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 p

People were involved in making choices about their care. People we spoke with told us staff treated them with respect and supported them to make their own choices. Staff had knowledge and understanding about people’s needs and preferences. We found people's privacy, dignity and independence were respected.

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.

People we spoke with told us they were very happy living at St David’s Nursing Home and were well looked after. One person said, “I am really happy here, everything is wonderful”. Another person said, “I am very happy living here, the staff are lovely”.

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.

The people who use this service prefer to be referred to as residents. This preference is respected within this report.

Residents we spoke with told us they were involved in making decisions about their care. They felt the staff always respected their privacy and dignity and that they were supported to remain as independent as possible.

Residents told us that they felt their needs were being met and that their care was delivered in the way they preferred. They felt safe living at the home, felt the staff were available when they needed them and that staff had the skills they needed when providing their care and treatment.

Residents told us they felt their opinions were listened to and taken into account by the management and staff.

One resident told us that the staff always asked if everything was alright before they left the room and commented: "All I have to do is say if I want something different and it is done." Another resident commented: "They take good care of me, I highly recommend St David's."

Visitors we spoke with were happy with the care their relatives received at the home. One visitor commented: "They really care for the residents with attention and affection. The home is very clean and the staff show great respect and dignity to the residents. The staff work extremely hard and take extra time to get things right."