Archived: St David's Nursing Home

Updated 12 January 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 15 and 20 October 2014 and was unannounced. We spoke with seven people who lived at St David’s Nursing Home, three relatives, four registered nurses, five care staff, and the cook. We observed care and support in communal areas and also looked at the kitchen and 13 people’s bedrooms. We reviewed a range of records about people’s care and how the home was managed. These included the care plans for seven people, the staff training and induction records for all staff employed at the home, seven people’s medication records and the quality assurance audits that were available. Not everyone we met was able to tell us their experiences, so 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.

The inspection team consisted of three inspectors. Before the inspection the provider was sent a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Before our inspection, we reviewed the information included in the PIR along with information we held about the home. This included notifications of deaths, incidents and accidents that the provider is required to send us by law. We contacted the commissioners of the service and two healthcare professionals from the local GP surgery. We also had feedback from a tissue viability nurse and a dietician.

Updated 12 January 2015

We inspected the home on the 15 and 20 October 2014 unannounced. St David’s Nursing Home is registered to provide accommodation for people who require nursing and personal care. The home provides care for up to 23 older people, some of whom are living with dementia. They also provided end of life care. At the time of our inspection St David’s Nursing Home supported 15 people.

At the time of our visit 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.’ However the registered manager was not living in this country and the manager in day to day charge left the service in September 2014. There was no clear management structure in place.

People’s safety was at risk in a number of areas. Risk assessments were not all accurately completed and for one person there were none in place. We found that pressure relieving equipment had not been correctly set and therefore did not protecting people at risk from pressure damage.

Procedures for unforeseeable emergencies including evacuation were incomplete and had not ensured individual people’s safety. The on call emergency contact list (the person to take responsibility and offer support to staff) was not up to date and contained only the registered manager’s number overseas.

The service had not taken into account people’s ability to make decisions for themselves. Staff were not following the requirements of the Mental Capacity Act 2005. Nor had they taken action to review the service with regards to the Deprivation of Liberty Safeguards for people whose liberty may be being restricted.

We found that people’s health care needs were assessed. However, people’s care was not planned or delivered consistently or monitored. In some cases, this either put people at risk or meant they were did not have their individual care needs met. People were not always supported to eat and drink enough to meet their needs.

All the people we spoke with were very complimentary about the caring nature of the staff. They also told us that staff treated them with kindness and respect. However we saw that care was mainly based around completing tasks and did not take account of people’s preferences. We were concerned that some very frail people living at the home have felt isolated as there were not enough meaningful activities for people either as a group or individually.

People told us contradictory things about the service they received. While some people were very happy, others were not. In addition, our own observations and the records we looked at did not always match the positive descriptions some people had given us.

Staff training was difficult to track due to staff changes and a lack of an up to date training programme. We also saw evidence that the learning had not always been put into practice. The provider did not have a system to assess staffing levels and make changes when people’s needs changed. This meant they could not be sure that there were enough qualified staff to meet people’s needs. Furthermore, people and visitors raised concerns about the low number of staff.

The process for monitoring the quality of care was not effective. The process had not picked up on the concerns we found during our visit, so had not led to the necessary improvements.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.