This inspection was unannounced and took place on 06 August 2015.
At the last inspection in October 2014, we asked the provider to make improvements in relation to staffing levels, monitoring the quality of the service and the accuracy of records. The provider sent us an action plan to say that they would be meeting the relevant legal requirements by 28 February 2015. Other improvements were also required in relation to the management of people’s medicines, staff knowledge of the requirements of the Mental Capacity Act 2005 (MCA), access to activities that complemented people’s hobbies and interests and the completion of staff training. We found that some improvements had been made but that further improvements were required.
St Nicholas House is a service that provides accommodation and care to older people and is registered for up to 39 people. There are two units operating at the service, a residential unit and a dementia care unit. On the day of our inspection, there were 30 people living in the residential unit and five people in the dementia care unit.
There was a registered manager working at the home who had been registered with us since 5 June 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We found that some improvements had been made to how people’s medicines were managed, staff knowledge in respect of the MCA 2005 and in the provision of activities that complemented people’s hobbies and interests. However, staffing levels were not adequate on the day of the inspection to provide people with safe care or that met their individual preferences, although it is acknowledged that the service had tried to cover the staff absences but had not been successful due to an agency staff member not turning up for their shift.
Actions to mitigate risks to people’s safety were not always being taken and the systems in place to monitor the quality of the service and accuracy of some people’s care records remained ineffective. Some staffs refresher training was overdue which meant that they may not have up to date knowledge and skills to provide people with safe care.
Staff were seen asking people for their consent before providing them with care. However, the principles of the MCA 2005 had not always been followed when decisions had been made on behalf of people who lacked the capacity to consent to some aspects of their care.
The provider had systems in place to reduce the risk of people experiencing abuse. When concerns were raised, the registered manager had investigated these thoroughly and action had been taken to protect people when necessary. New staff were checked before they started working at the home to make sure that they were safe to do so. The premises where people lived and the equipment they used was well maintained and safe.
Staff knew the people they cared for well and treated them with kindness, compassion, dignity and respect. People had access to plenty of food and drink and saw healthcare professionals for specialist advice when they needed to help them maintain their health.
People and relatives were listened to and their opinions were respected. There was a system in place to fully investigate any complaints or concerns that were received.
The service had an open culture where people and staff could raise concerns without fear of recrimination. People who lived in the home and the staff were encouraged to make suggestions on how to improve the care that was provided and these were acted upon.
The managers and staff at the home acknowledged that there were issues with staffing levels that had impacted on their ability to sometimes provide people with safe care that met their individual needs. However, they demonstrated to us that they were working hard to correct this and were pro-active in trying to improve the quality of life of the people living at St Nicholas House.
There were some of breaches of the Health and Social Care Act 2008 [Regulated Activities] 2014 and you can see what action we told the provider to take at the back of the full version of the report.
We have made a recommendation about following the principles of the Mental Capacity Act 2005 when making best interest decisions on behalf of people.