St Nicholas Care Home

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.

St Nicholas Care Home is owned and operated by Randomlight Limited. The home provides nursing and personal care for up to 176 people over six separate units. At the time of the inspection 2 of the units were not operating. Of the 4 houses operating, 1 provided general nursing care, 1 provided nursing care to people who have a learning disability, 1 nursing care for people living with dementia and 1 unit provided residential personal care to people with dementia. There were 73 people accommodated at the time of the inspection.

People’s experience of using this service

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: On Brocklebank house the service was not able to demonstrate how they were meeting some of the underpinning principles of ‘Right support, right care, right culture’. The house was bigger than most domestic style properties. It was registered for the support of up to 28 people with a learning disability.

People were supported to have maximum choice and control of their lives and staff supported /did them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: On Brocklebank house there was a strong commitment to good practice in line with promoting an individualised approach to care. There was good information around how to preserve dignity and respect, and people were clearly encouraged to go into the community and do activities which were meaningful for them. Care was person-centred and promoted people’s dignity, privacy and human rights

Right Culture: We found any negative impact on people was mitigated by the fact the building was separate from the other houses on site.

Medication was not always managed safely. Due to some recording issues with the electronic system we could not always be sure if people had had their medicines or not. There were no ‘as and when required’ (PRN) protocols in place for staff to follow. Incidents and accidents were recorded, however over all analysis was poor and we could not tell what processes had been put in place to prevent further reoccurrence. Some risk assessments lacked sufficient detail with regards to how to keep people safe from harm. The home was clean and tidy, and people told us they felt safe living at the home. There was enough staff on shift to be able to support people safely. Staff were recruited and selected safely.

Governance systems were in place and had highlighted some but not all of the concerns we found during our inspection in relation to poor risk assessments. However not all governance systems had been efficient with regards to picking up the medication concerns and the incident and accident oversight. This led to one serious incident not being reported correctly.

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

Rating at last inspection

The last rating for this service was good (published 11/11/21).

Why we inspected

The inspection was prompted in part due to concerns received about pressure area management, and person to person injury. A decision was made for us to inspect and examine those risks.

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

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.

The provider was responsive during and after our inspection to ensure any concerns were promptly dealt with.

Enforcement and Recommendations

We have identified breaches in relation to risk management, medications, records and governance.

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.

St Nicholas Care Home is owned and operated by Randomlight Limited who were registered in February 2019. The home provides nursing and personal care for up to 176 people over six houses. At the time of the inspection two of the houses were not operating. Of the four houses operating; one provided general nursing care, one provided nursing care to people who have a learning disability, one nursing care for people living with dementia and one unit provided residential personal care to people with dementia. There were 86 people accommodated at the time of the inspection.

When we inspected the house for people with a learning disability [Brocklebank], we considered best practice guidance for care services supporting people with learning disabilities. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. 'Right Support, right care, right culture' is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

On Brocklebank house the service was not able to demonstrate how they were meeting some of the underpinning principles of ‘Right support, right care, right culture’. The house was bigger than most domestic style properties. It was registered for the support of up to 28 people with a learning disability. 17 people were using the service at the time. This is larger than current best practice guidance. However, we found any negative impact on people was mitigated by the fact the building was separate from the other houses on site. There was also a strong commitment to good practice in line with promoting an individualised approach to care. There was good information around how to preserve dignity and respect, and people were clearly encouraged to go into the community and do activities which were meaningful for them. A previous recommendation for staff to not wear uniform had been actioned.

People’s experience of using this service

Most people living at the home and their relatives told us the staffing at the home was relatively stable. There was still a reliance on agency staff to cover shifts but those agency staff attending the home had been consistent and generally knew the home well. There was also a good use of senior care staff to assist care planning, wound care and medicines management.

Previous incidents of poor outcomes because of staffing issues such as high medication errors and lack of timely and appropriate care, had decreased. The feedback from both staff and people living in the home and their relatives, was overall positive. One person told us “I’m definitely safe, the [staff] are always passing my door and asking if I’m alright.” This was an improvement from the last inspection.

People received their medicines on time. Staff were trained and their competency was checked to help ensure safe standards. Medication records were generally very clear; we made some suggestions on the day of the site visit and these were actioned immediately. This was an improvement.

Other records such as care records, assessments and care plans, were of a good standard and regularly audited and updated. This was an improvement.

There was a lack of positive evidence around involving and updating people and their relatives in the care planning process.

