St David's Nursing Home

We found the following examples of good practice.

Staff were using personal protective equipment (PPE) in the correct way.

All areas of the building were very clean, and no malodours were present.

Hand hygiene points in the bathrooms and along corridors were accessible and fully stocked.

Staff regularly checked the quality of cleaning completed by their team members. There was a routine set up for the staff team at each shift to clean certain areas of the service such as sinks and high touch areas, and empty the bins. The staff and housekeeper were very aware of their role in ensuring infection prevention and worked together as a team.

Senior staff completed checks and audits with any improvements picked up and actioned afterwards. There was a named infection prevention and control lead at the service who oversaw the practice and documentation related to infection prevention and control.

Any updates and changes in the guidance were shared regularly with the staff team during handovers and meetings. Staff told us communication was really good and everyone worked as a team to ensure the people and the service stayed infection-free.

People and staff who tested COVID-19 positive were able to isolate in accordance with current guidance. This effectively prevented the spread of infection. At the time of inspection, there were no positive cases in the service.

St David’s Nursing Home is a care home service which also provides nursing care. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.

The service supported older people, some of whom were living with dementia. At the time of our inspection there were 32 people living in the service.

People’s experience of using this service:

We received highly positive feedback about the service and the care people received. The service met the characteristics of Outstanding in the areas of effective, responsive and well-led. The service met the characteristics of Good in safe and caring.

People received safe care. Medicines were managed safely and there were enough skilled staff deployed to meet people’s needs and keep them safe.

People were supported by extremely knowledgeable staff who had completed the provider’s mandatory training and additional training in relevant areas.

Staff had respectful, caring relationships with people they supported. They upheld people’s dignity and privacy and promoted their independence.

People received exceptionally personalised care and support which met their needs, reflected their preferences and promoted their self-worth. The provider upheld people’s human rights.

There was an extremely positive, open and empowering culture. Staff roles and responsibilities were clear, and staff were supported and encouraged to complete additional training and qualifications.

Staff had cultivated highly effective relationships with professionals to deliver extremely high-quality care and support. Staff used creative, individualised methods support people to remain active members of their local community.

Rating at last inspection:

At the last inspection the service was rated Outstanding overall. At this inspection the service was rated Outstanding overall.

Why we inspected:

This was a planned, comprehensive inspection of the service.

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated Outstanding. We will continue to monitor the service through the information we receive.

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

The service had a registered manager as required. A registered manager is a person who has registered with the CQC 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 registered manager and the provider were present and assisted us during this inspection. They worked closely together to ensure people received appropriate care and the service was operating well.

People and relatives told us great things about the service they received. They valued their strong relationships with staff. They also felt staff would go the ‘extra mile’ when supporting them. The registered manager and provider spoke with a great passion about the care and support they provided to the people and their families. It was clear this was also disseminated well to the staff team. Staff were highly motivated to provide care with much kindness and consideration. People and their families really felt they mattered to the staff team and the registered manager.

The registered manager and staff had an excellent understanding of and motivation to meet people’s social and care needs. They were constantly finding creative and innovative ways to ensure people lived their lives to the full. People were able to engage in a wide range of meaningful activities and maintain links with the community regularly. It helped them avoid becoming isolated. People really enjoyed keeping busy because it made them feel as if they were at home. People could also spend time with their visitors or by themselves if they wished so. Their choices were always respected by attentive and understanding staff. It was paramount to the service to ensure people's wellbeing was respected and protected. All interactions observed between staff and people living at the service were provided with the greatest respect and friendliness. People and relatives confirmed staff always respected their privacy and dignity. People benefitted greatly from living at a service that had a very open and welcoming culture.

End of life care was provided with a great care and compassion. People and their families were always supported with the utmost consideration and understanding to ensure their decisions and preferences were taken into account. Staff were skilled and attentive to deliver care following people’s and families wishes ensuring they were comfortable. The provider and the registered manager always ensured appropriate facilities and support were available to people, those who were important to them and staff, during the care and after the person’s death. They worked with other professionals who were very positive about the quality of the service and the care provided.

