St Davids Residential Care Home

St Davids Residential Care Home is a care home providing personal and support to 15 people aged 65 and over at the time of the inspection. The service can support up to 18 people. The home is an adapted period building in a seaside resort.

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

Improvements had been made, since the last inspection, to the overall condition and safety of the care environment. People were being protected from the risk of scalds, and adaptations had been made to radiators. People were being protected from the risk of falling from height, as changes had been made to window restrictors and the gates on the landings leading to flights of stairs. There was an ongoing refurbishment plan in place, and people had contributed to the decorations, for example through crafts and having photographs on the walls of events such as people’s birthdays.

People we spoke with felt comfortable speaking openly in front of staff to give us feedback about the standards of care provided. One person gave high praise regarding the food and levels of care provided by staff. We observed people to be actively interacting with staff, including the registered provider, who people felt able to approach and discuss any concerns with.

Staff told us about the systems and processes implemented to maintain people’s safety during a recent COVID-19 outbreak at the service, and acknowledged that whilst this had been an emotionally challenging time to work, they had worked well as a staff team to keep people safe and prevent social isolation and loneliness.

The interim manager and registered provider had implemented additional governance checks and processes since the last inspection, to try to ensure that shortfalls in care provision were being identified and addressed in a timely way; some systems were still being embedded into practice at the time of the inspection visit.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was Requires Improvement (published 11 June 2021). A warning notice was served on 14 May 2021 in relation to the breach of regulation 17 (good governance), with timescales for the provider to be compliant by the 01 September 2021. At this inspection enough improvement had been made and the provider was no longer in breach of regulation 17 and had met the requirements of the warning notice.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

St David’s Residential Care Home is a residential care home providing personal care to 14 people aged 65 and over at the time of the inspection. The service can support up to 18 people. The home is an adapted period building in a seaside resort.

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

Whilst the people who used the service had benefited from some improvements to the service since our last inspection, the provider had failed to ensure the environment was safe and free from harm. Their governance monitoring system had been ineffective at identifying and rectifying these concerns. However, prompt action was taken by the service to make these areas safe.

The outcomes for most people were good. However, for some, this was not the case and a lack of staff meant we observed that they were left unstimulated and without meaningful interaction for a long period of time. This also put people at risk.

Communication was generally good however, some relatives we spoke with reported that this could be improved as they did not always feel fully involved in their family member’s care. Staff reported good internal communication, a positive atmosphere and a supportive management team.

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. We also saw that people’s needs were met in relation to their nutritional, healthcare and medicines needs.

Most relatives and all the staff we spoke with talked positively about the service and management of the home. Relatives told us they would recommend it with one commenting, “I cannot fault it” while another said, “[Family member] is really happy and I would recommend it. Staff know how to treat people and they are very caring, and they listen.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (report published on 22 October 2019) and there were four breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, although we found some improvements, the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about multiple aspects of the service including staffing, risk management and quality of care. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to environmental safety issues, infection control management and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St David’s Residential Care Home is a residential care home providing personal care to 13 people aged 65 and over at the time of the inspection. The service can support up to 15 people. The home accommodates people in one adapted building.

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

Concerns were identified at this inspection relating to the management of risks and people’s care records. Effective governance procedures were not in place and the registered manager was not provided with sufficient support to perform their role effectively. This resulted in some people being placed at risk of harm in aspects of their lives.

Certain individual and environmental risks were not effectively managed. Individual risks had not been consistently reviewed, assessed and mitigated and there was no formal process in place to analyse accidents and incidents or learn when things went wrong. The recruitment processes did not provide assurance that suitable staff would always be appointed.

Governance and oversight of the service was poor and this hindered service development. Some of the audits in place to monitor the service were ineffective. Regulatory and legislative requirements were not routinely met.

We could not be assured from the care records and from speaking with staff, that people were always supported to have maximum choice and control of their lives or that staff supported them in the least restrictive way possible and in their best interests.

Staff received regular training on relevant areas of care and people’s nutritional and health care needs were met. The registered manager had developed a caring and committed culture within the service. People and staff were happy and felt valued. People who used the service told us they liked the staff and that they were kind to them; our observations confirmed this.

Most people we spoke with were happy with the care provided however improvements are required in a number of areas to meet regulations and legislation and to fully protect people from risk of harm.

Rating at last inspection

The last rating for this service was Good (published 23 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified four breaches of regulations in relation to safe care and treatment, staff recruitment, consent and the governance and management of the service.

Please see the action we have told the provider to take at the end of this report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

St David’s Residential Care Home provides accommodation for up to 18 older people. There were 15 people living in the home when we visited.

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.

During our last visit to the home in December 2014, we found that there were breaches of two regulations. These were about seeking consent from people, and assessing and monitoring the quality of the service. During this visit, we found that improvements had been made in these areas and the regulations were met.

Staff reported concerns to the registered manager or CQC if they had any; however, they had not received safeguarding training. This meant there was some risk of staff not identifying potential abuse. However, the registered manager was clear about safeguarding procedures and the proprietor had organised for all staff to receive training imminently.

