Archived: St. David's Home

St David's Home is a care home with nursing providing personal and nursing care for up to 76 adults living in 4 units. 1 area is used to provide rehabilitation support to people with a range of physical disabilities with the aim of being able to live a more independent life and to return to their home or move to other accommodation. At the time of the inspection there were 63 people staying at the home. The home is operated by St David's Home For Disabled Soldiers, Sailors and Airmen, a registered charity.

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

People and relatives said care staff treated them well. However, most people said the quality of the service needed to improve and it was not well-led. A relative told us, “I would tell people not to go there. I wouldn't recommend it to anyone.” The culture of the service did not always promote supporting people to achieve good outcomes.

The provider had not always assessed, monitored and managed risks to people's safety and well-being. People's medicines were not always managed in a safe way. Some people had experienced an inconsistent approach to safeguarding them from avoidable harm.

Some people's care plans were not always up to date, sufficiently personalised or reflective of the care and support people received.

The systems in place to monitor the quality of the service and make improvements when required

had not always been effective. The provider had not made enough improvements since the last inspection to address breaches of regulations.

The service provided a variety of weekday activities for people but this resource was not available to people who stayed in their rooms.

There were appropriate staff recruitment processes and infection prevention and control procedures in place. Staff, people and relatives had opportunities to comment on the running of the service. There were systems for recording and responding to complaints.

Staff worked with other agencies to provide people with joined up care.

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 8 August 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 4 consecutive inspections.

At our last inspection we recommended that the provider consider current guidance on assessing and monitoring safe staffing levels. At this inspection we found the registered manager had implemented a protocol for determining staffing levels.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and providing people with safe care. A decision was made for us to inspect and examine those risks. We had also carried out an unannounced focused inspection of this service on 10 and 11 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment, infection control and good governance. We undertook this focused inspection to also check they had followed their action plan and to confirm they now met legal requirements. As such, this report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this report.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St David’s Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, medicines management, person-centred care and good governance. We have made recommendations regarding the call bell system, activities provision, complaints handling and service culture.

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

Follow up

We will request an urgent 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

St David's Home is a care home with nursing providing personal and nursing care for up to 76 adults living in four units. One area is used to provide rehabilitation support to people with a range of physical disabilities with the aim of being able to live a more independent life and to return to their home or move to other accommodation. At the time of the inspection there were 62 people staying at the home. The home is operated by St David's Home For Disabled Soldiers, Sailors and Airmen, a registered charity.

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

The provider had not always assessed, monitored and managed risks to people's safety.

The approach to assessing, recording and managing environmental and equipment-related risks was partial and inconsistent.

Infection prevention and control procedures were in place but were not always followed consistently.

The systems in place for monitoring the quality of the service and making improvements were not always effective as they had not enabled the provider to take timely action to address the issues we found.

There were enough staff to meet people’s needs safely. There were suitable recruitment processes in place. Staff felt supported by the managers.

There were appropriate medicines support procedures to help people take their prescribed medicines.

The service worked in partnerships with other agencies to meet people’s needs.

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 9 November 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection control and people visiting the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection prevention and control so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led. We found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St David’s Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed. We have identified breaches in relation to safe care and treatment, infection control and good governance.

We have made a recommendation about managing staffing levels.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

St David's Home is a care home with nursing providing personal and nursing care for up to 76 adults living in four units. One unit is used to provide rehabilitation support to people with a range of physical disabilities with the aim of being able to live a more independent life and to return to their home or move to other accommodation. At the time of the inspection there were 54 people staying at the home. The home is operated by St David's Home For Disabled Soldiers, Sailors and Airmen, a registered charity.

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

There were infection prevention and control procedures in place but these were not followed consistently. Staff wore suitable personal protective equipment to work safely.

People's medicines were not always managed in a safe way. The provider had recently introduced digital medicines management systems to make improvements to this support.

People who had recently moved to the service did not always have personalised care plans in place.

Some aspects of the building needed repairing and improving. The provider had a plan of work to make these improvements.

People told us they felt safe. Staff treated people with respect and promoted their dignity and privacy.

Most people spoke highly of the programme of the engaging activities provided by staff and volunteers throughout the day.

There was a new manager in post who had started six weeks before our visit. People, relatives and staff were uniformly complimentary of the manager, their approach and leadership and positive effect on the culture of the service.

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.

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 18 December 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and 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 where we have rated the service.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St David's Home on our website at www.cqc.org.uk.

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 infection control, medicines support, person-centred care and good governance at this inspection.

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

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

St David's Home is a care home with nursing providing personal and nursing care for up to 76 adults living in four units. One unit is used to provide rehabilitation support to people with a range of physical disabilities with the aim of being able to live a more independent life and to return to their home or move to other accommodation. At the time of the inspection there were 54 people staying at the home. The home is operated by St David's Home For Disabled Soldiers, Sailors and Airmen, a registered charity.

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

People’s medicines were not always managed in a safe way. The provider’s arrangements for keeping appropriate medicines records, making sure staff’s medicines training is up to date and the management of covert medicines were not always effective.

Relatives told us they thought people were safe at the home. However, the provider had not always assessed, monitored and managed risks to people's safety in the home environment.

There were appropriate infection prevention and control procedures, although the provider had not always maintained a clear record of how it made sure staff practices adhered to these. Staff had suitable personal protective equipment to work safely.

The provider had systems in place to monitor the quality of the service and take action to make improvements. However, these were not sufficiently robust to have identified and addressed the issues we found at this inspection and ongoing improvement was still required.

People were treated with respect and staff promoted their dignity and privacy.

People's care plans provided information about the support they required. This included some personalised information about a person’s background, interests, preferences for their care, and their communication needs. The provider was in the process of transferring plans to a new digital systems at the time of our visit.

