We carried out this inspection on 4 April 2017. It was an unannounced inspection. When St David’s House was previously inspected in September 2014, no breaches of the legal requirements were identified.

St David’s House is a residential care home with 21 beds situated within the 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 we visited, 15 people lived at St David’s House. Three of those people are continuing their on-going education at the main WESC college.

The WESC Foundation provides further education programmes for younger people with visual impairments and other disabilities. People benefitted from a wide range of work experience opportunities as the college had their own retail charity shops and they worked in partnership with local businesses. WESC Foundation also employed other healthcare staff such as a clinical psychologist, speech and language therapists and physiotherapy services as well as mobility services. The people at St David’s House had access to all the specialist services and facilities on site, even when they no longer attended the college.

A registered manager was in post at the time of our inspection. 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 and associated Regulations about how the service is run. On the day of our inspection the registered manager was absent on annual leave. We spent time with the deputy manager and other members of the provider’s management team.

People were observed at ease in the company of staff and there was a clear friendship and bond between people and staff. People’s relatives said they felt people were safe and spoke very highly of the staff at the service. There were sufficient staff on duty to meet people’s needs and recruitment processes were robust. Staff knew how to recognise and respond to actual or suspected abuse. People received their medicines in accordance with their assessed needs and risk assessments were completed when required. Incidents and accidents were monitored and the environment was maintained.

People received effective care in line with their assessed needs. People’s relatives spoke highly of the care provision and the staff that provided it. The service had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA).

The service had completed capacity assessments and ensured people had independent advocates when required in accordance with the MCA. However, we found that when a capacity assessment indicated that a person lacked the capacity in a particular area of care, the associated best interest decision was not consistently completed in line with guidance or fully recorded. We have made a recommendation relating to this. Staff received training and supervision to carry out their roles effectively and an induction was undertaken by new staff. People received the support they required to eat and drink and people had access to healthcare professionals.

We observed caring observations between people and staff. Relatives we spoke with commented positively on the standard of care provided and written compliments received by the service reflected this. Staff understood the needs of the people they supported and a keyworker scheme promoted the delivery of person centred care. Staff were observed responding to people’s needs durin

At the time of our inspection there were sixteen people living at the service. During our inspection we spoke with two people and the relatives of one person who lived at the service.

People living at the service had complex needs and people we met were unable to communicate their experience of living at the service in detail. We saw from observations during our inspection that these people were confident in their environment and interacted well with staff and other people living at the home.

People told us they were involved in their care and support and this was confirmed by relatives and staff we spoke with.

The service encouraged people to be as independent as possible and set goals with people for them to achieve.

We found that people’s needs were assessed before coming to live at the home. Care plans were in place to guide staff on the support people needed.

The home worked with other services to ensure that when people moved into or out of the service, this was done in a planned way which ensured the safety and welfare of the person.

Medication was administered safely and the home had systems in place to monitor this.

The service had policies and procedures in place about protecting people from abuse.

Staff were trained and supported to enable them to carry out their roles effectively.

Overall, we found the provider had an effective system to regularly assess and monitor the quality of service that people received.

We met with four people who lived at St David's House and asked about their experiences and we talked to four relatives. We looked at three people's care records. We spoke to seven staff including the registered managers, nursing and therapy staff, local managers and care workers. One person we spoke with told us how happy they were living at St David's House. They told us how easily they can access all areas of their home and how much they enjoy cooking chilli con carne for everyone on the adjustable height hob in the kitchen. One relative said, "its really good, x considers this place his home. We are very happy for him to live here, he has lots of friends here. Staff know him well and how to support him". Another relative said "x is doing very well and is ready to take the next steps. Currently, he is working on making choices and on developing skills such as making his bed and doing his washing".

People's care was tailored to individual needs. Care records included detailed assessments of people's health and social care needs and identified individual goals. People were supported and encouraged to be as independent as possible and to fulfil their potential. People's care needs were supported by a range of staff of trained and experienced staff which included care workers, nurses, occupational and speech and language therapists, and physiotherapists.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The registered location, St David’s House  comprises of a care home with 21 beds and a health team, which includes nursing  and therapy staff. The provider is West of England School and College, for people with visual impairment,  known as WESC Foundation. It provides further education programmes for young people with visual impairments and other disabilities. The care home, St David’s House is made up of three separate lodges, Maple, Ash and Mulberry. A few people who live at St David’s House are students at the college but most have finished their formal education. Commissioners have agreed further funding for individuals to continue to live there in order to enable them to gain further independent living skills and to have support to access the community for work and leisure.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The provider employed health professionals to help support people’s health care , mobility and psychological needs. These included nurses, a clinical psychologist, occupational therapy,  speech and language, and physiotherapy staff. Young people who live at St David’s House have access to all the specialist services and facilities on site, even when they no longer attend the college.  

People were supported by staff who were trained and skilled to meet people’s individual needs. Staff were confident at enabling people to become more independent but some staff felt less confident with managing people's health care needs. Following a recent decision to reduce nursing provision on site, some staff were feeling anxious about their increased responsibilities, and senior staff were supporting them with this. Improvements were needed in documenting how people’s health care needs were being addressed in their care records, so they were clearer and more accessible to staff and others.

People felt safe and their risk of abuse was reduced because staff were trained to recognise signs of abuse, reported them and were confident any concerns were dealt with. Staff understood the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected, although further actions were needed for one person. Risks for individuals were identified and managed to reduce them as much as possible. People were supported to take some risks in order to increase their independence and lead more fulfilling lives.

People were supported by staff who were compassionate and kind. Staff spoke about people as individuals and care was personalised to meet people’s individual needs. People’s privacy and dignity was promoted by staff who demonstrated a positive regard for each person in their interactions and in how they spoke about them.

People, relatives and staff gave us a number of examples which showed people were supported to become more independent. They had access to a wide range of work experience opportunities because the provider has their own retail charity shops and worked in partnership with local businesses which offered work placements. When a person was ready to move on from the college, the provider worked with the person, health and social care professionals and the new provider to ensure they were supported to do so in a planned and phased way. This meant the new service had all the information, support and training they needed to support the person appropriately.

People benefitted from a service that was committed to continuous learning and improvement. There was a positive culture which praised and encouraged people and staff for their achievements. There was strong leadership which put people first, and senior management led by example. The provider had robust quality monitoring systems to monitor the quality of care provided.