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We are carrying out a review of quality at Nicholas House. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Inadequate

Updated 31 July 2021

About the service:

Nicolas House is a residential care home that is registered to provide care for up to 30 people, this includes people living with dementia. Accommodation is situated on three floors with two lounges and a conservatory. There are specialist baths and wet rooms. The home also offers respite provision and day care facilities for non-residents. At the time of our inspection 16 people were using the service.

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

People's relatives expressed concerns about the falls their family members had experienced at the service, comments included, “I really don’t know how mum falls so often, although she does have high blood pressure. I do get a phone call each time she has fallen. In my opinion the home needs to keep regular observations during the night with mum’s high risks of falls." Another relative felt their family member was safe in the home but stated, “[Family member] has had several falls which has rendered her quite disabled. She broke her hip and was admitted into hospital following one fall.”

We found people were placed at significant risk of harm because the provider demonstrated a lack of knowledge and understanding of how to assess, monitor and manage risks. Records showed people who had been identified at risk of falls, continued to sustain injuries, some of which resulted in fractures. Action taken by management and staff when people fell, were not in line with the provider’s prevention and management of falls policy. As a result of this, people remained at significant risk of harm.

People and relatives told us staff wore personal protective equipment (PPE). However, one person commented, “When assisting with bathing the carers are in full kit, but they are not always completely masked.”

We observed staff did not always wear PPE in line with government guidelines and best practice.

We found quality assurance systems and processes in place to identify and assess risks to people’s welfare and safety, remained ineffective. For example, care plans were not regularly reviewed and updated when people had sustained injuries; audits and monitoring systems failed to identify risks; records were not fit for purpose, inaccurate and partially completed. Audits failed to pick up on the issues we had picked up during our visit. There was no scrutiny at board level to identify these issues and ensure senior managers were accountable and well supported to meet their statutory duties.

The provider did not always notify The Care Quality Commission (CQC) when incidents that affected people happened and failed to work in accordance with the Duty of Candour. This is about provider being open and transparent when things go wrong.

People and relatives said they felt safe from abuse and medicines were administered safely. We have made recommendations in relation to the provider's safeguarding and medicines policies.

Rating at last inspection and update: The last rating for this service was inadequate (published 1 May 2020) and the service was placed in special measures. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not, enough improvement had been made and the provider was still in breach of Regulations.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 9 January 2020. Breaches of legal requirements were found. 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, staffing and fit and proper persons employed.

We undertook this focused inspection to check they had 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 requirements.

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 remained the same. This is based on the findings at this 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 COVID-19 and other infection outbreaks effectively.

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 continued breaches in relation to, safe care and treatment and good governance.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

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

Inspection areas

Safe

Inadequate

Updated 31 July 2021

The service was not safe.

Details are in our safe findings below.

Effective

Requires improvement

Updated 31 July 2021

Caring

Good

Updated 31 July 2021

Responsive

Requires improvement

Updated 31 July 2021

Well-led

Inadequate

Updated 31 July 2021

The service was not well-led.

Details are in our Well-Led findings below.