Nicholas House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider had recruitment checks in place, however, we found they had not always sought evidence of satisfactory conduct from previous employment for staff. People's weights were monitored and any concerns mostly acted on. However, one person had gained a significant amount of weight and no actions had been taken. Although staff received training in infection control, one staff member wore long acrylic nails which was an infection control and safety risk. The provider took immediate action to make the necessary improvements following our feedback. The environment was clean, hygienic and hazard-free. People told us they felt safe and well looked after. Incidents and accidents were recorded and lessons were learned. People received their medicines safely and as prescribed. There were regular medicines checks and the staff received training and had their competencies assessed. Individual risk assessments were in place and were comprehensive. These included appropriate guidance for staff to follow to meet people's individual needs. Systems were in place to minimise risk to people. There were procedures in place for safeguarding people and staff were aware of these. Safeguarding concerns were investigated and notified to the right agencies.

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 told us they felt safe from harm and abuse. Their comments included, “I feel safe. I have no worries about that” and “Yes I do feel safe.” Relatives echoed this and said, “Oh yes, [family member] is very safe here with all the staff. We’ve never had any problems with any of them”, “Everything is centred around residents’ happiness and wellbeing” and “I feel [family member] is safe and being looked after and [their] needs are being met.” Staff were aware of their responsibility to safeguard people and who to contact in the event of any safeguarding concerns. One staff member told us, “I would always report to the manager if I had any concerns” and another said, “If I was witness to any substandard care or saw something that I thought was wrong from any staff member I would report it immediately to the management and put it in writing to make sure all was documented.” The provider was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred. We saw evidence of this in the documents we viewed during our visit.

People told us they felt safe living at Nicholas House. They told us the staff were always available if they needed support. Relatives stated they were informed when their loved ones required support or treatment from different services. The staff team and management told us they worked well with other professionals to ensure continuity of care, including when people moved between different services or required temporary stays in hospital. A healthcare professional told us relationships with the service was “excellent” and communication was good. Staff told us they were happy working at the home, felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the service. The service had up to date policies and procedures in place. Staff were required to read and sign these to evidence they understood and agreed to follow these.

People and relatives were informed and involved in making decisions about their care. People said staff knew their needs met these safely. They said staff were responsive and answered their call bells promptly. One person said, “I’ve got one by my bed and one by my chair.” A relative added, “Maintenance staff make sure everything is safe. When the call bell has not worked, it has either been repaired/changed immediately or staff made sure [family member] knew to use the emergency call and did extra checks on [them].” There were processes to help ensure risks to people were assessed and mitigated. However, these were not always effective. For example, a Malnutrition Universal Screening Tool identified a person had gained 10kg in 7 months but there were no recorded actions about this. We discussed this with the general manager who assured us they would address this. Following our visit, the provider provided evidence they had taken appropriate action and had put more robust systems in place. Care plans were sufficiently detailed to inform staff how best to support people with complex health conditions. For example, one person was living with diabetes and their care plan detailed how to recognise signs the person was becoming unwell. When people could become distressed, there was clear guidance to inform staff how to support them to de-escalate or reduce their anxiety. There were effective systems to review care plans and ensure they were sufficiently detailed and contained key information and guidance for staff. We observed safe care being delivered to people. Staff were seen supporting a person to mobilise using their walking aid. This was done safely and gently, with the staff member explaining what was about to happen. Personal emergency evacuation plans were in place for each person. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

People and relatives were informed and involved in making decisions about their care. People said staff knew their needs met these safely. They said staff were responsive and answered their call bells promptly. One person said, “I’ve got one by my bed and one by my chair.” A relative added, “Maintenance staff make sure everything is safe. When the call bell has not worked, it has either been repaired/changed immediately or staff made sure [family member] knew to use the emergency call and did extra checks on [them].” There were processes to help ensure risks to people were assessed and mitigated. However, these were not always effective. For example, a Malnutrition Universal Screening Tool identified a person had gained 10kg in 7 months but there were no recorded actions about this. We discussed this with the general manager who assured us they would address this. Following our visit, the provider provided evidence they had taken appropriate action and had put more robust systems in place. Care plans were sufficiently detailed to inform staff how best to support people with complex health conditions. For example, one person was living with diabetes and their care plan detailed how to recognise signs the person was becoming unwell. When people could become distressed, there was clear guidance to inform staff how to support them to de-escalate or reduce their anxiety. There were effective systems to review care plans and ensure they were sufficiently detailed and contained key information and guidance for staff. We observed safe care being delivered to people. Staff were seen supporting a person to mobilise using their walking aid. This was done safely and gently, with the staff member explaining what was about to happen. Personal emergency evacuation plans were in place for each person. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