We made a recommendation to address this and meet best practice.

Arrangements were in place for checking the environment to ensure it was safe. There was a good standard of cleanliness and the houses we visited were generally well maintained.

We made a recommendation to further assess and improve to living experience for people living with dementia on Huskisson and Gladstone House’s.

The home has had consistent management since the last inspection. Feedback from all parties was that the registered manager and the senior managers in the home have made a difference in terms of settling the home down and providing a positive lead. Many of the issues identified on the previous inspection have improved, benefiting from a more consistent approach by managers. The system of auditing in place has helped to identify and monitor standards in the home. This was an improvement from the previous inspection.

Most people and their relatives told us they were happy with the standard of care and felt supported with their care needs. Overall, there was a positive and relaxed atmosphere in the home. People living in the home interacted freely and staff interactions were observed to be caring and supportive.

People’s dietary needs were managed with reference to individual needs and choice. Mealtimes provided a good social occasion

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 22 October 2019) and there were two breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an unannounced comprehensive inspection of this service on 16 September 2019. Breaches of legal requirements were found. The provider completed an action plan to show what they would do and by when to improve safe care and treatment and the governance of the home. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

The overall rating for the service has changed from ‘Requires improvement’ to ‘Good’. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Nicholas Care Home on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

St Nicholas Care Home is owned and operated by Randomlight Limited who were registered in February 2019. The home provides nursing and personal care for up to 176 people over six houses. Three houses provide general nursing care and one provides nursing care to people who have a learning disability. Another provides nursing care for people living with dementia whilst the remaining unit provides personal care to people with dementia. There were 109 people accommodated at the time of the inspection.

When we inspected the house for people with a learning disability we considered best practice guidance for care services supporting people with learning disabilities. ‘Registering the Right Support’ and other best practice guidance help ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. On Brocklebank House they didn’t apply the full range of the principles and values of Registering the Right Support and other best practice guidance.

Brocklebank house was bigger than most domestic style properties. It was registered for the support of up to 28 people with a learning disability. 17 people were using the service at the time. This is larger than current best practice guidance. However, we found any negative impact on people was mitigated by the fact the building was separate from the other houses on site. There was also a strong commitment to good practice in line with promoting an individualised approach to care. There were improvements needed however to further mitigate any negative effects on people, including a review of the current staff uniform policy. We have made a recommendation.

People’s experience of using this service

There were several shortfalls and inconsistencies in the completion of the paperwork used to record the administration of medicines. This meant there was a risk some medicines for people were not monitored safely and there was a risk some people might not receive their medicines.

The home did not always have enough employed nursing staff so there was high use of agency nurses. This affected communication and the consistency of the care given, which increased risk to people.

Most people we spoke with told us that, despite staffing issues, they felt safe in the home. This was not always the case however. A health care professional gave examples where clinical care had suffered due to inconsistencies in the nursing staff. There were measures in place to make staffing more consistent but further improvements were needed.

Randomlight Limited are a new provider for the service. They have introduced new care assessments and care planning documentation. Records varied in their detail, accuracy and did not evidence a good level of personalised care. There were shortfalls in the assessment and management of risk.

The acting manager could evidence a series of quality assurance processes and audits carried out. However, these checks and audits had not highlighted some of the issues we found on the inspection. They were effective in some areas of managing the home and were based on getting feedback from the people living there.

People living with dementia lived in a house that required further improvements to the environment to meet their needs and to assist with orientation. We made a recommendation regarding this.

Arrangements were in place for checking the environment to ensure it was safe. There was a good standard of cleanliness and the houses we visited were generally maintained.

Most people and their relatives told us they were happy with the standard of care and felt supported with their care needs. Overall there was a positive and relaxed atmosphere in the home. People living in the home interacted freely and staff interactions were observed to be caring and supportive.

People’s dietary needs were managed with reference to individual needs and choice. Meal times provided a good social occasion

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection:

The last rating for this service was requires improvement (published 12 July 2018). Since this rating was awarded the registered provider of the service has changed in February 2019. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

The service remains rated requires improvement. This service has been rated requires improvement since 2014 and has had three different providers over this period.

Why we inspected:

The inspection was prompted in part due to concerns, received from professionals, of planned care not being carried out and reports that people’s personal care was compromised.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report.

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

The provider made some immediate changes to the medicines management systems following our feedback. we will review the effectiveness of these at our next inspection.

Follow up:

We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed.

We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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