Archived: Nicholas House

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.

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. Not everyone who used the service received personal care. CQC only inspects where people receive 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 to achieve the best possible health outcome. The provider did not ensure they had robust systems in place to manage medicines, however this was actioned immediately during the inspection.

People were supported by staff to pursue their interests and were starting to look at goals for individuals.

People were supported to have maximum choice and control of their lives and staff attempted to support people in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice.

Staff adhered to safe practices when wearing personal protective equipment (PPE).

People had access to specialist health and social care support. Staff supported people to have an active role in maintaining their own health and wellbeing.

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

People had care plans and risk assessments; however, these were not always clear and coordinated.

People did not always have enough appropriately skilled staff to meet people’s needs and to keep them safe.

Staff were able to communicate with people and were able to describe how certain expressions may mean something to that individual. However, there were care plans that indicated people may benefit from additional communication tools and this was not used at the time of the inspection.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff were starting to understand, and responded to, people’s individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. 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.

People's quality of support was not always enhanced by the quality assurance system the provider had in place. Actions were not always documented, and it was unclear if actions were completed. This had an impact on people's care.

People did not always have risk assessments in place, to identify risks people faced and how staff should manage these. Staff were not always knowledgeable about the content of these risk assessments.

People were supported by staff who understood best practice in relation to supporting people with a learning disability. However, there were areas of improvement needed in relation to training and ensuring staff had the right skills.

The service had a recent change in management. Staff acknowledged this had helped improve the service and the support they received.

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

Rating at last inspection

This service was registered with us on 10 November 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. The information shared with CQC about the incident indicated potential concerns about the safety of people. This inspection examined those risks. The local authority and police investigated these concerns and concluded there was no neglect with regards to the death.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe management of medicines and risk, lack of staff training and quality assurance systems this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside 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.