This inspection took place on 20 October 2016 and was unannounced.

St David’s Residential Care Home provides accommodation for up to 18 older people. There were 15 people living in the home when we visited.

The service had a registered manager. 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.

During our last visit to the home in December 2014, we found that there were breaches of two regulations. These were about seeking consent from people, and assessing and monitoring the quality of the service. During this visit, we found that improvements had been made in these areas and the regulations were met.

Staff reported concerns to the registered manager or CQC if they had any; however, they had not received safeguarding training. This meant there was some risk of staff not identifying potential abuse. However, the registered manager was clear about safeguarding procedures and the proprietor had organised for all staff to receive training imminently.

People living in the home had documented risk assessments in place which were individual to their own needs. These provided staff with guidance on how best to protect people from risk of harm, whilst supporting them to take risks such as improving their walking. Staff supported people to maintain as much independence as possible and improve their mobility where possible.

Risks to the environment were managed appropriately. People received their medicines as they were prescribed. Where they required extra healthcare, staff supported them to access this whenever people needed.

People were supported by staff who had the knowledge and skills to provide good care to them. Staff were well supported, and there were enough staff to keep people safe and meet their needs. They were also robustly recruited to ensure they were deemed safe to work with people.

Staff asked people for their consent, and people decided on how they wanted to be cared for by staff. Staff were kind and knew people well, and they had built good, trusting relationships with people. Staff promoted people’s privacy and dignity as well as their independence.

People were supported to eat a good choice of freshly prepared meals, according to their own preferences. Everyone had access to drinks whenever they required.

People chose how they wanted to live and staff supported them to go out. People followed their own hobbies wherever possible. Staff engaged people in activities when they had the opportunity, and took people out.

There was good leadership in place, and teamwork between the staff. There were processes in place to assess, monitor and improve the quality of the service. This included gaining feedback from people, staff and relatives, as well as carrying out various audits to pick up any potential areas for improvement. However the proprietors had not always provided the registered manager with the resources they required to manage the service, deliver care and provide training.

This inspection took place on 4 December 2014 and was unannounced.

At the last inspection dated 19 June 2014 four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were found. During this inspection we found that meeting nutritional needs and safety and suitability of premises had been addressed and now met the regulations required. However, two breaches were still outstanding regarding quality monitoring and safe storage of records.

This is a care home that does not provide nursing. It can accommodate up to 18 people. On the day of out inspection 14 people were living there.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

The people who live in this home told us they felt they were supported safely. They told us call bells were answered quickly and that staff knew what they were doing. Action from the last inspection, required to be taken by the provider had been acted upon, which included the fitting of a new fire alarm system, making the fire safety system safe.

Staff were aware and would recognise abuse and knew how to report this on to their manager if they had any concerns that a person living in the home was not safeguarded from abuse.

Some people felt restricted and said their freedom to do what they wished was not always allowed. Risks had not been assessed and acted upon so that people could be offered the freedom they requested. This meant the provider was not meeting the requirements of the law that stated that people should be supported and their independence promoted.

Safe procedures for medicines were in place and staff dealing with medicines were competent and skilled.

Staff were trained and able to do the job effectively and were being supported to develop their knowledge further.

The meals were enjoyed and people knew on the day what choices were available. Those people who required support to eat their meals were offered this by staff who were respectful in their approach.

The local GP practice which included the district nurse offered support to people to meet their health care needs. Other health professional support, such as occupational therapists, were involved with the care and support as and when required.

We received many compliments about the staff in the home. People, including relatives told how good they were. However, we did find that confidentiality was not always followed to protect people’s privacy.

Although each person had a care plan to tell staff how they wished to be supported and involved in their lives in the home, some of those plans were better than others. Improvements required had been recognised by the new manager and had started to be implemented.

We had not been notified nor could we find any complaints about this home. People told us they would have no problem in complaining if they felt they needed to.

People told us they could talk to the management and staff and felt they would be listened to. What was not evident was how the provider ensured the service was assessed and monitored for the quality of the service delivered. The provider was not meeting the requirements of the law by having an effective system in place to assess and monitor the quality of the service.

You can see what action we told the provider to take at the back of the full version of the report.

We looked at the personal care or treatment records of people who use the service, carried out a visit on 19 June 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and talked with other authorities.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

What people told us and what we found:

An inspector for adult social care carried out this this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with six people who used the service, spoke with two family members of people who used the service, the registered manager and three other members of staff. We also carried out observations, reviewed records relating to the management of the service which included four care plans, daily records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that action had been taken to improve toilet facilities on the ground floor. This meant that staff could support people with mobility aids more safely. Staff made sure that they offered people support, encouragement and reassurance when they were assisting with their mobility.

Systems for identifying and managing risks to people living in, working at and visiting the home were not sufficiently robust. Maintenance issues were not addressed promptly. This increased the risk of harm to people. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safety and maintenance of premises. They also need to tell us how they are going to improve the identification and management of risks within the home.

