St David's Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of the legal regulation in relation to good governance.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was not always an open or positive culture. People using the service, relatives and staff explained they did not always feel their needs were considered in the governance of the service. People told us complaints and concerns were not always addressed to their satisfaction. They did not feel leaders were visible and they did not have opportunities to share their opinions of the service. There were forums for people to give feedback, including meetings. However, some people felt these were not effective. A relative commented, “We are not getting value for money because there are not enough staff and we do not have a say.” People and relatives thought staff were kind, although their needs were not always met in a person-centred way.

Staff felt leaders were not always accessible or responsive. Some staff told us they did not think there was a supportive atmosphere. Their comments included, “There is a mistrust and tension making the home feel uncomfortable at times” and “Staff feel frightened to make a mistake.” However, staff enjoyed their job caring for people. They had good relationships with people and each other. A staff member said, “Working at St David’s Care Home is rewarding because it allows me to make a real difference in people’s lives.”

The leaders were not always compassionate or inclusive. The registered manager described having an open-door policy and welcoming feedback from staff and people using the service. However, this was not the experience of everyone. People and their relatives told us they did not have opportunities to speak with the registered manager and did not routinely see them. Many of them did not know who the registered manager was. Their comments included, “I get the feeling they are not interested” and “The [registered] manager does not appear to appreciate or address problems.”

Most staff did not feel included in decision making and some felt poorly treated. Their comments included, “My manager is not approachable” and “The registered manager is not visible in the home.”

The provider told us they did not provide support for people living with dementia. This was not included in their Statement of Purpose. However, they were caring for people with dementia. Some people with this condition had recently moved to the service. Staff had completed training to understand about meeting this need, the registered manager told us there was a ‘dementia champion’ staff member who had completed advanced training, and relevant care plans were in place for people with this need. Providers are required by law to have an up to date and accurate Statement of Purpose that sets out, “The range of service users’ needs which those services are intended to meet.”

There were systems to enable staff and others to speak up when something was wrong. However, staff told us they did not always feel able to do this because they were frightened of the consequences. Some staff told us they feared losing their jobs and right to work in the United Kingdom if they raised concerns with the management team. A member of staff commented, “Many staff members feel unsupported, unheard and reluctant to raise concerns for fear of being dismissed or treated negatively.”

Other staff who had spoken up explained their concerns were not always heard or acted on. Their comments included, “Managers are frequently unwilling to listen to professional advice or concerns raised by frontline staff”, “Suggestions intended to improve resident care, safety and staff wellbeing are often ignored without meaningful discussion” and “There have been repeated incidents where concerns raised by carers and nurses have been dismissed.”

Failure to seek and act on feedback from staff and other stakeholders, as well as a situation where staff fear speaking up because of negative consequences, presented a risk that people would receive inappropriate and unsafe care.

There were systems to ensure workforce equality and inclusion. However, some staff felt they were not treated equally and there was discriminatory practice. The provider had already been alerted to these concerns by staff before our assessment. A senior manager told us they were trying to address this and had invited the human resources team to visit the service and speak with individual staff to discuss their concerns.

There were suitable policies and procedures designed to make sure staff were well treated and did not face discrimination. These included procedures during recruitment and throughout their employment. Staff undertook a range of training to understand about equality and diversity.

The systems for monitoring and improving the quality of the service were not always effectively operated. People using the service, staff and relatives told us feedback was not always acted on. The provider used a dependency tool to calculate staffing levels. However, this had not identified how staff deployment negatively impacted on people’s experience. Systems did not ensure staff absences due to activities such as training and short notice sickness were covered.

The provider’s systems did not always predict or mitigate risks. For example, poorly managed transitions to the service and failure to act on staff alerts when they identified a potential problem. Systems to ensure people lived in a safe and well-maintained environment had not always been effective. For example, whilst there were plans to address fire safety risks, the provider did not have a robust plan to ensure people’s safety whilst waiting for the action.

The service developed links with local places of worship, schools and community organisations. They supported people to take part in a range of social and religious activities.

The registered manager worked closely with other managers and local authority representatives to discuss best practice and lessons learnt. They attended forums and kept themselves updated with best practice and changes in guidance and legislation.

The processes to ensure learning happened when things went wrong were not always followed. Leaders had not always recognised when changes were needed, nor had they done enough to make the required improvements.

Staff and professionals raised concerns that concerns were not acted on. A professional told us, “I feel the service could be improved further by ensuring consistent staffing levels, regular staff training and development as well as enhancing and improving communication with management.”

There were plans to improve the environment, including renovation and redecoration of some areas. This work had started.