incidents and comments and complaints. This reduced the risks to people and helped the service to improve.

Is the service effective?

People told us that they were satisfied with the care provided and said their needs were met. One person said, 'I really relax when I'm here and they meet my every need'. Another told us, 'They encourage me to be as independent as possible but are always there if I want them'.

People's care and support needs were assessed with them, and people confirmed they had been involved in writing their care plans and these reflected their current needs. We saw that their written consent was obtained for the care and support to be provided. Their verbal consent was also sought before any care and support was delivered and staff respected their right to refuse their help.

Specialist equipment was available when required and the design of the premises enabled people with physical impairments to move around freely and safely.

Evidence showed that staff received the relevant training and support to provide effective care for people using the service. It was clear from what we saw and from speaking with staff that they had a good understanding of people's care and support needs and knew how to respond effectively in an emergency situation.

Is the service caring?

People were supported by caring and attentive staff. We saw that care workers treated people with dignity and respect and were friendly, patient and positive in their interactions with them. One person said, 'The carers are good at their jobs and care for you so well. I wouldn't go anywhere else'. Another said, 'I feel loved and cared for'.

People's preferences and diverse needs were recorded and care and support was provided in accordance with their wishes.

The atmosphere at Princess Marina House was relaxed and cheerful. Several staff we spoke with told us that they had been working in the service for several years and loved their jobs and enjoyed caring for people.

Is the service responsive?

Everyone had a person centred care plan and for people using the service permanently, these were reviewed and updated regularly and in response to their changing needs. Records confirmed that people received the care and support as described in the plan.

People were able to undertake a range of activities both within and outside the service if they wished. There was a library, wi-fi access and a licensed bar. The service also had three minibuses to enable people to access the community both locally and further afield for organised trips.

Staff were responsive to people's changing health care needs. Several people gave examples of how the service had responded effectively when they were unwell by obtaining help and advice quickly from the appropriate health care professionals.

Is the service well led?

The service had a quality assurance system in place which included audits and reviews carried out by the manager and the provider. The evidence showed that any concerns or shortfalls identified were addressed quickly and that improvements were implemented when required.

People who use the service, staff and visiting professionals were asked their views about the care and support provided and we found examples where action had been taken to improve the service provided as a result of their responses.

Staff we spoke with were clear about their roles and responsibilities and all said they were well supported by their manager and a good team who all worked effectively together.

People told us that they were happy with the care and support they received.

One person told us, "It couldn't be better, I get all the help I need".

Another person told us, "They are very good, you only have to ask".

We looked at people's individual care records. We saw that there was guidance for staff on how care and support should be provided in order to meet people's individual needs.

Staff demonstrated that they knew how care was to be delivered in line with people's wishes and preferences.

We spoke with two members of staff, who were on duty. We found that they had a good understanding of their roles and responsibilities.

We also gathered evidence of people's experiences of the service by looking at a selection of records. This included care records, medication records and records of complaints that had been received. We found that care records needed some improvements to ensure they provided care staff with appropriate information to follow with regard to the can to be delivered. This would mean individual needs would be met. We also found they demonstrated that people had given consent to the care they had received.

The manager demonstrated they had in place a system for recording and investigating any complaint that been made.

Medication records we examined demonstrated people had received medication that had been prescribed to them. They also demonstrated a robust system for recording medication that that been received and that unused medication had been disposed of safely.