The Queen Alexandra Hospital Home is a nursing home which provides a multi-disciplinary approach to care and rehabilitation of people with neurological and medical disabilities, predominantly, but not exclusively, to people who have served with HM Forces or who had relatives in the forces. The service is registered to provide nursing care for up to 60 people, on a short term or long term basis. The Queen Alexandra Hospital Home has three wards: Alexandra, Norfolk (North) and Norfolk (South). At the time of our visit there were 53 people living at the service and one person receiving short term care. Nine bedrooms were being shared. These rooms were spacious and offered privacy to those living in them. The service is equipped to aid rehabilitation of people back into the community, if appropriate, and to promote independence. Communal areas offered people a variety of options of where they could spend their time including if they were receiving visitors. Premises are purpose-built to meet people’s needs.

At the last inspection carried out on the 8 and 9 October 2014 the service was rated Good. At this inspection we found the service remained Good.

We carried out this inspection as part of our routine schedule of inspections and to check that people were still receiving a good standard of care and support.

People and their relatives felt that The Queen Alexandra Hospital Home provided safe care and that premises and equipment were well maintained. Staff, including the nursing team, responded to people's needs promptly and had been trained to recognise the signs of potential abuse; they knew what action to take if they had any concerns. Risks to people were identified, assessed and managed safely by staff. Staffing levels were sufficient to meet people's needs and safe recruitment practices were in place. Medicines were managed safely to ensure people received their medicines as prescribed.

People received effective care from staff that had completed extensive training in a range of areas. Registered nurses completed additional training to meet people's needs. Staff were given opportunities for them to study for additional qualifications. All staff training was up-to-date. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift.

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.

People were supported to have sufficient amounts of food to eat and plenty to drink to maintain a healthy diet. They had access to healthcare professionals. This included access to professionals employed directly by the service such as speech and language therapists, physiotherapists and an occupational therapist. This meant people’s needs could be assessed promptly and support and treatment could be commenced without delay. People's rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were respected by the staff that supported them.

People were involved in decisions about their care as much as they were able. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided personalised information. People's personal preferences and their likes and dislikes were documented so that staff knew how people wished to be supported. There was a variety of activities on offer which people could choose to do if they so wished.

Complaints were dealt with in line with the provider's complaints procedure.

Weekly and monthly checks were carried out to monitor the quality of the service provided. There were regular staff meetings and feedback was sought on the quality of the service provided. People and staff were able

At the time of our visit we were informed that there were currently fifty three people living or staying at the home, which also included individuals receiving respite care.

We looked around the home which was clean and free from unpleasant odours. The home had three wards, one offering twenty two single rooms with ensuite facilities the other wards had accommodated twenty three or fifteen people in single or double rooms with shared bathroom block. We saw that individuals had personalised their room with photographs, books, TV’s and pictures. On display in their rooms were people’s program of their activities for the week. All the door ways and corridors were wide enough for wheel chair access and there was a lift so people could access the first and ground floors which enabled people to move around independently.

During our visit we spoke with four people who used the service, and three visitors. We also spoke with five staff including the registered manager. We spent time observing how staff interacted and supported people. We saw staff treat people in a sensitive, respectful and professional manner.

All the people we spoke with liked being at the Queen Alexandra Hospital Home, one person told us that they were ‘very happy here’ and that the ‘staff were superb’. Another individual told us that they ‘couldn’t fault it’ and that ‘everybody was lovely’. One of the relative’s we spoke with told us that the staff ‘go that extra mile’.

We spoke to seven people during our inspection visit. We also used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people who used the service.

People we were able to speak with who lived in the service told us they liked living at The Queen Alexandra Hospital Home.

We were told "Excellent, sometimes I grumble but the staff are very good,” "Caring and kind staff,” and "I know I'm safe, staff look after us very well.” We also spoke with relatives/visitors. One visitor told us “Wonderful place, the staff are very committed.”

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We found that care and treatment was planned and delivered in a way that ensured people’s safety and welfare. There were effective recruitment and selection processes in place and staff records and other records relevant to the management of the service were accurate and fit for purpose.

We were told that independence and individuality were promoted within the home. People living there told us they were supported and enabled to do things for themselves. They said they were encouraged to express their views and make or participate in making decisions relating to their care and treatment.

People we spoke with confirmed that they had been asked how they preferred to be addressed and that this was respected.

We asked people whether staff knocked on doors and were assured that they always did. They also said they felt staff respected their privacy and were very careful to close doors when personal care was being provided.

The inspection took place on 8 and 9 October 2014 and was an unannounced inspection.

