InFocus Charity

Updated 12 March 2020

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection Team:

One adult social care inspector carried out this inspection.

Service and service type:

St David’s House is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service had a registered manager who was the Head of Care. 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.

Notice of inspection:

The inspection took place on 14 and 20 November 2019 with the first day being unannounced.

What we did when preparing for and carrying out this inspection:

We reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about, such as potential abuse, safeguarding concerns and information shared with us by local commissioners who commission care services at the home. We sent the provider a provider information return (PIR). This is a form which gives them an opportunity to tell us about their service and what they do well. The provider had completed the form in detail and during our inspection we gave the management and staff an opportunity to tell us and show us how the information in the PIR translated into practice.

During our inspection visit, with staff support, we spoke with six people to understand their experience of living at St David’s House. Staff translated what people said and how they were feeling. Due to people's complex needs, we could not have detailed conversations with them, however we saw how people and staff worked with each other to ensure people's feelings and thoughts were shared and valued.

We spoke with the registered manager (Director of Care and Support Services), St David’s House manager, deputy manager, (Chief Executive Officer (CEO), training manager, catering manager, and lead nurse. We spoke with nine support staff and four relatives.

We reviewed a range of records. For example, we looked at four people's care records, multiple medication records and a range people's individual communication methods, progress report such as Rebound and case studies. We also looked at records relating to the management of the home. These included systems for managing any complaints, recruitment and supervision. We looked at the provider's checks on the quality of care provided that assured them they delivered the best service they could.

Updated 12 March 2020

About the service

St David’s House is a specialist residential care home providing nursing and personal care and support for up to 21 people within the 14 acre campus of the West of England School and College (WESC) Foundation. The service is made up of three separate lodges, Maple, Ash and Mulberry. At the time of this inspection, 19 people were living at St David’s House.

The WESC Foundation provides specialist services for children, young people and adults with a visual impairment and other complex needs. WESC offers school and college education provision, supported internships and work experience in the community and through their own retail and horticulture enterprises. WESC vision and mission is to promote a society where visually impaired young people with additional needs are valued for their contribution and their rights and independence are promoted. People living at St David’s House had often, but not always, transitioned from their education provision with WESC towards a more independent adulthood, developing their skills and accessing opportunities in their community. They were able to continue to access all WESC specialist services, including healthcare and day centre.

The service was a larger home, bigger than most domestic style properties. It was registered for the support of up to 21 people. At the time of this inspection 19 people were using the service. This is larger than current best practice guidance. The service understood the principles and values that underpinned Registering the Right Support which ensures people can live as full life as possible and achieve the best outcomes. People received planned and co-ordinated person-centred support that was appropriate and inclusive for them. However, the size of the service having a negative impact on people was mitigated by the building design being divided into three lodges. People, staff and visitors were able to access St David’s House separately from WESC School and College at any time although on the same campus.

People and staff worked together to campaign for inclusion into the community, working on positively educating society in general and celebrating their contribution. People were able to access the community in many ways and were now planning sports teams and events to encourage the community to also visit the campus. People enjoyed visiting a wide range of activities in the community including work experience whilst also being able to access the specialist facilities on site for those visually impaired. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People's experience of using this service:

Relatives and our observations confirmed the care and support people received was exceptional. A comment from a relative summed this up by saying, "We know how much [person’s name] loves [St David’s House], she is so well looked after and treated. There’s always something going on. Staff have to be something special to work with these young adults.” Relatives, professionals and our observations confirmed staff provided exceptionally safe care. Risks to people's safety had been thoroughly assessed, monitored and managed so they were supported to stay safe while their freedom was encouraged and respected. People were supported by a small team of consistent staff that fully understood their needs, whilst understanding the beneficial outcomes of supporting people to take risks to achieve. For example, a person who had previously only been able to mobilise all their life with a support worker was now independently enjoying new freedom, going out safely using a cane.

Robust systems, processes and practices were followed and sustained effectively to safeguard people from situations in which they may experience harm. People understood what safeguarding was and told us how they would talk to support staff. Staff worked closely with families, for example, to ensure they knew how to understand peoples’ behaviours and how to promote positive visits and maintain close family relationships.

People received personalised care that was exceptionally responsive to their needs. The service also worked closely with regular agencies, however agency staff did not work with people who needed a more consistent knowledge approach. There was a strong sense of leadership in the service that was open and inclusive. Key worker roles were very meaningful and enabled managers to praise, share and comment on staff ideas to enhance peoples’ lives regularly.

People were fully supported creatively to live healthier lives by having on-going support to access suitable healthcare services from specialists who understood peoples’ complexities, supported by a nursing team. A GP who ran a weekly clinic told us, “We take our time to understand people, their communication and what is in their best interests for them. We work as a team.”

People who used the service were treated with compassion and kindness and staff developed meaningful relationships respecting privacy and dignity. Safe recruitment practices were followed. Innovative methods to include people in the recruitment process were in place to ensure suitable staff were employed to work with vulnerable people.

Medicine records confirmed people received medicines safely. People lived in an environment that was clean and free from the risk of the spread of infection and was fully adapted to enable people to be as independent as possible.

Staff were given the support, specialist training and opportunities to progress within the organisation. This included people’s experiences and ideas when developing relevant training that made a difference to people’s lives in positive ways. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and live data recording systems in the service supported this practice.

People had been fully involved in agreeing their care plans and participated in reviews of the care and support provided to them. For example, communication and hospital passports were excellent and innovative ways were found to help people ensure their voices were heard using effective methods of communication. People and relatives benefited from a robust data management recording that helped support staff understand their responsibilities so that risks and regulatory requirements were met.

The provider had flexible ways of encouraging regular feedback from people who used the service, relatives, care staff and professionals. Full analysis and actions taken were reported on and shared throughout the staff teams across WESC. A comprehensive complaint process ensured a multi-disciplinary approach, so people could be sure their concerns were addressed in partnership.

Comprehensive quality checks were available in real time as the provider could access a live data recording system which could review all records and incidents instantly and on a regular basis. Excellent team work was promoted and staff were clear about the vision and values of the service. The registered persons worked in partnership with other agencies, local businesses and stakeholders to support the development of joined-up care. They actively promoted peoples’ value within the community and constantly looked for ways for people to be fully embraced within society and for others to understand living with visual impairment and other complex needs. People also were able to tell us how they were passionate about educating society saying, “We can go anywhere, I’m off to work now. I love it!”

Rating at last inspection:

Good (report published 4 April 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection when we rated the service as good overall. At this inspection there had been further improvements which resulted in the service being rated outstanding overall.

Follow up:

We received further feedback via emails from support staff and relatives. We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received we may inspect sooner.

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