People told us they felt safe living at the home. Staff understood well their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident any concerns would be addressed appropriately. Risk assessments were carried out to ensure people's safety. Staff recognised and responded to changes in risks to people who use the service. People received effective personal care and support from staff who knew them well and were trained and supervised. There were contingency plans in place to respond to emergencies.

People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure those rights were promoted. People were treated with care and kindness. The managers and staff were knowledgeable about Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA). Staff were following the principles of the MCA when supporting people to make a decision. The service was meeting the requirements of DoLS. The DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. At the time of our inspection 16 authorisations were in place.

The registered manager ensured there were enough qualified and knowledgeable staff to meet people's needs at all times. The service had employed skilled staff and took steps to ensure the care and support was person-centred to people at all times. Staff were knowledgeable and focused on following best practice at the service making sure people received high quality care and support.

Our observations and the records we looked at confirmed the very positive descriptions people and relatives had given us. Staff understood well the needs of the people. People told us they were encouraged to do things for themselves and staff supported them to be independent when they could. People received support that was individualised to their personal preferences and needs. The staff monitored people’s needs and care plans were reviewed regularly or as changes occurred. People and their families were always involved in the planning of their care.

There were robust recruitment processes in place. All necessary safety checks were completed to ensure prospective staff members were suitable before they were appointed to their posts. People told us staff were available when they needed them and staff knew how they liked things done.

People received their prescribed medicine safely and on time. The service followed safe procedures for storing and handling medicines and kept accurate records.

People had a nutritious and balanced diet and hot and cold drinks and snacks were available between meals. People had their healthcare needs identified and were able to access healthcare professionals such as their GP. Staff knew how to access specialist professional help when needed.

People felt staff were happy working at the service and had a good relationship with them, each other and the service’s management team. Staff told us the management team was open with them and communicated well with them about what was happening at the service and with the people living there. People and/or their relatives told us they felt the service was managed well and that they could approach management and staff with any concerns.

The registered manager assessed and monitored the quality of care consistently with the help of staff and other members of staff within the company. The service encouraged feedback from people and families, which they used to make improvements to the service where necessary. Throughout our inspection we saw examples of appropriate support that helped make the service a place where people felt included and consulted.

We found that people who use the service had care plans detailing their assessed needs and how they would be supported. People and their families told us the staff knew them well and provided with the care and support they needed. People were supported and encouraged to live active lives both at home and in the community.

People who use the service were protected from abuse because their staff had appropriate knowledge and training on safeguarding vulnerable adults. People and their families we spoke to told us they felt safe in the home and would report any concerns to staff or the management.

The provider had a robust recruitment process in place to make sure staff were properly recruited and suitable to work at the home. This way people who use the service were not placed at risk of being cared for by inappropriate staff.

There was information provided about how to complain. People who use the service and their families told us they felt confident about bringing up concerns or making a complaint if they needed to. We found people and their families had their comments and complaints listened to and acted upon.

Care plans showed that people were involved in making decisions about how they wished to be cared for and were asked for their consent before the staff delivered any care or treatment. The staff demonstrated different communication techniques to ensure people understood what was being proposed to them. The care given by staff reflected what was documented in people's care plans, and care plans were regularly reviewed and updated.

We saw that the premises and environment were safe and clean. Both individual and communal areas were comfortable and adapted to people's needs and wishes. We observed health and safety information, and the staff we spoke with could explain how to reduce the risk of infection.

During our visit we saw staff approach the duties they needed to undertake with confidence and competence. Staff were well supported and there was a comprehensive training and education schedule in place to ensure staff were able to meet the needs of people using the service.

This home had various methods that were used to ensure the quality of the care was assessed. Meetings, reviews and senior management audits were in place and records were available.