Nicholas House Care Home

Nicholas House Care Home is a residential care home providing personal care to up to 40 older people including people living with dementia. The care home accommodates people in one adapted building over two floors. At the time of our inspection there were 28 people using the service.

People’s experience of using this service and what we found

This was a targeted inspection which considered staffing and recruitment. Based on our inspection of staffing we found systems were in place to determine appropriate staffing numbers in line with people’s assessed need, however these were not always consistent.

We have made a recommendation in relation to their system used for capturing staffing numbers required.

Systems were in place to ensure staff had been recruited safely.

People were happy with the care they received, they felt safe and well looked after. People and staff were positive about their experiences with the service.

For more details, please see the full report which is on the Care Quality Commission's (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 April 2022).

Why we inspected

We undertook this targeted inspection in relation to a specific concern we had about staffing arrangements in place at the service. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Nicholas House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nicholas House Care Home is a residential care home providing care for 24 people aged 65 and over at the time of inspection, some of whom were living with dementia. The service can support up to 40 people. The care home accommodates people in one adapted building over two floors. One area of the home is used to support people living with dementia.

People’s experience of using this service and what we found

Medicines were managed safely. Improvements had been made to the recording of medication. Staff received training and competency checks in relation to medicines.

Care records contained information about people’s needs and risks. People’s preferences and choices were considered and reflected within records.

People received safe, person centred care. Good systems were in place to protect people from abuse. Staff demonstrated a good level of understanding in relation to safeguarding. Appropriate referrals to the local safeguarding team had been made. People, relatives and staff spoke positively about the manager and felt able to raise concerns and were confident that these would be addressed.

People and relatives said they felt the service was safe and people were well supported and received good quality care. Staff cared for people with compassion and kindness and treated them with dignity and respect, their independence was promoted.

Staff knew people well and were knowledgeable about when to refer to other health professionals for advice and support. 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 systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 31 March 2021).

At our last inspection we recommended the provider improved the standards of record keeping in relation to medicines. At this inspection we found the provider had acted on the recommendation and had made improvements.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nicholas House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nicholas House Care Home is a residential care home that was providing care for 17 people aged 65 and over at the time of inspection, some of whom were living with dementia. The service can support up to 40 people. The care home accommodates people in one adapted building over two floors. One area of the home is used to support people living with dementia.

People’s experience of using this service and what we found

Medicines were managed safely although improvements were needed to improve standards of record keeping. We have made a recommendation about this.

Since the last inspection, the provider had improved safety and risk management within the service. Improvements had been made to ensure high standards of cleanliness of the environment were maintained. New flooring had been laid in communal areas and bedrooms and old items of furniture had been replaced. New windows and window restrictors had been fitted on the top floor of the service which met health and safety regulations. Fire safety issues had been addressed and regular fire drills were carried out.

The quality of record keeping in relation to people’s care and safety had improved. Care records contained up to date information about people’s needs and risks. People’s preferences and choices were considered and reflected within records.

People and relatives said they felt the service was safe and that people were well supported and received good quality care. Good systems were in place to protect people from abuse. Staff demonstrated a good level of understanding in relation to safeguarding. Appropriate referrals to the local safeguarding team had been made.

Staff cared for people with compassion and kindness and treated them with dignity and respect, their independence was promoted. People were involved in the provision of activities available for them to take part in. There was a wide range of opportunities for people to engage in activities and follow hobbies and interests. People enjoyed the food provided and were supported to make sure they had enough to eat and drink.

Staff were recruited safely and received the training and support they needed to undertake their role. Staff spoke positively about the support they received from the registered manager and the team.

People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed. People and their relatives said they felt the service had improved under the new registered manager who was responsive to feedback and committed to improving the service. Meetings were held with people, their relatives and staff to exchange information and gather feedback.

Staff knew people well and were knowledgeable about when to refer to other health professionals for advice and support. 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 systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 8 September 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 8 September 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

The provider has taken action to effectively mitigate the risks identified in the previous inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nicholas House Care Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• Visits were arranged in line with government guidance.

