Dewi –Sant provides care and accommodation for up to 34 older people some who are living with dementia. At the time of the inspection there were 30 people living in the service.

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.

Some of the people who lived in the home had limited communication therefore we spent time observing people.

At the last inspection, on the 29 April and 5 May 2015 the service was rated Good overall. However it was Requires Improvement in Safe because medicines were not being managed safely and call bells were not always answered promptly.

At this inspection we found the service remained Requires Improvement in Safe but Good overall.

People’s medicines were not always managed safely or properly. People received their medicines safely and all medicines were signed for. However, there was an error in medicines that required additional security that had not been investigated or reported to the appropriate authorities. This error had been found between the weekly audits. Only one staff was witnessing medicines that required additional security being administered to people and hand written entries on Medicines Administration Records (MAR) only had one signature. The registered manager took immediate action to investigate the error during the inspection and changed procedures to ensure safe practice on medicines.

People and staff told us there were sufficient staff to meet people’s needs. A new call bell system had also been installed and no one commented on the waiting times being excessive. Risk assessments were completed to enable people to retain their independence and receive care with minimum risk to themselves or others. People said; “I am sure I could talk to any of the staff” and “The staff are wonderful and they help me when I am worried.”

The Provider Information Record (PIR) recorded; “Each individual also has a hospital passport with a summary of their details. None of our residents go into hospital without the support of staff, this ensures that they feel safe and that a thorough handover is completed.”

People continued to receive effective care and support from a staff team who were knowledgeable and had the skills required to effectively support them. Staff were competent and trained well. People had the support needed to help them have maximum choice and control of their lives and staff supported people in the least restrictive way possible. Policies and systems in the service supported good practice. People's wellbeing and healthcare needs were monitored by the staff and people accessed healthcare professionals when required.

People all agreed that the staff team were very caring. We observed staff being patient and kind. There was a calm atmosphere in the service. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received. One person said; “1st Class care.” And a relative said; “Mum is well cared for.”

The staff team remained responsive to people's individual needs. Personalised care and support was provided to each person to help ensure people were able to make choices about their day to day lives. Complaints were fully investigated and responded to. A relative said; “Any concerns and I would talk to the staff.”

People were supported to take part in a range of activities according to their individual interests. Trips out were also planned for people.

The service continued to be well led. People and staff told us the registered manager was approachable and “Had an open door policy.” The registered manager and provider sought people's views to make sure peopl

People and their relatives were very happy with the service they received. Comments included “Nothing is too much trouble.” And “They are all marvellous here; I can go home not worrying.”

Staff interacted with people in a friendly respectful way. They were attentive to people’s needs. Staff gave people time without rushing and answered call bells without delay.

Care plans demonstrated people’s care needs and how they were being met. The unregistered manager was in the process of involving family with this process but this had not yet been completed.

The environment was clean and there were systems in place to minimise the risk of infection.

The home feels more homely and welcoming.

People told us that because the hallway is a long way for some people to walk up and down, it's good to be able to sit and rest on the armchairs that have been moved into the hall. Some people prefer not to sit in the lounges. They enjoy sitting on these chairs because they feel involved in daily life of the home.

People in general enjoyed the activities, but the variance in ability levels meant that some tasks asked of people were too complicated while others found it very easy.

In general the staff engaged well with the people they were caring for. Communication supported people’s well being and people were given information in ways they could understand and at a pace that was suitable for them.

Staff generally respected people’s choices and listened to and acted upon requests.

Staff were respectful in their comments.

Care plans did not contain enough information about the person’s mental and psychological health needs or of how they impacted upon the individual. There were no specific risk assessments in place.

The daily menu had choices of food however people were asked the day previously about their choices. People were not consulted about their preferences and tastes. The menu was not varied. Mealtimes were short with little or no interaction between the people eating in the dining room.

There have been no further safeguarding alerts or concerns.

The staff we observed responded competently and appropriately, with confidence when handling and administering medicines. Some staff need further supervision and/or training to ensure they too manage medicines in accordance with relevant guidance.

Dewi Sant is being refurbished and rooms are being redecorated. The outstanding building works from previous visits have been completed or are included in the refurbishment plan.

The provider has advised CQC that a deputy manager and manager have been appointed with effect from 31 January 2011. We have received verbal confirmation that an application to register the manager will be sent to us shortly.

The inspection took place on 29 April and 5 May 2015 and was unannounced.

Dewi-Sant Residential Home provides care and accommodation for up to 34 people. On the day of the inspection 31 people were using the service. Dewi-Sant Residential Home provides care for older people who may have mental health conditions which include people living with dementia.

The service had 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.

Medicines administration records were all in place, but had not all been correctly completed. An action plan had been put in place to address all the issues found. Processes had been changed and fed back to staff. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, speech and language therapists and district nurses.

Call bells were not always answered promptly. Action had been taken to address this concern. A new call bell system was in the process of being installed and practice had been changed to regularly monitor call bell response times.

People and staff were relaxed throughout our inspection. There was a calm and pleasant atmosphere. People were often seen laughing and joking and told us they enjoyed living in the home. Comments included; “I’m well looked after by caring staff we have quite a laugh at times.” and “You couldn’t get better at a top hotel, I love living here.” A relative said, “I think this home is excellent, my brother has been living here for years and I can’t fault any aspect of it”. A healthcare professional commented that he and a colleague had discussed how they would like to live at the home themselves.

People spoke highly about the care and support they received, one person said, “I’m really well cared for the staff are really really good.” Another stated: “On the whole it is an excellent place to live, I would recommend it to anyone”. Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People or where appropriate those who matter to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.

People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful and reflected people’s interest and individual hobbies. One person said, “I’m encouraged to do things for myself”.

People told us they felt safe. Comments included, “I feel safe and protected” and “I’m surrounded by caring people, that’s what makes me feel safe”. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People and those who mattered to them knew how to raise concerns and make complaints. People told us concerns raised had been dealt with promptly and satisfactorily. No written complaints had been made to the service.

Staff described the management to be supportive and approachable. Staff talked positively about their jobs. Comments included: “I really do love my job.”; “I have learnt so much, I love working here” and “This job is my life, I absolutely love it, it is like we are all one big family”.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. A staff member said: “The training is great, gives you the confidence to do your job to the best of your ability”.

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.