Queen Alexandra Hospital Home provides a multi-disciplinary approach to care and rehabilitation of people with neurological and medical disabilities, predominantly, but not exclusively, to people who have served with HM Forces or who had relatives in the forces. The service is registered to provide nursing care for up to 60 people, on a short or long-term basis. Queen Alexandra Hospital Home has three wards: Alexandra, Norfolk (North) and Norfolk (South). At the time of our visit there were 53 people living at the service, with two people in hospital. The service is exceptionally well-equipped to aid rehabilitation of people back into the community, if appropriate, and to promote independence. Premises are purpose-built to meet people’s needs.

The service has 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 told us that they felt safe and described a feeling of warmth as they came through the door. Staff had received safeguarding training and knew how to recognise the different types of abuse and what action they would take should they suspect abuse was taking place. Physical restraint was not used, except for wheelchair users, to prevent falls from occurring and for people with acquired brain injury, to prevent them from pulling out intravenous lines. Best interest decisions were taken as needed to ensure that people were not restricted unnecessarily. The service followed the requirements under Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded and reported in a timely manner, lessons learned and action taken to prevent reoccurrence. Staffing levels were sufficient to keep people safe and meet their needs. Staff said, “You do get time to spend with everyone, you get to know everyone”. Staff were recruited and references and checks undertaken, including criminal records to ensure they were safe to work with people. People’s medicines were administered, managed, stored and disposed of safely. We observed the administration of medicines and that people were asked for their consent before receiving their medicines.

The service delivered an outstanding and effective level of care. People’s nutritional needs were monitored and a dietician’s services were bought in to ensure people received individualised nutritional care. People were on diets that were tailored to meet their individual needs. Staff were extremely attentive when supporting people to eat their meals and there was a relaxed, warm and friendly atmosphere in the dining room. Access to healthcare services was readily available both internally and externally. The service employed the service of an occupational therapist, speech and language therapist, neuro-psychologist and others. A GP visited twice a week. There was a holistic approach to people’s care. People had access to regular physiotherapy sessions with trained staff in a centre that had equipment such as a treadmill, balancing machine and walking rails. The service had exceptionally well equipped and purpose-built premises so that people could be provided with high quality support that met their individual needs and promoted their independence.

Staff were fully trained in essential areas and also in specific areas to ensure that people’s complex needs were met effectively. People’s capacity was assessed prior to admission to ensure that their needs were met at the point of admission. The provider was pro-active in their approach to ensure that staff were trained in any additional areas as required, so people’s needs could be met swiftly. Assessments were undertaken by a neuro-psychologist when people entered the service. This specialist was funded by the service which meant that people’s needs could be assessed promptly and support and treatment could be commenced without delay. People were able to come and go as they pleased and could access the community freely.

Staff knew people very well and said, “I love working here. You really get to know the patients well”. One person said, “I love being here and the grounds are amazing”. People spoke very highly of the staff and the care that they received. Staff communicated effectively with people who had little or no verbal communication and involved them in all aspects of their care. An emphasis was on people being supported to be as independent as possible. Work was in progress to build a wheelchair clinic to review and repair wheelchairs. Relatives were encouraged to be involved in their family member’s care and could visit whenever they wished. Staff were trained in end of life care and people and those that mattered to them were fully involved in planning the care they wished as they came to the end of their lives. There was a multi-denominational chapel on site and a chaplain provided people with spiritual and emotional support if they wished.

The service was responsive to people’s needs – with their care needs and with arrangements to prevent them from being at risk of social isolation. People’s care needs were reviewed regularly by a range of professionals, including a multi-disciplinary team. There was a range of activities on offer at the service, for example, craftwork, painting and sewing. staff. Outings were organised to London and a specially equipped coach ensured that wheelchair users could also access the community. People knew how to raise any concerns and complaints were dealt with in a timely manner.

People were actively involved in developing the service and their views and opinions were sought and acted upon. Questionnaires showed that people were very positive about all aspects of their care. Fundraising was a major factor in providing the excellent quality of care and the service had a team dedicated to raising funds. This funding enabled people to receive services from a range of specialists so that individualised care and treatment could be delivered speedily. Funding also subsidised outings and was used to provide state of the art facilities at the service. Staff surveys showed that staff were happy in their roles and felt supported. Senior managers were overseen by a Board of Directors who took an active part in overseeing the service and visited regularly. Effective quality assurance processes and procedures ensured that every aspect of the service was audited to maintain a high quality service and also to identify any improvements that would help to maintain and raise the quality of service and care provided. The service worked with a range of other organisations and staff were kept up to date about latest guidance for delivery of care and treatment.