• Staff were wearing PPE in line with government guidance and designated areas were set up within the service for staff to remove and apply PPE.

Further information is in the detailed findings below.

Nicholas House Care Home is a residential care home that was providing personal care to 24 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 40 people.

The care home accommodates people in one adapted building that has been extended over the years and is on two floors. One area of the home on the ground floor is used to support people living with dementia

People’s experience of using this service and what we found

People living at Nicholas House did not receive a safe, effective or well led service. During the inspection, we identified concerns relating to people's safety which included poor oversight of fire safety issues by the provider, a lack of training and guidance for staff on how to support people in the event of a fire and insufficient staffing levels during the night which all put people at significant risk of harm. The provider had also failed to take appropriate action to ensure the premises were safe because windows on the first floor were single paned and were not fitted with safety glass.

The service did not have sufficient infection prevention and control measures in place. Areas of the premises were found to be unclean, and the condition of furniture and equipment was poor.

Medicines were not managed safely. Staff did not always have guidance to ensure they administered 'as required' medicines to people safely. Medicines were not stored safely, and stock levels of medication including controlled medicines were not recorded. Staff had not been trained or assessed to carry out key tasks for people such as medicine administration.

Systems were not in place to monitor accidents and incidents.

Safeguarding concerns had not been reported by staff and management. The registered manager was not clear of their role and responsibility in relation to safeguarding. Staff demonstrated a limited understanding of safeguarding and records showed they had not received appropriate training in this area.

Staff members we spoke with raised concerns about the management of the service.

The provider had failed to carry out inductions with newly recruited staff to ensure that they were fully prepared to support people using the service in a safe and effective manner.

Staff were not provided with supervision, appraisals or training in line with the provider’s policies.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had no oversight of the safety and quality of the service. Quality assurance systems were not established and operated effectively to ensure compliance with regulations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 July 2019) and we found a breach of one regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was prompted by serious concerns we had received about the service in relation to safeguarding. This is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led.

We have found evidence that the provider needs to make improvements. Please see safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nicholas House Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to fire safety and managing risks, management of medicines, staff training and support, failing to operate effective monitoring systems to improve the quality and safety of the service, poor recordkeeping, notification of incidents and safeguarding people from risk of harm or abuse.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Nicholas House Care Home is a residential care home that was providing personal care to 26 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 40 people.

The care home accommodates people in one adapted building that has been extended over the years and is on two floors. One area of the house on the ground floor is used to support people living with dementia. A second area on the upper floor is used to provide people with capacity and good mobility an increased level of independence. Bedrooms are mainly single occupancy, some with en-suite facilities. People share the lounges, dining rooms, activity rooms and gardens.

People’s experience of using the service and what we found.

People did not always experience a well-run service. A new manager was in post just one week before our inspection. Prior to this there had been a year of inconsistency with a new registered manager running the service for ten months and the operations manager for two months. During this time the staff were inconsistently led, quality assurance systems were ineffectively used and records were not maintained. Failings in service provision and staff insight had not been properly monitored, identified or addressed. The provider was, therefore, in breach of the regulation on good governance, with ineffective quality monitoring systems and record keeping. The new manager had not yet been able to influence improvements at Nicholas House Care Home.

We identified failings in some of the support people received with their personal hygiene. The provider failed to ensure parts of the premises were safely maintained. They had not ensured all people's personal risks were reduced. There was inconsistency in assessing people’s needs. Staff supervision was ineffective. All of these were a potential risk to people’s health and wellbeing. We made five recommendations about these failings.

People were safely supported and protected from harm or abuse. Safeguarding systems in place supported this. Staffing levels were safe and new staff were recruited using robust procedures. Management of medicines were safe. Staff learnt lessons after dealing with problems.

Staff were trained to support people with mobility, nutrition and health care, as well as any diagnosed conditions, but were not always able to apply their learning. The premises were designed to meet the needs of the people that used the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were respected with regard to privacy and dignity and staff encouraged their independence. Staff were caring and followed support plans to meet people’s needs. People communicated in their own way and staff learned about these. People’s concerns were addressed and compassion shown to them at the end of their life.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection.

