Archived: St Nicholas Care Home

Updated 23 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection which took place over two days on 1-2 March 2017. The inspection team consisted of two adult social care inspectors, a pharmacy inspector 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.

We were able to access and review the Provider Information Return (PIR) as the manager sent this to us as part of the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed other information we held about the service.

During the visit we visited all five of the units that currently make up St Nicholas Nursing Home [one unit was closed]. These included two units supporting people living with dementia. Some of the people living at in these houses had difficultly expressing themselves verbally. 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 were able to speak with 15 of the people who lived at the home. We spoke with 11visiting family members. As part of the inspection we also spoke with two health care professionals who were able to give some feedback about the service.

We spoke with 26 staff members including nursing, care/support staff and the home’s manager. We also spoke with other senior managers in the organisation.

We looked at the care records for 10 of the people living at the home, three staff recruitment files, medication records and other records relevant to the quality monitoring of the service. These included safety audits and quality audits, including feedback from people living at the home and relatives/visitors. We undertook general observations and looked round the home, including some people’s bedrooms, bathrooms and living areas.

Updated 23 March 2017

St Nicholas Nursing Home is owned and operated by BUPA, a large national organisation. The home provides nursing and personal care for up to 176 people in six separate units. Three units provide general nursing care; one provides nursing care for people living with dementia. One unit provides personal care to people with dementia and one provides nursing care to people who have a learning disability. The home is set within a residential area and is close to all amenities and public transport.

There were 75 people accommodated at the time of the inspection.

This was an unannounced inspection which took place over two days. The inspection team consisted of two adult social care inspectors, a pharmacy inspector 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.

The service had a manager in post who was nearing the completion of becoming registered with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected the home in August 2016 and, although improved in some areas, we found continuation of serious breaches of regulations. The home was rated as ‘inadequate’ overall; the home had been placed in special measures following an inspection in February 2016 and we continued with this measure. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

We had already taken enforcement action from a previous inspection as we had issued a notice to stop any further admissions to the home. The statutory notice we issued remained in place at this inspection.

At this inspection we found improvements in all areas and all previous breaches of regulations had been met. Because of the improvements the overall quality rating has been raised to ‘requires improvement’ and the home has been removed from special measures.

At our last inspection in August 2016 we had found the home in breach of regulations relating to safe administration of medicines because people were not always protected by the medication administration systems in place. At this inspection we found people protected against the risks associated with medicines because the provider’s arrangements to manage medicines were now consistently followed. The breach had been met.

Previously we had found some people were not assessed for any risks regarding their health care needs. The risk of not updating changes to people’s care plans is that staff might be unaware of their changed care needs and care might not be effectively monitored and reviewed exposing people to unnecessary risk. We now found more consistency regarding this and clinical risks such as, pain assessment and management, assessing risks around people with diabetes, people assessed as risk of falls, and risk of inadequate nutrition were now being consistently monitored. The breach had been met.

We had previously found staff needed to be more aware of the first aid procedures and equipment used in case of an accident or emergency; first aid equipment had also not been checked and maintained. This had been attended to and the breach was now met.

We had previously found that the home was not fully operating in accordance with the principles of the Mental Capacity Act 2005 (MCA). Although there were examples indicating good practice we found some hesitancy and misunderstanding in particular around the use of the ‘two stage mental capacity assessment’ and when this should be used as part of making ‘best interest’ decisions for people. On this inspection we found improvements had been made. Staff evidenced a better understanding of the principals involved, including an understanding of the need to assess individual decisions relating to care and treatment.

On the previous inspection we found the systems in place to monitor on-going standards in the home had not been effective. On this inspection the provider had continued to developed systems to monitor the quality of care in the home; these had helped to improve consistency in areas of clinical care management, such as medication safety.

We saw references in care files to individual ways that people communicated and made their needs known. We also saw good examples where people had been included in the care planning so they could play an active role in their care although there was recognition that this could be further improved.

Previously we had made comments regarding the accessibility and user friendliness of the care records and care documentation in use. We found care records had improved and were easier to follow and to access necessary information.

Staff told us the training they received was good. We saw that there had been recent training / update around the principles of the MCA following recommendations from the last CQC inspection. The ‘training matrix’ we saw showed that staff were updated regularly in key areas of care and there was an established induction programme for staff.

We observed there was enough staff to carry out care in a timely manner. We saw staff were attentive to the needs of people and no one appeared to be in distress through lack of attention.

Staff files showed appropriate recruitment checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

People we spoke with and their relatives told us they felt safe in the home. People knew who to speak with if they felt concerned about anything. We made observations on all units including those specialising in people with dementia and learning disability. We saw that people who could not express their thoughts and feelings vocally were settled and supported. Staff were observed to be attentive to people’s care needs as they arose. Nobody we spoke with or observed expressed any issues regarding their safety.

There have been a number of safeguarding investigations at St Nicholas Nursing Home since our last inspection; these had reduced in number from previous inspections. The home had assisted the local authority safeguarding team and agreed protocols had been followed in terms of investigating. This helped ensure any lessons could be learnt.

We found that the home was clean and hygienic.

We observed meal times and saw that meals were served appropriately and the portion size was also appropriate. We saw that people who needed support to eat had sufficient staff time allocated and that staff took time to talk with and socialise with people.

People we spoke with and their relatives said that they (or their relatives) were being treated with respect, dignity and kindness.

A complaints procedure was in place and people, including relatives, we spoke with were aware of this procedure. We spoke with the manager who showed us how complaints were recorded and responded to.

We saw that people were provided with a range of social activities and these continued to be developed with particular reference to providing activity for people with dementia.