Archived: St Nicholas Care Home

Updated 1 February 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

St Nicholas is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a manager who had been in post since February 2019, but they were not registered with the Care Quality Commission.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we reviewed the information that we held about the service and registered provider. This included any notifications and safeguarding information that the service had told us about. Statutory notifications are information that the service is legally required to tell us about and include significant events such as accidents, injuries and safeguarding notifications. We also contacted the local authority and safeguarding team for feedback about the service.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We used all this information to plan our inspection.

During the inspection-

We spoke with two people who used the service and two relatives about their experience of the care provided. We spoke with three members of staff including the manager, a member of care staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked at three people’s medicines records. We also looked at one staff recruitment file and related supervision records. We reviewed a range of documents relating to the day to day running of the service, these included manager and provider reports. Observations were made of the care and treatment people received throughout the inspection. We requested copies of people’s care records to review after the inspection.

After the inspection

We reviewed three people’s care records in detail. We requested copies of documents we had not been provided with when we had originally requested them during the inspection. We followed up a safeguarding referral we had asked the manager and nominated individual to make.

Updated 1 February 2020

About the service: St Nicholas is a residential care home that was providing accommodation and personal care to 10 people aged 65 and over at the time of the inspection.

People’s experience of using this service and what we found

At this inspection we found a continuation of failings at this service. Sufficient action had still not been taken to address the seven breaches of the regulations we found at our previous inspections in November 2018 and May 2019. At this inspection in November 2019, we found an additional breach of the regulations.

This will be the third consecutive inspection that this service will be rated as inadequate overall.

The provider had not ensured the manager for the service had registered with us as is required and there continued to be a lack of oversight of the service from the provider. Governance systems remained ineffective at identifying shortfalls within the service and improvements noted by relatives had not been actioned.

Risks relating to people’s health and wellbeing had not always been identified or plans put in place to mitigate these risks. People were not supported to maintain an adequate intake of food and fluid.

Staff practice relating to infection control remained poor and there continued to be several environmental risks identified in the home that had not been managed well.

Reviews of accidents and incidents remained poor and investigations to learn lessons from incidents did not take place. The provider continued not to report notifiable incidents.

We found an additional breach of the regulations. This was because the provider failed to report a safeguarding incident to the local authority and thoroughly investigate the concerns.

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 continued to receive care that did not always uphold their dignity or respect their privacy.

Records of people’s care still lacked person-centred detail and were not reflective of people’s most current needs.

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 rating for this service was inadequate (published 26 July 2019) and there were multiple breaches of regulation. At this inspection we found sufficient improvements had not been made, and the provider remained in breach of seven regulations. We also found one new breach relating to safeguarding people from abuse and improper treatment.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 May 2019. Breaches of legal requirements were found in relation to safe care and treatment, good governance, meeting nutritional and hydration needs, need for consent, person-centred care, dignity and respect and notification of other incidents.

We undertook this focused inspection to check the provider had now met the legal requirements. This report only covers our findings in relation to the key lines of enquiry which relate to those requirements.

The ratings from the previous comprehensive inspection for those key lines of enquiry not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service is inadequate. This is based on the findings at this inspection.

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.

Enforcement

We have identified breaches in relation to safe care and treatment, good governance, need for consent, person-centred care, dignity and respect, meeting nutritional and hydration needs, safeguarding people from abuse and notification of other incidents.

CQC used its powers to keep people safe, and a Notice of Proposal to vary a condition on the Registered Provider's registration, to prevent the regulated activity being carried on at St Nicholas Care Home, was sent to the Registered Provider on 18 January 2019. On 26 March 2019 the Notice of Decision was sent to the Registered Provider advising that we had decided to adopt the proposal to vary a condition on their registration.

The Registered Provider appealed against this decision to the First Tier Tribunal (Care Standards) under section 32 (1)(b) of the Health and Social Care Act 2008. The appeal hearing was held on 9, 10, 11, 12 and 13 December 2019, and the decision was made that CQC's action "was both necessary and proportionate." The appeal was dismissed by the tribunal judge and CQC was informed of this decision on 22 January 2020. This means that the Registered Provider can no longer provide any regulated activities at St Nicholas Care Home and the service is now closed.

Following the Tribunals decision, the local authority took swift action to ensure that all people living in the service were supported to move to alternative accommodation. The last person moved out on 24 January 2020.

This service is therefore no longer in operation.