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Inspection carried out on 15 September 2017

During a routine inspection

Prince of Wales House is a residential care home providing personal care for up to 49 older people with dementia. The service also provides specialist care for people living with dementia. There were 49 people living in the home when we visited.

At the last inspection in July 2014 the service was rated Outstanding. At this inspection we found the service remained Outstanding.

Why the service is rated Outstanding.

The service has built on their previous success and sustained the outstanding model of care and support provided to people living in the home referred to as the ‘whole team’ approach. The directors of the company, management team and staff continued to find ways to improve the service and remained driven by their passion for caring for people, including those with dementia. The vision and the value of the service to ‘enable people to live as they choose’ remained embedded in the home.

Staff had an excellent understanding of people’s needs and were imaginative in the way they provided person centred care which put people at the heart of the service. They continued to find creative ways of supporting people to have an exceptional quality of life.

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.

The ‘whole team’ approach identified at our previous inspection continued to be a driving force in delivering a truly person centred service. Staff who have shown specific interests in particular areas, such as infection control were designated ‘Champions’. These champions continued to play an essential role in developing best practice, sharing learning and acting as role models for other staff.

Staff had a good understanding of systems in place to manage medicines, safeguarding matters and behaviours that are challenging to others. People’s medicines were managed so that they received them safely.

There were sufficient staff available to ensure people’s wellbeing, safety and security is protected. A robust recruitment and selection process was in place. This ensured prospective new staff have the right skills and are suitable to work with people living in the home.

Staff were compassionate, kind and caring and have developed good relationships with people using the service. People are comfortable in the presence of staff. Relatives confirmed the staff were caring and looked after people very well. People were provided with the care, support and equipment they need to stay independent.

Staff understand the importance of supporting people to have a good end of life as well as living life to full whist they are fit and able to do so. End of life care plans included people’s thoughts, feelings and wishes to ensure their passing is comfortable, pain free and as peaceful as possible.

A lot of consideration and thought has gone into the decoration and lay out of the service. The overall effect created was a homely and peaceful environment with due consideration given to the needs of people with dementia.

Staff spoke consistently about the service being a good place to work. The registered provider has worked in partnership with other organisations and has taken part in several good practice initiatives designed to further develop the service. Staff won an award at the Suffolk Care Awards in 2016 in recognition of the outstanding service provided at Prince of Wales House and were highly commended for the food and catering. The registered provider has a number of schemes in place to drive improvement and reward staff that use their initiative and for their outstanding contribution.

Further information is in the detailed findings below

Inspection carried out on 9 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The service was last inspected on 03 June 2013 and at the time was meeting all regulations assessed during the inspection. This was an unannounced inspection, which meant the provider did not know we were coming.

Prince of Wales House is a residential care home providing personal care for up to 49 older people. The service also provides specialist care for people living with dementia. There were 46 people living at the service when we visited.

A registered manager was in post. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

There was a strong and visible person centred culture in the service. (Person centred means that care is tailored to meet the needs and aspirations of each individual.) The vision of the service, ‘Everyone who comes through our doors will be included in our home and supported to feel safe, secure and wanted’ was shared by the management team and staff. The registered manager had introduced a new model of working, referred to as the ‘whole team approach’. This meant that all staff had a shared responsibility for promoting people’s wellbeing, safety and security. We saw that this ‘whole team approach’ was at the heart of the service provided, enabling people to have a full and meaningful life.

Staff described working as one big team, and being committed to providing care that was centred on people’s individual needs, which had created an environment that was much more vibrant, and friendlier. Staff told us that the management team were very knowledgeable and inspired confidence in the staff team and led by example.

The provider had systems in place to manage risks, safeguarding matters and medication and this ensured people’s safety. Specific care plans had been developed where people displayed behaviour that was challenging to others. These provided guidance to staff so that they managed the situation in a consistent and positive way which protected people’s dignity and rights. A thorough recruitment process was in place that ensured staff recruited had the right skills and experience and were safe to work with people living at the service. Staff rotas showed that there was consistently enough staff on duty to keep people safe.

We found that the care planning process centred on individuals and their views and preferences. ‘My Story’ booklets gave a detailed biography of the person’s life so far. Staff told us that these were being developed further to encompass people’s current interests and relationships because their lives did not stop when they moved into the service. Staff were finding creative ways to support people to live as full a life as possible and to enhance their wellbeing. There was a welcoming and friendly atmosphere in the service with a real ‘buzz’ of activity.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The registered manager had a good understanding of the MCA 2005 and DoLS legislation, and when these applied. Documentation in people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests.

People were able to discuss their health needs with staff and had contact with the GP and other health professionals, as needed. People were protected from the risks associated with nutrition and hydration. People spoke positively about the choice and quality of food available. Where people were at risk of malnutrition, referrals had been made to the dietician for specialist advice.

The service had innovative ways of ensuring that staff received the training they needed to deliver a high standard of care. Staff had been trained and appointed as ‘champions’. Champions were staff that showed a particular skill or interest in dementia, promoting people’s dignity, reducing falls, end of life care and infection control and acted as role models for other staff. Staff told us that they had received a lot of training. One member of staff highly praised the provider for the training it offered to all their staff.

The service had a strong commitment to supporting people and their relatives, before and after death. People had end of life care plans in place, which clearly stated how they wanted to be supported during the end stages of their life. A staff champion had been appointed taking a lead on promoting positive care for people nearing the end of their life. A visiting district nurse described the service as, “Absolutely wonderful and genuine place. The service is well-managed and the staff have a good attitude, they are always upbeat, very helpful, approachable and friendly.”

There was a strong emphasis on promoting and sustaining the improvements already made at the service. The provider was a member of several good practice initiatives, such as the Dementia Pledge, University of Bradford and Stirling Dementia Resources, Social Care Institute of Excellence, My Home Life and Dignity in Care.

Systems were in place which continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well and that management took steps to learn from such events and put measures in place which meant they were less likely to happen again.

Inspection carried out on 4 June 2013

During a routine inspection

We spoke with seven people who used the service about their experiences of the service they were provided with. People told us they were happy living in the service. One person said, “We are very well cared for.” Another person said, “The staff are very nice to you. I like it here.”

People told us that they chose what they wanted to do in their daily lives and that the staff listened to them and acted on what they said. One person told us, “I do what I want to, when I want to.” Another said, "The staff are kind to us and help us when we need help."

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

We looked around the service and found it to be homely, clean and well maintained. We saw that the provider had arranged appropriate servicing of equipment and had undertaken risk assessments of the environment.

Inspection carried out on 31 October 2012

During a routine inspection

We spoke with five people who used the service. They told us that they were treated with respect and that their views and choices were listened to and acted upon. People said that they were consulted about the care and support that they were provided with.

People told us they enjoyed the food. They said they liked the menu as it provided them with a variety of choices at meal times. One person told us, “It’s very tasty and moorish. You would never go hungry here.” Another person told us how they decided what they wanted to eat off the menu. They said, “Before the main meals are served, they (staff) show you two plates of food already made up. You can see what is on offer and pick what you fancy. They bring you over a freshly made up plate with your food on which is warm.”

People were complementary about the staff and manager. They told us their needs were met and they were well looked after. One person said, “The staff are very kind and friendly and do their best to help you.”

People said that staff respected their privacy and dignity. One person said, “They (staff) knock on the door before coming in my room and call out so I can hear them and don’t get startled."

Inspection carried out on 6 December 2011

During a routine inspection

People told us that they liked living in the home. Staff were kind and attentive. The food was good and plentiful. They could choose what they did, when they got up, and what they ate.

Reports under our old system of regulation (including those from before CQC was created)