This inspection took place on 12 and 13 June 2017 and was unannounced.

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

We used a number of different methods to help us understand the experiences of people using the service. This was because the people using the service had complex needs which meant not all of them were able to tell us their experiences. We spoke with six people living at the home, two visiting health care professionals, four relatives and fourteen members of staff, which included the manager.

People we spoke with said staff treated them with dignity and respect. They told us they had choices in all aspects of their daily living. Relatives said that people received the care and support they required. People and their representatives were involved in the development and review of their care plans. People told us they were satisfied with the care they received. A visiting professional said “The best thing about St David’s is the openness. Staff work well with other professionals and there is good communication”.

Most people said they enjoyed the meals provided at the home and choices were available.

We observed medicines given to six people at lunchtime and noticed that they were given according to the home’s medicines policies and with patience and encouragement.

People using the service and relatives told us they felt there was enough equipment to promote the independence and comfort of people.

People we spoke with said they felt there was mostly enough staff on duty to meet their needs. Two out of four relatives commented there should be more staff on duty and sometimes people had to wait to receive support. Three relatives said that staff were “nice”, “caring” and they had “no complaints”.

People told us that they had their medicines on time.

Many of the people we spoke to praised the home, its staff, the food and the activities. People told us they liked the amount of space that the home provides and that there are places were they could have company or be more private. They said that they were not restricted to where they spent their time. One said “We can choose what we want to do” and others told us that their wishes were respected.

People told us the meals were good, there was a good variety of food, and there are choices at every meal. A small number of people said that the food wasn’t always cooked how they would like it but said they understood the difficulties of producing food for so many people. One person told us that “the food is good, but so it should be for the fees”.

The activities available are enjoyed by many people, although those people who said that they preferred not to join in had no pressure to do so. Activities are provided from Monday to Friday and some people told us they would also like the activities at weekends. People told us their visitors were welcome and they can enjoy a meal with them.

People told us that they liked their rooms, and they had all the equipment they needed. They said they could make the rooms as personal as they wished. They told us they enjoyed using the grounds, particularly in the summer.

When we asked about the staff team, some told us that they could not fault the staff and that most of the staff are excellent.

All of the people we spoke to said that they would be confident to raise their concerns although a small number of people did not think that their concerns were always acted upon.

Overall, we found that people were satisfied with the standard of services provided in the home.

This inspection took place on 8, 9 and 11 December 2014. The visit on 8 December was unannounced and we told the registered manager we would return on 9 and 11 December to finish the inspection.

St David’s Home provides nursing care and support for up to 68 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 has 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.

People told us they were happy with the care they received and we received positive comments from people, their relatives and visiting health and social care professionals. They told us the home was well run and people’s health and social care needs were identified and met.

Staff supported people in a caring and professional way, respecting their privacy and dignity.

The provider carried out checks before employing staff to work in the home to make sure they were suitable to work with people using the service.

Staff had the training they needed and they were able to tell us about people’s individual needs and how they met these in the home.

Staff understood and followed the provider’s safeguarding and whistleblowing procedures and they understood the importance of reporting any concerns about the welfare of people using the service.

People and their relatives told us they knew about the provider’s complaints procedure and they were confident the manager would respond to any concerns they might have.

People consistently received their medicines safely and as prescribed. We discussed good practice points with the manager who was receptive and we saw they were addressed.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). The Deprivation of Liberty Safeguards provide legal protection for vulnerable people who are, or may become, deprived of their liberty in a hospital or care home.

Care records reflected people’s health and social care needs and staff regularly reviewed each person’s care and support. The manager, senior staff, nurses and care staff communicated effectively to make sure all staff were up to date with each person’s care and support needs.

The manager kept up to date with new information and sought out new experiences that could benefit people using the service. Systems were in place to monitor the quality of the service.