Records were not accurate. This meant that they were at risk of receiving inappropriate care. People’s confidential records were not all stored securely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring records are maintained accurately, stored appropriately and are fit for purpose.

We observed that staff responded to call bells promptly. One person told us that if they used their call bell, “They’re here like a shot.”

People were not subject to unnecessary restrictions on their movements or contact with their friends and family. No applications for depriving people of their liberty, as set out in the Deprivation of Liberty Safeguards, had been needed.

Is the service effective?

People’s care needs had been assessed and staff were able to tell us about the support they offered to people to meet those needs. We saw staff assisting and encouraging people with their mobility. We also observed that people were encouraged with fluids. A relative told us they had noticed staff prompting people regularly. This meant that people’s risk of dehydration and urine infections was minimised. People who needed encouragement to eat were given this.

However, the lack of evidence of regular weight monitoring meant that weight change would not be detected promptly so that interventions could be made where necessary. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people receive good nutrition.

For one person, our discussions, observation and review of records showed that staff had been successful in supporting the person to regain confidence and increase their mobility since moving to the home.

Is the service caring?

People were supported by staff who were kind and caring. A relative told us they visited very frequently and had never had any concerns about the way people living in the home were treated or spoken to.

People and their relatives were asked for their views about the service but there was no evidence of what had been done to address any suggestions for improvement. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to taking account of the views of people, their relatives and representatives and staff.

One person said, “I love it here. I’m spoilt rotten.” Another told us, “All the girls [staff] are good.”

Is the service responsive?

Staff were able to tell us how people’s needs had changed. They sought further expertise and advice when they found people’s health had deteriorated, showing that they responded appropriately.

Is the service well led?

Staff had a good understanding of their roles and gave priority to supporting people with their care.

There was not an effective quality assurance system to identify and address shortfalls promptly so that the service continually improved. We have asked the provider to tell us what they are going to do to ensure the requirements of the law in relation to quality assurance are met.

Prior to our inspection we received information on our website, where people could share their comments about services, and from the local authority safeguarding team regarding the staffing levels in the service. The purpose of this inspection was to check that there were adequate staff numbers to meet people's needs in a safe and effective manner. We sat in the communal areas in the service for the majority of our inspection and observed the care and support provided to people. We looked at the staff rota and spoke with people who used the service and staff. We found that there were insufficient numbers of staff to meet the needs of the people who used the service.

We spoke with seven of the 15 people who used the service. All told us that they felt that they were happy and that the staff treated them with kindness and respect. We visited two people who preferred to stay in their bedrooms during the day and they told us that their call bells were answered promptly. However, people in the communal lounge told us that there were times when staff were not available. This was confirmed in our observations. One person said, "We are on our own." Another said, "They could do with a few more staff, they (staff) work very hard and are always on the go."

We looked around the service and found that it was clean and hygienic. However, we found that the communal lounge was in need of redecoration and the toilets on the ground floor were not fit for purpose.

We did not speak with the people who used the service during this inspection. The purpose of the inspection was to check that improvements had been made following our last inspection of 13 May 3013.

Our inspection of 13 May 2013 found that improvements were needed in the training provided to the staff and how the service was monitored by the provider to ensure that people were provided with safe care and support.

During this inspection we looked at the provider monitoring records and staff training and supervision records. We spoke with the registered manager and two staff members. We found that improvements had been made. However, we found that a training programme was in place but it had not yet been fully completed, we will continue to monitor this.

We spoke with six people who used the service about their experiences of the service they were provided with. People told us that they were happy living in the service. One person said, “It is A1.” Another person said, “The food is good and the rest.” Another said, when we asked if they liked living in the service, "Yes really, it is quite nice.” We also spent some time sitting in the lounge to observe the care and support that people were provided with. We saw that staff were attentive to people's needs and they responded to requests for assistance promptly.

People told us that the staff treated them with respect and kindness. One person said, “They (staff) are all pretty good.” Another person said, “They (staff) are always kind.” This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were not provided with the training that they needed to meet the needs of the people who used the service. The provider did not have robust systems in place to assess and monitor the service that people were provided with.

People we spoke with told us that they liked living at this home. One person said “The home is spot on.” People told us that the food was very good and one person said “There are always choices.” They said they could have visitors when they wished and that they were able to do what they wanted. One person described to us how the service had met their spiritual needs and they were grateful for this.

People were seen in various places throughout the home including their own rooms where people had stated this was their preference. We were told that “Staff are very obliging.” We saw the interaction between staff and people using the service which was warm and friendly. People told us they could have visitors when they wished and that they were made welcome by staff.

We did not speak to people during our visit to St Davids Care Home on 13 September 2011.

People told us that they like living in this home. One person with whom we spoke said, "The staff are very kind and help me when I need it." Another person told us, "I don't have to wait very long before someone comes to help." We were also told, "The staff are lovely and helpful here." People with whom we spoke said they felt involved in the planning and review of their care. One person told us, "I am putting on weight because I eat so much." Another person said, "If I don't want what is on the menu, the cook will do me something else." A further person said, "The cook is very good, we have some lovely food here."