About the service Nicholas House Care Home is a residential care home that was providing personal care to 24 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 40 people.
The care home accommodates people in one adapted building that has been extended over the years and is on two floors. One area of the home on the ground floor is used to support people living with dementia
People’s experience of using this service and what we found
People living at Nicholas House did not receive a safe, effective or well led service. During the inspection, we identified concerns relating to people's safety which included poor oversight of fire safety issues by the provider, a lack of training and guidance for staff on how to support people in the event of a fire and insufficient staffing levels during the night which all put people at significant risk of harm. The provider had also failed to take appropriate action to ensure the premises were safe because windows on the first floor were single paned and were not fitted with safety glass.
The service did not have sufficient infection prevention and control measures in place. Areas of the premises were found to be unclean, and the condition of furniture and equipment was poor.
Medicines were not managed safely. Staff did not always have guidance to ensure they administered 'as required' medicines to people safely. Medicines were not stored safely, and stock levels of medication including controlled medicines were not recorded. Staff had not been trained or assessed to carry out key tasks for people such as medicine administration.
Systems were not in place to monitor accidents and incidents.
Safeguarding concerns had not been reported by staff and management. The registered manager was not clear of their role and responsibility in relation to safeguarding. Staff demonstrated a limited understanding of safeguarding and records showed they had not received appropriate training in this area.
Staff members we spoke with raised concerns about the management of the service.
The provider had failed to carry out inductions with newly recruited staff to ensure that they were fully prepared to support people using the service in a safe and effective manner.
Staff were not provided with supervision, appraisals or training in line with the provider’s policies.
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.
The provider had no oversight of the safety and quality of the service. Quality assurance systems were not established and operated effectively to ensure compliance with regulations.
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 12 July 2019) and we found a breach of one 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 enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This inspection was prompted by serious concerns we had received about the service in relation to safeguarding. This is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led.
We have found evidence that the provider needs to make improvements. Please see 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nicholas House Care Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to fire safety and managing risks, management of medicines, staff training and support, failing to operate effective monitoring systems to improve the quality and safety of the service, poor recordkeeping, notification of incidents and safeguarding people from risk of harm or abuse.
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.
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.