Nicholas House

Updated 26 January 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Nicholas House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the site visit, the home manager had applied to register as the manager with the CQC. At the time of the inspection report, our registration team had completed the assessment of the manager’s application and added them to the CQC’s register.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we held and had received about the service since the time of the last inspection. We sought feedback from the local authority, safeguarding team and other professionals who work with the service. We checked information held by Companies House, the Food Standards Agency and the Information Commissioner’s Office. We checked for any online reviews and relevant social media, and we looked at the content of the provider’s website. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

The site visit took place on 16 December 2021. We made telephone calls to relatives on 22 December 2021. We spoke with two people and 12 relatives about their experience of care and support provided by the service. Some people were not able to participate in a conversation with us. We spoke with the nominated individual about their oversight of the service. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with the home manager, deputy manager, two senior care workers, a care worker, two housekeepers, a laundry worker and the maintenance person. We also spoke with a physiotherapist who works with people at the home. We reviewed a range of records. This included three people’s care records, three staff personnel files and three people’s medicines administration records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We requested and received further care documentation, quality assurance documents, and were provided with a variety of additional evidence for consideration.

Updated 26 January 2022

About the service

Nicholas House is a care home providing personal care to 13 people. The service provides care to adults, some of whom may live with dementia. The service can support up to 30 people. The building has three floors, and each person had their own bedroom. There were shared facilities such as bathrooms and showers, lounge and dining areas as well as staff stations and offices.

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

The prevention and management of trips, slips and falls had improved. Actions were taken to mitigate risks including regular updates of the risk assessments, care plans, working with the physiotherapist, reporting of accidents and incidents, and completion of follow up investigations. Infection prevention and control had improved, however further action was required to ensure correct use of personal protective equipment . There were sufficient staff deployed and personnel files contained the information required by the regulation. Although service users received their medicines, improvement was required to the documentation, for example ‘as required’ protocols and guidance for high risk medicines.

There was positive feedback about the home manager. Oversight of the service at local and trustee level had improved with the changes in the management team. Auditing of care documentation was taking place, and there was evidence of follow up by the management team. There were related action plans, with the actions being tracked for progress on each one. The home manager understood the duty of candour process and had applied it to notifiable safety incidents, for example serious injuries. Statutory notifications required by law were being submitted without delay.

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 inadequate (published 31 July 2021) and there were multiple breaches of regulations. 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 were made and the provider was no longer in breach of some regulations.

This service has been in Special Measures since 11 March 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 was a planned inspection based on the previous rating.

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.

We carried out an unannounced comprehensive inspection of this service on 18 May 2021 and 19 May 2021. Breaches of legal requirements were found. We issued a warning notice and the provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance, duty of candour and notifying CQC of certain events.

We undertook this focused inspection to check they had complied with the warning notice and followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those breaches of regulations.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. 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 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.