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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 1 May 2020

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, 25 people were using the service.

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

During this inspection, we checked to see if the provider had addressed the concerns found at our previous visit on 12 February 2019. We found the provider had not made the improvements they told us they would, and there were multiple repeated breaches of the regulations.

People were placed at significant risk of harm. Risk management plans to reduce identified risk of harm to people’s health and welfare, did not provide staff with enough information to reduce or mitigate those risks. Unsafe recruitment practices placed people at risk of being cared for by staff who were not suitable. The provider did not take prompt action to address poor staffing levels. People were placed at potential risk of harm as the service did not act on recommendations to prevent fire. The provider did carry out necessary checks to ensure staff were competent to administer medicines safely. We have made a recommendation about this.

The assessment of people’s needs and choices and delivering of care was not in line with standards, guidance and the law. The provider could not be assured staffs' working practices would prevent discrimination and protect people's human rights. Staff were not appropriately inducted, trained and supported. The service did not always make effective use of health and social care professionals to support people to achieve good health outcomes. As a result of this we could not establish if people received effective oral hygiene care.

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.

Peoples’ care needs, and preferences were not always considered and regularly reviewed to make sure they were still relevant. The provider did not maintain a record of all complaints, outcomes and actions taken in response to complaints.

The management team lacked an understanding of equality, diversity and human rights. We have made a recommendation about this. There were no systems in place to communicate how feedback received had led to improvements. We have made a recommendation about this. There were ineffective quality assurance systems in place which did not improve the quality of the service and protect the welfare and safety of people.

People and relatives were happy with the service provided and spoke positively about the caring nature of staff. Staff said they were supported and described the management of the service as open and approachable.

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 6 March 2019) and there were 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 not, enough improvement had been made and the provider was still in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

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 provid

Inspection areas

Safe

Inadequate

Updated 1 May 2020

The service was not safe.

Details are in our safe findings below.

Effective

Requires improvement

Updated 1 May 2020

The service was not always effective.

Details are in our effective findings below.

Caring

Good

Updated 1 May 2020

The service was caring.

Details are in our caring findings below.

Responsive

Requires improvement

Updated 1 May 2020

The service was not always responsive.

Details are in our responsive findings below.

Well-led

Inadequate

Updated 1 May 2020

The service was not well-led.

Details are in our Well-Led findings below.