People were supported in a safe and well maintained environment that met their needs. People and relatives told us they liked the home and felt it was homely and well decorated. There were effective systems in place to monitor and regularly check the safety and upkeep of the premises. The management team and staff worked together to help ensure any potential risks were identified and addressed promptly such as faulty equipment or trip hazards. The maintenance team completed daily and weekly checks of all areas of the home to ensure safe systems were in place. These included water temperatures, fire safety checks and kitchen equipment. They also responded promptly to any reports from the staff where repairs were required. Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly. There was a service emergency plan in place to ensure people were supported in the event of an emergency. The home was clean and well-maintained with good quality fixtures, furnishings and furniture. Communal areas were light and airy which allowed people to mobilise easily. There were areas available for people to enjoy activities and spend time following personal interests or have visitors. There was a calm and happy atmosphere where people were supported to do what they wanted in their own time. Bedroom doors were painted in different colours and each one had a picture and the person’s name to help people identify their own room. Bedrooms appeared personalised with photographs and items belonging to the person. A hydration station was positioned at the entrance to the corridor and people were supported to help themselves. There was some dementia signage around the home, and objects and pictures to help people with reminiscence. The general manager told us they were planning to develop the environment to further meet the needs of people, particularly those living with dementia.

People told us there were enough staff around and felt they were suitably qualified to meet their needs. Their comments included, “I think there are enough, there’s never been an issue”, “Yes there are, I never wait” and “If you want a cup of tea or coffee, they’ll do it and there’s loads of biscuits, you don’t have to wait.” Although the provider carried out checks on the suitability of staff before they started working at the service, we found one member of staff did not have any references to evidence conduct in previous employment and a file for another staff member contained only one reference. We raised this with the managers who assured us nobody was ever employed without 2 references and thought these may have been mislaid. However, they assured us they would review all staff records and put in place a more robust employment check system. Evidence of this was sent to us following our feedback. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom, Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. The staff told us they were sometimes short-staffed but since new staff had been employed, this had improved. The provider confirmed new staff had been recruited and some of these were undergoing an induction at the time of our inspection. Where they had employed agency staff, they had ensured these were regular and familiar with the service so they knew people's needs and could meet these. Throughout our visit, we observed there were staff available to meet people’s needs promptly and effectively. New staff completed inductions, where they shadowed experienced staff and their skills and abilities were assessed by senior staff. These systems helped assure the provider staff were suitable and could carry out their roles.

People told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic, and relatives confirmed they did not have any issues with cleanliness of the service. However, we found staff did not always follow good practices around infection control. For example, we observed a member of staff wore long acrylic nails whilst managing people’s medicines, and another member of staff had long nails. This presents an infection control and safety risk. We reported this to the general manager who took appropriate action without delay. The provider had dealt with an infection which had inadvertently entered the home by an unknown source and had infected a number of people and staff. We saw evidence they had taken prompt action to prevent the infection from spreading further and shared information with appropriate agencies promptly. The management team had worked together with the staff team and other professionals to support people to manage and get better. We observed a dedicated staff team ensured the service was kept clean, tidy and malodour free. Cleaning staff followed a cleaning schedule and used appropriate personal protective equipment (PPE). Care staff wore PPE when supporting people to help protect people from cross infection. Appropriate systems were in place in relation to infection control. The provider ensured staff had access to PPE and were trained in the use of this. The provider’s infection prevention and control policy was up to date. Information about the risk of infection was shared appropriately with people using the service and visitors. The managers and senior staff carried out audits to ensure standards of cleanliness were good.

People and their relatives felt medicines were managed safely. One relative told us, “[Care coordinator] and the senior carers ensure medication is always on time and as prescribed. Things such as asthma inhaler, eyedrops, ointments are administered by staff and tablets/liquid medications are observed to ensure [they are] taken” and another said, “[Senior staff] make sure [family member’s] medications are administered correctly. They’re so caring and let us know if they’re concerned about anything.” Senior staff were trained in the administration of medicines and had their competencies checked regularly. One staff member told us, “I am fully trained to administer medication.” Processes and systems were in place to ensure medicines were safely stored and administered. The provider used an electronic system which minimised the risk of errors. All medicines stock was in date and securely stored. Protocols were in place for ‘as required’ (PRN) medicines. This informed staff when medicines such as pain killers, should be given and how long there should be between doses. Staff competency in administering medicines was reviewed on an annual basis or more often if necessary, to ensure skills were up to date.