St Davids is a ‘care home’ for 16 older people. There were 15 people living in the home when we visited, some of whom were living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection on 17 February 2016 we rated the service as overall ‘good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. 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.

Audits were not always effective in highlighting gaps in the management of medicines. Some improvements were required to ensure risk assessments were reviewed more regularly. People, relatives and staff were happy with the way the service was being led and both the registered manager and provider were approachable and visible in the home. There was a culture of openness and empathy and the views of people were used to plan improvements to the service.

People continued to receive a safe service. People told us they were happy living in the home and that they felt safe. There were enough staff on duty to meet people’s needs and allow staff to spend time with people without being rushed. The home was clean and tidy which reduced the risk of infection and staff knew how to report any concerns if required. People told us they received their medication at the right time.

People continued to receive an effective service. Staff received training that was relevant to their role and which helped them meet people’s needs effectively. People told us they enjoyed the home cooking provided by the cook and we saw that staff monitored people’s health needs closely to ensure people were referred to healthcare professionals when needed.

People continued to receive a caring service. People were treated with kindness and respect and staff enjoyed supporting and caring for people.

People’s independence was promoted; staff actively encouraged people to do as much as they could for themselves. People were supported to keep in touch with relatives and friends and develop new relationships. Relatives were happy with the quality of the service and were made to feel welcome in the home.

People continued to receive a responsive service. People enjoyed a range of activities and trips that were organised in line with their wishes and preferences. Healthcare professionals told us that the service worked hard to ensure people received high quality end of life care. People’s needs were assessed and care was delivered in line with these assessments.

Further information is in the detailed findings below.

This inspection took place on 6 January 2016 and was unannounced. St David’s Residential Home was last inspected on 24 November 2013 when we found that all the areas inspected were being met.

St David’s Residential Home can provide care and accommodation to up to 16 older people. St David’s Residential Home does not provide nursing care. At the time of our inspection there were 16 people living in the home.

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 2008 and associated Regulations about how the service is run.

People were protected from abuse because there were systems in place to ensure that staff were able to identify abuse and able to raise concerns if they had any. People were protected from the risk of injury from the care provided because risks had been identified and management plans to minimise the risks were in place.

There were sufficient numbers of appropriately trained and supported staff through supervision and day to day discussion to ensure that people received safe and effective care. Staff were monitored to ensure the care and support provided to people was appropriate and involved people in making choices.

Systems in place ensured that people received their medicines as prescribed.

People were involved in making choices and decisions so that they received care that was personalised and based on their needs and preferences and that protected their human rights.

People were supported to eat and drink food that met their dietary requirements and that they enjoyed eating.

People's health needs were met appropriately by staff that liaised with healthcare professionals to provide the support people needed.

People received a caring and personalised service where they were valued and cherished as individuals. Staff provided support that was sensitive, kind and compassionate in a small, friendly environment. Privacy and dignity was maintained and people's independence and self-confidence was promoted. People's wishes were identified and people were supported to fulfil them.

People received care that was responsive to their needs and they were encouraged to be involved in the running of the home. People were able to comment on the suitability of new staff and what they wanted to do to ensure that that their social and emotional needs were met. There was a complaints process in place but people were happy with the service. Family and friends were able to visit their relative at all reasonable times.

The service was well led and there was an open and inclusive environment where people's views were listened to and acted on. People were at the centre of the service and staff were supported to see things from people's point of view. There were systems in place that ensured the service was continually improved and the quality of the service maintained and improved where possible.

We spoke with seven people who lived at the location; we also spoke with the provider, the manager and the deputy manager, two care staff and the person working in the kitchen. Six relatives spoke with us.

One person living at the home told us, “I do not have to do my washing anymore, but I can do all the good things. “Five of the seven people spoken with told us that they always have a choice about what they do and how they do it. It was observed that staff had given choices and asked each person what they wanted and how they could be assisted.

People using the service told us that the staff were respectful and polite and had met their needs the way they wished. Six relatives told us that they were very happy with the service and that staff were caring and had shared information with them as agreed. One relative told us that the staff had made it possible for her relative to attend her wedding.

We saw from records looked at that there were robust policies in place for the safe management of medicines. The deputy manager had carried out various audits which had ensured that medication was administered properly and managed to ensure the safety and wellbeing of the people living at the location.

All the people using the service and their relatives told us that they had been made aware of the complaints process. We saw that there was a copy of this on each bedroom door so that people could refresh their knowledge if needed. One relative told us that they had raised a concern and that this was dealt with immediately to their satisfaction. One person using the service told us, “I can always tell the staff what is not right; there is never a reason to complain.”

We looked at staff records and saw that checks had been made to ensure that the staff working at the home were skilled, knowledgeable and of the right attitude. Staff had a good induction and the staff spoken with told us that they felt supported and had attended training and other events.

There were 16 people living in the home on the day of our inspection. No one knew we would be visiting. We spoke with seven people, two relatives and two staff and the provider.

The people living in the home spoken with told us positive things about the home. One person told us, “Next to home it’s number two.” Another person said, “It’s wonderful, you get a 3 course meal each lunchtime and sandwiches later. Its very clean, nice staff and I can go to my room with my visitors.” Relatives complimented the home and the care that had been provided. One relative said “We’re very happy with the service. X likes it here.”

We saw that staff treated people with respect and dignity. People told us that choices were been offered and their views were taken into consideration.

People's needs had been assessed by a range of health professionals including doctors and optician. During our inspection we saw some people were seen by the district nursing team. This meant that people's health care needs had been monitored and met.

Staff had received a range of training which had included caring for people with dementia. This meant that staff had the knowledge to support the people who lived there and keep them safe.

Systems were in place to monitor how the home had been run to ensure that people had received a quality service.

We spoke with several people who live in the home and several members of the staff team in various roles.

People who live in the home told us that they were happy and well looked after.

Comments included;

“Excellent”

“They go the extra mile to make sure you have everything you need”

“The staff bend over backwards to treat us well”

“We are asked about everything and there is so much choice”.

People told us that the staff organised a wide variety of activities on a regular basis and gave them a choice about whether or not they wanted to participate.

People told us that the food was always good and there were several choices at each mealtime. They said that the staff would make sure that they could have items that were not on the menu if they asked in advance.

People said that they felt safe in this home. They said that the staff were always kind and patient.

People told us that they knew how to complain should they need to do so. They said that the manager was always available if they wanted to make a comment about the care.

Staff told us that the people who lived in the home made the decisions about what they did and how they spent their days. They were clear that they

Staff told us that they enjoyed working at this home. They said that they received regular training which helped them to do their jobs. Staff said that the owner and manager were very supportive.

We looked at surveys completed by professional visitors and family members. They all contained positive comments, including the following:

“I have always been impressed by the total quality of care given to clients in this home including the organisation and caring attitude of staff.”

“The staff always show that their priority is the happiness and well being of the residents and work beyond the call of duty to achieve this in all respects.”