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.

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 14 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this unannounced targeted inspection to check whether the Warning Notice we previously served in relation to regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Additionally, we checked if the provider had met regulations 9 (Person-centred care), 10 (Dignity and respect), 11 (Need for consent), 12 (Safe care and treatment), and 14 (Meeting nutritional and hydration needs) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which they were also breaching at our last inspection in October 2019. The inspection was also prompted in part due to a concern received about the safe management of medicines and a decision was made for us to inspect and examine those risks. 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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St David’s Home on our website at www.cqc.org.uk.

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 the management of medicines, providing safe care and treatment and good governance at this inspection. You can see the action we have taken at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Home is a nursing home providing personal and nursing care for up to 76 adults living in four units. One unit is used to provide rehabilitation support to people with a range of physical disabilities with the aim of being able to live a more independent life and to return to their home or move to other accommodation. At the time of the inspection there were 71 people staying at the home. The home is operated by St David’s Home For Disabled Soldiers, Sailors and Airmen, a registered charity.

People’s experience of using this service

People and relatives told us they felt safe living at the home. However, the provider had not always assessed, monitored and managed risks to people’s safety in the home environment. The provider did not ensure the hydration needs of some people were always being met.

Most people and relatives said staff were caring and treated people with dignity and respect.

People's care plans provided some information about the care tasks they needed staff to complete. However, these plans did not provide personalised information about people, their background, their preferences for their care, or their communication needs. The provider had started to introduce a new care plan format to better record this information.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; there were policies and systems in the service to support this practice but these were not implemented consistently.

There were systems in place to monitor the quality of the service and recognise when improvements were required. These were not sufficiently robust to have identified and addressed the issues we found at this inspection. The new manager had introduced some new systems to improve the quality of service.

Staff and volunteers provided people with a varied programme of activities throughout the day, which also included trips out into the local community.

Staff supported people to maintain their health and access other healthcare services when required. People were also supported by a team of occupational therapists and physiotherapists employed by the provider to help them to maintain their health and independence.

People were supported at the end of their life to have a comfortable and dignified death.

People knew how to make a complaint or raise a concern and the provider responded to these appropriately.

Staff received an induction, training and periodic supervision. Staff said the managers were approachable and told us they felt supported.

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

Rating at last inspection:

The last rating for this service was good (published 26 July 2017).

Why we inspected

The inspection was prompted in part due to concerns received about how people were supported to be safe from the risk of abuse and harm or poor care. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to providing safe care and treatment, medicines management, meeting people’s nutritional needs, seeking people’s consent appropriately, dignity and respect, person-centred care, and good governance.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, the local authority and Clinical Commissioning Group 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 Home provides nursing care and support for up to 76 people. The home has a separate rehabilitation unit with seven places for people who are supported to return home or move to other accommodation.

The home had a registered manager who has been in post since February 2008. 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.

The provider worked toward ensuring there were sufficient staffing levels to meet people’s needs. The provider had robust recruitment procedures in place to ensure only suitable staff were appointed to work with people who used the service.

The home had policies and procedures to help keep people safe from harm and abuse. People using the service and their relatives told us that they felt protected and safe.

The provider had assessed and reviewed risks to the health and wellbeing of people who used the service. There were robust processes in place for the reporting of incidents and accidents and there were various systems in place to ensure people lived in a clean, safe and well-maintained environment.

The provider had arrangements to ensure medicines were managed in a safe way and people received their medicines as prescribed.

Staff received regular supervision and appraisal of their work. People who used the service, their family members and external professionals thought the staff were well trained and had the skills they needed to care for them. Staff communicated well about changes to people’s needs to ensure that these needs were met and people were cared for appropriately and in an effective way.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA). People told us staff sought their consent before providing care and support to them.

People were supported in maintaining a nutritious and balanced diet and had access to external health professionals if required.

People who used the service and their family members told us the staff were kind, caring, polite and helpful. The interactions between people and staff were positive and caring. People were not rushed, they smiled a lot and appeared relaxed and comfortable.

Staff empowered people to be independent and encouraged them to make choices about their care and support. People could choose if they received personal care from a female or male worker.

People told us they received care that was responsive to their needs and preferences and they were involved in the planning and reviewing of their care. Staff worked with people in a person centred way and we saw examples of how their approach had made a difference to people's lives.

The home had a dedicated team of three activity coordinators who engaged people in meaningful, appropriate and purposeful activities throughout the day. People had access to a variety of innovative aids to ensure they could live comfortable and meaningful lives. Staff encouraged people to take part in a variety of events within the local community and beyond it.

The provider had organised regular meetings for people using the service and their relatives to discuss the running of the home. The provider had a complaints policy and people and their family members knew about it.

People knew the registered manager and they complimented them. People and their relatives thought the home was very well managed and the management team was approachable and proactive in resolving any issues and concerns brought by people and their relatives.

Staff worked well together as a team and they knew what was expected from them. The staff had been given the opportunity for continuous professional development and career progression within the home.

The service had robust quality assurance systems in place to ensure continuous high quality of the care provided. External health professionals gave positive feedback about staff and the management team at the home.

People who use the service and their relatives understood the care and treatment choices available. They told us people were involved in planning the care and support they received and staff always made sure people understood what was happening.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that people’s needs were assessed and recorded and systems were in place to identify and manage potential risks.

There were effective systems in place to reduce the risk and spread of infection. People told us they found the home clean and protective clothing and equipment was provided for staff. One person told us “they’re always cleaning. I’ve never lived anywhere so clean.”

Appropriate checks were undertaken before staff began work and staff were trained to care for people safely.

People were aware of the complaints system. People and their relatives told us they would talk to staff if they had any concerns and they were confident these would be addressed.