Archived: Nicholas House

Updated 18 August 2023

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 Health and Social Care Act 2008.

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 carried out by 2 inspectors (one of whom specialised in learning disabilities).

Service and service type

Nicholas House is a supported living service. It provides personal care to people living in their own house. The service provides care and support to people living in one 'supported living' setting, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post although they were absent at the time of our inspection.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We reviewed support plans and associated records for 3 people. We reviewed medicines administration and associated records for 3 people and spoke with 6 members of staff. We spoke with 3 relatives and 2 people who lived at the service and observed staff supporting 3 people. We spoke with a Registered Manager from another service supporting Nicholas House, a Deputy manager, the Operations Manager and the Head of Care.

After the inspection we received further documentation electronically, such as governance audits, recruitment files, supervisions, and minutes of meetings. We continued to liaise with the local authority about our concerns following the inspection.

Updated 18 August 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Nicholas House is a supported living service providing personal care to up to eight people. The service provides support to people with a learning disability and autism. At the time of our inspection there were three people using the service.

Nicholas House is one building with eight flats. Within the building there is an office for management and staff. All people who used the service at that time received personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Right Support: Model of Care and setting that maximises people's choice, control and independence.

Staff did not always support people with their medicines in a safe manner. There continued to be a lack of robust systems in place to manage medicines, however the provider took some action to remedy this. People were not supported to have maximum choice and control of their lives. This was because systems to support and deliver care were not utilised consistently at a local level around staff deployment and staff training. Most people were not supported to make decisions, engage in activities or access the local community.

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 required were in place but not effectively implemented within the service to support this practice.

Right Care: Care is person-centred and promotes people's dignity, privacy and human rights

People had care plans and risk assessments in place; however, these were not always up to date or shared with the staff who needed to be aware of them. Staff were seen to not communicate effectively with people. Additional communication tools to support effective communication had not been put in place. Care did not always promote people's dignity. People had for periods been without the required staff support which had placed them at risk and caused anxiety and distress. Most staff approaches were well intended and well meaning, but without sufficient support, staff did not understand how to assist people in the way that would best support their care and wellbeing. Staff training and supervision was not up to date and did not support staff effectively. The service worked with other agencies but professionals told us there were barriers to reviewing support needs. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The ethos and values of the provider were not embedded in care delivery. Management of the service was not robust. Staff felt unsupported by management and the provider. Oversight of the quality and safety of the service did not ensure actions to improve the quality of support were completed. Records relating to people’s care required review and updating to ensure they were fully reflective of people’s support needs. People were not supported by staff who understood best practice in relation to supporting people with a learning disability. People were not always able to exercise choice and live an ordinary life as other people. Relatives were not actively involved in decisions about the service they received. The behaviour of managers did not support people's involvement in care and help them to express their views and feelings.

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 26 September 2022). At that inspection we found the provider was in breach of regulations relating to safe care, staffing and governance. At this inspection we found the provider continued to be in breach of those regulations. We also found further breaches in relation to consent, dignity and respect, nutrition and safe care and treatment. The service is now inadequate.

Why we inspected.

This inspection was prompted by a review of the information we held about this service.

The inspection was also prompted in part due to concerns received from the local authority about safeguarding concerns, safe care, staffing and management of the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all our 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 have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. The provider had begun to take action to address immediate concerns but worked with the local authority to transfer care to another provider.

You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has changed from requires improvement to inadequate based on the findings of 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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to consent, staff training, medicines management, infection control, person centred care and overall management of the service at this inspection.

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.

Follow up

We will work with the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

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.