At the last inspection the service was rated good (published 8 June 2017).

Why we inspected.

This inspection was prompted by information of concern.

Enforcement.

We have identified a breach in relation to quality monitoring and recording systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. The provider already sent us a pre-action plan based on information in our initial inspection feedback form. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At the last inspection the service was rated Good. At this inspection we found the service remained Good. There were no breaches of regulation and while the service met all fundamental standards it was not as forward looking as it might have been or showed evidence of continued development.

The registered provider was required to have a registered manager in post and there had been a registered manager at the service for the last five and a half years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were protected from the risk of harm or abuse because staff employed were trained in safeguarding adults and understood their responsibilities. The registered provider had policies and systems in place to manager safeguarding incidents and maintained records of any suspected or actual safeguarding concerns. Risks were also managed and reduced so that people avoided injury or harm. The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people’s needs and recruitment systems were followed to ensure staff were suitable to support people. Medicines were found to be managed safely.

Qualified and competent staff were employed and supervised. Their personal performance was checked at an annual appraisal. People’s mental capacity was appropriately assessed and their rights were protected. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received adequate nutrition and hydration to maintain their health and wellbeing. The premises were suitably designed and furnished for providing care and support to people living with dementia.

Compassionate care was provided by kind staff that knew people's needs and preferences. People were involved in their care and asked for their consent before staff undertook any support tasks. Their wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.

People were supported according to person-centred care plans, which reflected their needs and were reviewed. They engaged in pastimes and activities if they wished to and were content. People had good family connections and support networks. An effective complaint system was used and complaints were investigated without bias. People and their friends and relatives were encouraged to maintain relationships of their choosing.

The service was well-led and people had the benefit of a culture and management style that were inclusive and caring. A system was in place for checking the quality of the service using audits, satisfaction surveys and meetings. People made their views known through direct discussion with the registered manager and staff or via the complaint and quality monitoring systems. People’s privacy and confidentiality were maintained as records were held securely on the premises.

People we spoke with told us they were comfortable and felt safe in the home and found safeguarding procedures were followed to ensure people were protected from harm .

People told us that staff supported them with their medication and received this when it was required. We found that staff responsible for administering medication had completed courses that were externally assessed, to ensure they were competent to handle medication safely.

People who used the service and their relatives told us that staff were, 'Kind and helpful.' They told us that staff provided support in a considerate and sensitive way and that staff were friendly and approachable. There was evidence that training on a variety of courses was provided, to ensure staff had the right skills to perform their work.

Systems were in place to enable the quality of the service to be monitored. We saw these included regular audits of the service, together with follow up actions to address shortfalls where this was required. People told us that overall they were, 'Very happy' with the service they received. A visiting relative told us they were, 'Reassured' by the service and confident appropriate action would be taken when this was needed. We saw evidence of positive feedback from relatives and a social care professional, who had commented on the 'Friendly staff who go out of their way to make clients happy.'

People and their relatives spoke positively about their care. One person told us, 'I like being here. I can see my plan of care and I get involved in a review of care. I have a key worker.' A relative told us, 'He's happy enough here and I am happy. The staff are very warm and very caring. If he is not well they ring me. This is the best thing that happened to him.'

People were protected from the risk and spread of infection. One person told us, 'I think it is as clean as it can be. They are at it every day. The two cleaning ladies are very good.' A relative said, 'I think they do very well cleanliness wise. The place always looks clean. There is no smell.'

There were effective recruitment and selection processes in place and people spoke positively about the staff that worked with them. One person told us, 'The staff seem to work together. They are all so cheerful and they will do anything for you.' A relative told us, 'The staff are brilliant. They have been excellent.'

People's complaints were fully investigated and resolved, where possible, to their satisfaction. A relative told us, 'I have had a complaint and it was dealt with very well. I brought it up with the manager and she dealt with it.'