St Nicholas Care Home

Updated 19 October 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

This inspection was carried out by 3 inspectors, a specialist professional advisor, who was a nurse and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

St Nicholas Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. St Nicholas Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 not a registered manager in post. The manager was new and had only been in post for a couple of weeks.

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 spoke with 13 people who used the service and 13 relatives about their experience of the care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 21 members of staff including the manager, deputy manager, nurses, care staff, domestic staff, kitchen staff, activity staff, administrative staff and a member of the maintenance team.

We reviewed a range of records. This included 19 people’s care records and multiple medication records. We looked at 6 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

Following our visits, we spoke with 2 professionals who visit the service on a regular basis.

Updated 19 October 2023

About the service

St Nicholas Care Home is a residential care home providing personal and nursing care to 93 people at the time of the inspection. The service can support up to 176 people within 6 buildings. At the time of the inspection however, 2 of the buildings were not in use. Of the 4 buildings operating, 1 provides specialist nursing care to people who have a learning disability and autistic people. This unit is known as Brocklebank House. Brocklebank House can accommodate 28 people. At the time of the inspection, 19 people were residing on this unit. The other units provided nursing and residential care to older people. Several people lived with dementia.

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

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.

Right Support:

The physical layout of the building was not homely or domestic in style. It was clear from the roadside people were living within a care setting.

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 in the service did not support this practice. People experienced locked and inaccessible areas within their own home. The reasons for any restrictions were not based on people’s individual risk. Systems to oversee the application of authorisations to deprive people of their liberty were not sufficiently robust.

People were not supported to develop their independence skills, and everything was done for them. People were not involved in or encouraged to participate in the day-to-day home related tasks such as cleaning or cooking.

Right Care:

Care was not person centred and people were not always being consulted before being provided with care. People’s communications needs were not always recorded and there was a lack of awareness of how to apply national best practice supporting people with a learning disability and autistic people. Some inappropriate language was used when referring to people who used the service.

People were not always supported to make informed decisions about their care. Some care plans were brief and did not include information how to best support people. Effective systems were not in place to ensure there was learning from events which occurred at the service.

Staffing levels were insufficient in Brocklebank House to enable all people to access the community to pursue their leisure interests and form meaningful relationships within their local community. The activities available were of poor quality and care staff did not recognise planning social and leisure activities as part of their role.

Right Culture:

The culture in Brocklebank House needed to be improved to meet the needs of people with a learning disability and autistic people. People were not given the opportunity to lead a fulfilled and valued life and experience high quality care.

Not all staff who worked on the unit had the appropriate skills and knowledge to support people effectively. When staff members did hold these skills, they weren’t always deployed in the most effective way.

Most, but not all, of the improvements we identified were in relation to meeting the needs of people living in Brocklehurst House. Frequent changes in management had impacted on the quality of the care delivered across the service in general. The provider had failed to put in sufficient measures to mitigate this risk. There was a lack of evidence of a commitment to continuous improvement. Actions from previous inspections had not been sufficiently addressed.

Although we identified significant improvements were needed, people across all units told us they were happy living at St Nicholas care Home. People received their medicines as prescribed and were supported to attend medical appointments when needed. Regular checks were made on the building and equipment to ensure they were safe to use.

We observed people receiving visits from family and friends and people’s bedrooms were welcoming and could be personalised to their taste. Staff members told us they felt supported in their role and all people we spoke with had confidence in the new manager who had recently been appointed.

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 23 March 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about management of the safety of people following an incident. 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 care home 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.

Enforcement

We have identified breaches in relation to staff skills and knowledge, person centred care, treating people with dignity and respect, ensuring the service operates in line with the Mental Capacity Act 2005, a lack of effective governance systems and provider oversight of the quality 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.