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Nicholas House Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 6 March 2019

About the service:

Nicholas House is a residential care home in south Buckinghamshire. At the time of the inspection 19 older people, some of whom were living with dementia, lived at the home.

People’s experience of using this service:

People and their relatives gave us positive feedback about the care and support they received. Comments included “Neither of us could speak highly enough about the staff we met during our visits,” “Nicholas House is a first class residential home and I would highly recommend it,'' “During this period we always felt she was very well looked after, treated with dignity, and in very safe hands,” “We visit frequently and there is always a very open, calm and friendly welcome for us when the front door is opened at Nicholas House” and “The staff were incredibly sensitive and caring in the last few weeks of her life. Really, we feel so much gratitude for the amazing staff.”

There was a lack of good governance at the home. There was a lack of formal quality assurance processes in place. Records relating to people’s care and treatment lacked details on how to minimise risks to them.

Environmental risks were not always assessed within the timescales recommended by national guidance.

The service did not ensure there was a robust recruitment process in place for new staff. New staff had started to work unsupervised without a full criminal record check by the Disclosure and Barring Service (DBS) being carried out. This placed people at risk of unsuitable staff supporting them.

People were cared for by staff who felt supported. However, records did not demonstrate staff were given appropriate opportunities to discuss their performance. We have made a recommendation about this in the report.

Staff were unsure if they had completed training in supporting people who required end of life care. We found there was mixed understanding from staff about what end of life care was. We have made a recommendation about this in the report.

We found the home to be light, clean and consideration had been given to the environment so people living with dementia were easily able to find their way around the home.

People were supported to receive their prescribed medicines on time.

People were supported by staff who demonstrated compassion and were kind. People’s dignity and privacy was maintained.

People were supported to maintain important relationships with family and friends.

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 supported to engage in meaningful activities both within the home and the local community. The home had forged links with local schools and other care homes.

Rating at last inspection:

The previous inspection was carried out on 9 June 2016 (Published on 7 July 2016). The service was rated Good at the time.

Why we inspected:

The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

We identified breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. Details of action we have asked the provider to take can be found at the end of this report.

For more details, please see the full report which is on the CQC website at

Inspection areas


Requires improvement

Updated 6 March 2019

The service was not always safe.

Details are in our Safe findings below.



Updated 6 March 2019

The service was effective.

Details are in our Effective findings below.



Updated 6 March 2019

The service was caring.

Details are in our Caring findings below.



Updated 6 March 2019

The service was responsive.

Details are in our Responsive findings below.


Requires improvement

Updated 6 March 2019

The service was not always well-led.

Details are in our Well-Led findings below.