We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:' Is the service safe?
' Is the service caring?
' Is the service responsive?
' Is the service effective?
' Is the service well led?
Below is a summary of what we found. The summary is based on our discussions with eight people who used the services, four family members and six staff members. In addition, we looked at four people's care and support plans.
Is the service safe?
Risk assessments were in place to ensure that as far as reasonably practicable people were safe in the home and that staff were safe in their working environment. Where risks to people had been identified measures had been taken to minimise or remove them. Appropriate vetting of staff combined with on-going support and appraisal meant that the provider took reasonable steps to ensure that vulnerable adults were protected from the risk of abuse. We looked at staff rotas and found that there were enough qualified, skilled and experienced staff to meet people's needs throughout the day and night.
Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to all care services. At the time of the inspection no applications had needed to be submitted. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one.
Is the service caring?
People we spoke with said that staff treated them with respect and consideration. They felt that staff listened to them and took time to explain things. People also told us that they were consulted about the care and support they received.
People's needs were assessed by staff and care and support was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for the staff providing the care.
During the inspection we observed that staff were kind and caring in their interactions with people.
Is the service responsive?
The provider had a system of dealing with complaints. We found that people's complaints had been dealt with in a timely manner. People knew how to make a complaint if they were unhappy about the service they received. The complaints process was displayed in the entrance hall, making it easily available to people and visitors to the home. Where shortfalls or concerns were raised these were addressed by the provider.
People told us that the provider responded to their changing needs in a timely manner. This meant that personal and nursing care needs were assessed and reviewed on a monthly basis or as and when needed. We looked at people's medical observation charts and found these to be accurate and up to date. Where medical observations were outside normal ranges we noted that senior nurses or matron were informed. Where changes occurred, the service referred to health professionals for advice and guidance if required. All changes were accurately documented and recorded.
People who used the services and their family members or representatives, were asked for their views about the care provided and these were acted on by the provider.
Is the service effective?
People using the service that we spoke with said, or indicated to us, that the care and support provided of good quality. From our observations we saw that care and support, both personal and medical, was effective and consistent.
Where practicable people were supported to be as independent as possible.
We saw that staff knew the people they were supporting and that the people receiving the care and support were happy. We noted that if something was not right that staff responded quickly to resolve matters.
People told us, or indicated to us, that they liked living at St David's and that staff were kind and caring.
Staff explained how they were able to communicate with people who were not able to express themselves verbally.
Is the service well led?
Views of people using the services and, where possible, of their families were obtained and opportunities were in place for social gatherings where further views and opinions of the services, and staff, could be gained by the provider.
Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training or support that they were confident this would be arranged by the provider.
There were quality monitoring systems in place and regular audits and spot checks took place.
Staff were clear about their roles and responsibilities. They spoke of how they worked as a team with the needs of the person central to the work they did.