This inspection took place on the 10 January 2017 and was unannounced.

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

This inspection was carried out on the 1 May 2015. Princess Christian Residential and Nursing Care Home provides accommodation for adults who require residential or nursing care some of whom are living with dementia. The registered provider is Nellsar Limited. The accommodation is provided over three units. On the day of our visit there were 84 people who lived at the service.

The service had a 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 did not always have access to activities that suited their individual needs. Some people did not think there was enough to do, whilst others enjoyed the activities that took place in the service.

We have made recommendations that all aspects of the service need to be cleaned and maintained. There were areas around the service that were an infection control risk. Some of the chairs, equipment and tables in the communal areas had fluid and food debris over them. The large blind in one of the day rooms was splashed with fluid. Most of the carpets in the hallways and around the home needed vacuuming.

Health and social care professionals were positive about the staff team at the service.

Staff were kind and caring and people’s privacy and dignity was promoted. Care provided was good and staff were knowledgeable about people’s needs. One relative said “It is absolutely marvellous here, you can’t fault anything

Staff had received appropriate training and supervision and staff underwent a detailed recruitment process before they started work. One relative said, “There always seem to be a lot of staff around.”

People’s safety was promoted and there were robust risk assessments in place to maintain this. Care plans and practice were reviewed regularly to ensure they were meeting the needs of people who were supported. One relative said “Staff are aware of (their family members) risk of falling. If (the family member) gets up, there is always a member of staff there to support (the family member)”

Accidents and incidents were reviewed by the manager to ensure any action needed to reduce the risk of recurrence was taken.

Medicines were managed safely and people received their medicines in accordance with prescriber’s instructions.

Staff knew how to recognise and respond to allegations of abuse.

People were offered a choice of nutritious food in accordance with their dietary needs. The chef was knowledgeable about people’s dietary requirements and staff assisted people to eat where needed. People who were at risk of not eating or drinking sufficient amounts had their intake and weight monitored.

The design of the environment helped people living with dementia to be as independent as possible.

Complaints were recorded and responded to in a timely way. There was a complaints policy and a system of logging the complaints and learning from them.

Effective audits of systems and practices were carried out. Where concerns had been identified these were addressed. Records were maintained in a clear way.

People and their relatives felt that the service was well managed. Staff felt supported and motivated by the manager. Annual surveys were sent to people and relatives and there was evidence of what action needed to be reviewed as a result of the survey.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and

where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service. The manager and staff were familiar with their role regarding MCA and DoLS.

During this follow up inspection we spoke with three relatives and two staff. We also made observations throughout the visit.

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.

There were 80 people living at the home at the time of the inspection. During the inspection visit we spoke with eight people and their relatives and spoke with one relative after the inspection.

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.

There were 80 people living at the home at the time of the inspection. During the inspection we spoke with three people who used the service and three relatives. We also spoke with two visiting professionals and nine staff, including the registered manager.

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.

People who used the service told us their medical needs were well looked after. The General Practitioner (GP) was called to visit them if they were unwell. They told us they were always consulted and supported about the care they wanted and received. They said staff spent time explaining changes to them. People told us they decided if they needed a duvet or just a sheet at nights during the recent hot weather and that they could have had a fan if they wished.

People told us their bedrooms were cleaned daily and there were domestic staff employed to do the cleaning. They said the home is usually clean and tidy. People said they had never experienced shortage of any type of linen, towels or flannels. They told us their laundry was taken away as needed and returned in their named baskets or on hangers to their bedrooms sometimes twice daily. People told us they had no problems obtaining incontinence pads and they were not aware there were any shortages.

One person said they ordered chips and got sauté potatoes, and that they did not eat one of the two vegetables on their plate. However, apart from these little mistakes the food is much improved and is now quite good and the food comes to us hot. People who used the service told us there is an increase in staffing numbers and their personal care is much improved.

We spoke with one person using the service who told us they were happy at the service even though they were bored. They felt the activities provided were childish and they had seen all the movies in the cinema.

One person who used the service told us the food is awful and it's a shame to have to wait so long for their meal. Others told us the food is good. Relatives spoken to on the day of the site visit told us they have never sampled the food, but their relatives seem to enjoy their meals.

Generally, people spoken to who use the service were not fully able to answer questions asked about safeguarding matters. However their relatives were present and were able to answer the questions from a relative/visitor's point of view.

Relatives told us the manager is in contact with them and would inform them if an incidence occurred relating to their relative. Relatives said they visited the home regularly both day and night and have never witnessed any actions or suspicions of abuse by staff or other people using the service. However, they have on occassions witnessed some shouting and pushing amongst people who use the service, but this is quickly interrupted by staff, so that no harm came to the people involved.

People told us that staff were kind and approachable. We observed staff interacting with people in a respectful, kind and sensitive manner.

People who use the service told us there is never enough staff. We have not had a bath or shower in a long time. Another person told us There is not enough staff, far from it. The staff we have are good and they do the best they can.

People using the service told us the manager is approachable and always come to the lounge to see them.