This inspection took place on 15 and 16 August 2016 and was unannounced. St David’s Nursing Home is a care home with nursing that provides a service to up to 39 older people. At the time of our inspection there were 31people living in the home.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.