Nicholas House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People's capacity to consent to key decisions about their lives had been assessed and considered. The management team ensured that principles of the Mental Capacity Act (2005) were complied with, and people's human rights were upheld. People's needs were robustly assessed, and they received information to support them to make decisions when moving into the home. Care plans were clear and person-centred and reflected people’s wishes and preferences. These were regularly reviewed and updated. The management and staff worked well with healthcare professionals to support people to achieve good health outcomes.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's needs were assessed before they moved into the home so the staff were aware of how to meet these. People and relatives told us they were involved in a pre-admission assessment so they could discuss their needs and preferences. They said they also had the opportunity to obtain information about the service and what they offered. One person told us, “They asked me what I like and if I like this or that.” Pre-admission assessments were detailed and included how people wanted their care. They were used to inform people’s care plans and these were developed and updated over time.

Overall, people were happy with their care and treatment and said their needs, wishes and preferences were respected. People received input from healthcare professionals as needed, such as the district nurse and the GP. Staff told us they were well trained and had received an induction before they started working for the service. This was to help ensure they had the necessary skills to meet people's needs. They were empowered to learn from professionals to improve their skills in order to meet people’s needs better and more effectively. The managers and staff communicated with people about their care and treatment and involved relatives and relevant agencies. They ensured they were up to date with current good practice that was relevant to people’s care and this was reflected in their care plan. The provider and staff were keen to undertake new and innovative approaches that evidence showed could improve the way their service delivers care. For example, since working closely with the physiotherapy team, staff had been empowered to learn and support people to improve their mobility and therefore their quality of life. Staff were provided with an induction prior to delivering care to people. This included completing the Care Certificate. This is a set of modules designed for staff working in this type of care service. The staff received training in all aspects of their role. This included training the provider identified as mandatory, such as infection control, first aid, safeguarding, health and safety and medicines administration.

Relatives we spoke with felt involved in the care of their family members. One relative told us, “The care staff are all good, as with the management team. [Senior staff] especially always keeps us informed of any visits from the GP and changes to medication.” The staff and management worked well with other agencies involved in the care of people who used the service to improve people’s lives and meet their needs. For example, physiotherapists, district nurses and the GP. Healthcare professionals confirmed the communication with the service was good and staff were eager to learn and improve their skills to meet people’s needs. The service worked closely with the physiotherapy team to help improve people’s mobility and prevent falls. One of the physiotherapists told us, “We work together to support people. We look at falls data, the environment and equipment. We provide training in-house, including train the trainer programme, so it empowers staff to become champions. We empower staff to ask the right questions and work with them. We had a lady who came here and was not able to mobilise. A few weeks later, she was mobile again. We work holistically so we look at all the person's needs.”

People were listened to when they were unwell and were able to get medical support. A relative told us, “I visited [family member] yesterday and mentioned that [they had] said they weren’t feeling too well, and the staff instantly said they’d go and check on [family member]. That is so reassuring to hear” and another said, “If [family member] has been unwell between our visits we are notified straightaway.” The staff carried out regular checks on people to help ensure they remained healthy and identify any concerns quickly. People were supported and encouraged to maintain their mobility and fitness. The provider employed two activity coordinators, who provided a range of activities people enjoyed. We saw these activities were person-centred and people were consulted. People were also encouraged to take part in outings of their choice. These included going to shops and cafes or attending the local library, which organised singing, memory games and various entertainment. Relatives were pleased with the activities provided and thought these contributed to an improvement in their family members’ wellbeing, mobility and dexterity. Their comments included, “The physio has a gym for residents – [family member] previously enjoyed [their] weekly ‘bike’ rides”, “Armchair exercises are another weekly feature with a trained physio. Residents are encouraged to join in and do what they can – all enjoy it.” Another relative explained that following major surgery for a fracture, “Staff were brilliant, assisting [family member] back to health and following hospital/physio guidance on regaining [their] mobility, [they were] soon able to walk with a zimmer frame and assistance, advancing a few steps each day.”

People and their relatives told us they were consulted about their care and treatment and had the opportunity to feedback to the managers and make suggestions. A relative described how their family member’s health and wellbeing had improved since they had moved into the home. However, one relative said they did not always feel listened to by the staff and some of the management team. We fed this back to the general manager who provided evidence they were dealing with this situation and had organised a meeting with the relatives. They also planned to organise a multi-disciplinary meeting to discuss and agree the best ways to meet the person’s needs. The staff had the opportunity to feedback about the service and felt listened to and involved in service delivery. The general manager told us they, the deputy manager and staff routinely monitored people’s care and treatment to help ensure their needs were met and make improvements where necessary. They ensured that outcomes for people were positive and consistent. A healthcare professional who was involved in the care of people felt the overall culture of the home was one of openness, was welcoming to people and relatives and strived to promote new ideas. They added, “[General manager] has been an integral support and advocate for the Physiotherapy service at Nicholas House, clearly understanding the importance of promoting person centred care and independence for those at various stages of their journey.”

People were supported and included to make decisions about their care and support. People we spoke with told us the staff asked for their consent before providing care and we saw evidence of this during our visit to the service. They said staff gave them choice and respected their wishes. Where necessary, the provider had applied for appropriate authorisations in a timely manner to help ensure people were not deprived of their liberty unlawfully. However, some authorisations had not been granted in a timely manner and we saw evidence the provider had been in contact with the local authority to request these. Mental capacity assessments were in place and regularly reviewed and care plans clearly reflected the support people required to make decisions. All staff received training in the Mental Capacity Act (2005) and had a fair understanding of the principles of the Act.