People living in the home had documented risk assessments in place which were individual to their own needs. These provided staff with guidance on how best to protect people from risk of harm, whilst supporting them to take risks such as improving their walking. Staff supported people to maintain as much independence as possible and improve their mobility where possible.

Risks to the environment were managed appropriately. People received their medicines as they were prescribed. Where they required extra healthcare, staff supported them to access this whenever people needed.

People were supported by staff who had the knowledge and skills to provide good care to them. Staff were well supported, and there were enough staff to keep people safe and meet their needs. They were also robustly recruited to ensure they were deemed safe to work with people.

Staff asked people for their consent, and people decided on how they wanted to be cared for by staff. Staff were kind and knew people well, and they had built good, trusting relationships with people. Staff promoted people’s privacy and dignity as well as their independence.

People were supported to eat a good choice of freshly prepared meals, according to their own preferences. Everyone had access to drinks whenever they required.

People chose how they wanted to live and staff supported them to go out. People followed their own hobbies wherever possible. Staff engaged people in activities when they had the opportunity, and took people out.

There was good leadership in place, and teamwork between the staff. There were processes in place to assess, monitor and improve the quality of the service. This included gaining feedback from people, staff and relatives, as well as carrying out various audits to pick up any potential areas for improvement. However the proprietors had not always provided the registered manager with the resources they required to manage the service, deliver care and provide training.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

What people told us and what we found:

An inspector for adult social care carried out this this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with six people who used the service, spoke with two family members of people who used the service, the registered manager and three other members of staff. We also carried out observations, reviewed records relating to the management of the service which included four care plans, daily records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that action had been taken to improve toilet facilities on the ground floor. This meant that staff could support people with mobility aids more safely. Staff made sure that they offered people support, encouragement and reassurance when they were assisting with their mobility.

Systems for identifying and managing risks to people living in, working at and visiting the home were not sufficiently robust. Maintenance issues were not addressed promptly. This increased the risk of harm to people. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safety and maintenance of premises. They also need to tell us how they are going to improve the identification and management of risks within the home.

Records were not accurate. This meant that they were at risk of receiving inappropriate care. People's confidential records were not all stored securely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring records are maintained accurately, stored appropriately and are fit for purpose.

We observed that staff responded to call bells promptly. One person told us that if they used their call bell, 'They're here like a shot.'

People were not subject to unnecessary restrictions on their movements or contact with their friends and family. No applications for depriving people of their liberty, as set out in the Deprivation of Liberty Safeguards, had been needed.

Is the service effective?

People's care needs had been assessed and staff were able to tell us about the support they offered to people to meet those needs. We saw staff assisting and encouraging people with their mobility. We also observed that people were encouraged with fluids. A relative told us they had noticed staff prompting people regularly. This meant that people's risk of dehydration and urine infections was minimised. People who needed encouragement to eat were given this.

However, the lack of evidence of regular weight monitoring meant that weight change would not be detected promptly so that interventions could be made where necessary. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people receive good nutrition.

For one person, our discussions, observation and review of records showed that staff had been successful in supporting the person to regain confidence and increase their mobility since moving to the home.

Is the service caring?

People were supported by staff who were kind and caring. A relative told us they visited very frequently and had never had any concerns about the way people living in the home were treated or spoken to.

People and their relatives were asked for their views about the service but there was no evidence of what had been done to address any suggestions for improvement. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to taking account of the views of people, their relatives and representatives and staff.

One person said, 'I love it here. I'm spoilt rotten.' Another told us, 'All the girls [staff] are good.'

Is the service responsive?

Staff were able to tell us how people's needs had changed. They sought further expertise and advice when they found people's health had deteriorated, showing that they responded appropriately.

Is the service well led?

Staff had a good understanding of their roles and gave priority to supporting people with their care.

There was not an effective quality assurance system to identify and address shortfalls promptly so that the service continually improved. We have asked the provider to tell us what they are going to do to ensure the requirements of the law in relation to quality assurance are met.

We spoke with seven of the 15 people who used the service. All told us that they felt that they were happy and that the staff treated them with kindness and respect. We visited two people who preferred to stay in their bedrooms during the day and they told us that their call bells were answered promptly. However, people in the communal lounge told us that there were times when staff were not available. This was confirmed in our observations. One person said, "We are on our own." Another said, "They could do with a few more staff, they (staff) work very hard and are always on the go."

We looked around the service and found that it was clean and hygienic. However, we found that the communal lounge was in need of redecoration and the toilets on the ground floor were not fit for purpose.

Our inspection of 13 May 2013 found that improvements were needed in the training provided to the staff and how the service was monitored by the provider to ensure that people were provided with safe care and support.

During this inspection we looked at the provider monitoring records and staff training and supervision records. We spoke with the registered manager and two staff members. We found that improvements had been made. However, we found that a training programme was in place but it had not yet been fully completed, we will continue to monitor this.

People told us that the staff treated them with respect and kindness. One person said, 'They (staff) are all pretty good.' Another person said, 'They (staff) are always kind.' This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

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.

Staff personnel records that were seen showed that staff were not provided with the training that they needed to meet the needs of the people who used the service. The provider did not have robust systems in place to assess and monitor the service that people were provided with.