Archived: St David's Home

Updated 12 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by 2 inspectors, a medicines specialist advisor, a nurse specialist advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St David's Home is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under 1 contractual agreement dependent on their registration with us. St David's Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service had a manager registered with the CQC, who was on leave when we visited. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included speaking with a relative of a person who uses the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 8 people who used the service and 8 relatives about their experience of the care

provided. We also spoke with 15 members of staff. This included care workers and senior care workers, nurses, a chef, an activities coordinator, laundry workers, the maintenance manager, the

quality manager and the registered manager. The registered manager was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with 6 professionals who have recently worked with the service. We viewed a variety of documents related to people’s care and the running of the service. This included 11 people’s care and risk manage plans, 5 people’s medicines support records, complaints records, audits, meeting notes, and 5 staff recruitment records. After our visits we continued to seek clarification from the provider to validate evidence found.

Updated 12 July 2023

About the service

St David's Home is a care home with nursing providing personal and nursing care for up to 76 adults living in 4 units. 1 area is used to provide rehabilitation support to people with a range of physical disabilities with the aim of being able to live a more independent life and to return to their home or move to other accommodation. At the time of the inspection there were 63 people staying at the home. The home is operated by St David's Home For Disabled Soldiers, Sailors and Airmen, a registered charity.

People’s experience of using this service and what we found

People and relatives said care staff treated them well. However, most people said the quality of the service needed to improve and it was not well-led. A relative told us, “I would tell people not to go there. I wouldn't recommend it to anyone.” The culture of the service did not always promote supporting people to achieve good outcomes.

The provider had not always assessed, monitored and managed risks to people's safety and well-being. People's medicines were not always managed in a safe way. Some people had experienced an inconsistent approach to safeguarding them from avoidable harm.

Some people's care plans were not always up to date, sufficiently personalised or reflective of the care and support people received.

The systems in place to monitor the quality of the service and make improvements when required

had not always been effective. The provider had not made enough improvements since the last inspection to address breaches of regulations.

The service provided a variety of weekday activities for people but this resource was not available to people who stayed in their rooms.

There were appropriate staff recruitment processes and infection prevention and control procedures in place. Staff, people and relatives had opportunities to comment on the running of the service. There were systems for recording and responding to complaints.

Staff worked with other agencies to provide people with joined up care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 August 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 4 consecutive inspections.

At our last inspection we recommended that the provider consider current guidance on assessing and monitoring safe staffing levels. At this inspection we found the registered manager had implemented a protocol for determining staffing levels.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and providing people with safe care. A decision was made for us to inspect and examine those risks. We had also carried out an unannounced focused inspection of this service on 10 and 11 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment, infection control and good governance. We undertook this focused inspection to also check they had followed their action plan and to confirm they now met legal requirements. As such, this report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St David’s Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, medicines management, person-centred care and good governance. We have made recommendations regarding the call bell system, activities provision, complaints handling and service culture.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an urgent action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.