InFocus Charity

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

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 during the inspection and care records were personalised. This ensured people received care that reflected their current needs. The environment of the service was adapted to ensure people’s independence was promoted. There was a wide range of activities people could partake in.

We received positive feedback about the management and leadership of the service. The management were actively involved in care provision and staff told us they were well supported in their roles. Staff spoke of a good team ethos and a mixed skill set that brought positive outcomes for people. There were systems to communicate with staff and staff had the opportunity to feedback on their employment. Governance systems monitored the quality of service provided and records relating to people’s care delivery were regularly reviewed. People could feedback on their care and there were systems to communicate with parents, carers and staff.

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.

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.