Nichols House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care. Medicines, the environment and risks people could experience were not always well managed.
 

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a well-established culture of safety. Concerns identified during the inspection relating to medicines management, environmental safety and restrictive practices had not been identified through governance systems prior to the inspection. This meant there was a risk that opportunities to learn and improve were missed.

However, incidents or events where people needed reassurance such as when people experienced emotional distress were well managed. A staff member said in relation in incidents, “The manager will go through them and let us know if there is anything we should have done differently.”
 

The provider did not always work effectively with people and healthcare partners to establish and maintain safe systems of care. While some referrals to healthcare professionals had been made where required, these were not consistent across the service. For example, one person had not been referred to speech and language therapy (SALT) despite known choking risks, and there was no evidence of pharmacy involvement where medicines were administered with food. This meant people were not always supported by appropriate professionals to ensure their care and treatment were delivered safely.

In response, the provider contacted the pharmacy during the inspection and told us they would make a referral to speech and language therapy to address the identified risks.

People were protected from abuse. Staff had received safeguarding training and understood their responsibilities. A staff member said, “If I had any concerns I would report to my line manager if no action was taken, I can go to the safeguarding team.”

Risks to people were identified; however, care planning did not always clearly set out how these risks should be managed in practice or was not always up to date. Guidance around supervision, behavioural support and epilepsy management was not always clearly defined, which increased the risk of inconsistent approaches.
Despite this, staff knew people well and were able to describe how they supported them.
Relatives generally felt risks were well managed. For example, one relative said, “They understand[them]. They know [they]can’t be left alone.” However, another relative raised concerns about staffing arrangements on one occasion, stating this “isn’t safe.” This demonstrated that while risks were often managed, there were not always consistent assurances.
 

The provider did not always detect and manage risks in the environment. We observed two fire doors with excessive gaps and fridge temperature recordings above safe limits without evidence of action taken. However, the environment was generally clean and homely. A relative said, “The home is clean.”

There were enough staff deployed to meet people’s needs. Staff described how staffing levels were planned to support people both in the home and in the community. A staff member said, “We have enough staff on shift, we do proper planning to make sure we have enough on and for when we go out.” Relatives also confirmed this. One relative said, “There seems to be enough staff, she always has 1-1 in the home and 2-1 when in the community.” Staff were recruited, trained and supervised safely.

The provider did not always assess or manage the risk of infection. Some aspects of infection control required improvement. Fridge temperatures were recorded above safe limits without evidence of action, and food items were not always labelled upon opening, which increased risks in relation to food safety. However, we observed the home to be clean, and relatives confirmed this. One relative said, “The home is clean.”

Medicines were not always managed safely. For example, we found expired medicines, and protocols were not always in place or did not contain the required safety-related information for medicines used on an ‘as required’ basis. Where medicines were administered with food, there was no evidence of pharmacist involvement in these decisions. Best practice had not been followed to ensure two staff members signed transcribed medicines information on medicines administration records to confirm accuracy. This meant systems and documentation to support safe medicines management were not always effective, which increased risks to people.

However, staff were able to explain how people preferred to receive their medicines. In response, the provider told us they had reviewed medicines arrangements with a pharmacy, removed expired medicines, and planned actions to improve documentation and oversight.