Background to this inspection
Updated
18 January 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered 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 inspection took place on 10 December 2015 and was unannounced. The inspection was completed by one adult social care inspector.
Before the inspection, we asked the registered provider to complete a Provider Information Return [PIR] before the inspection was undertaken. A PIR is a form that is completed by the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the notifications received and reviewed all the intelligence CQC held to help inform us about the level of risk for this service. We spoke with the local authority safeguarding and commissioning teams to get their views on the service help us to make a judgement about the service.
During our inspection we spoke with the registered manager, two deputy managers, two members of care staff, two cooks, two people who used the service, two professionals and two visiting relatives.
We used the Short Observational Framework for Inspection [SOFI]. SOFI is a way of observing care which helps us to understand the experiences of people who could not talk with us. We saw staff’s interactions with people were kind, patient, respectful and supportive.
The care records for three people who used the service were reviewed along with the associated risk assessments and their Medicines Administration Records [MAR]. We also looked at how the service used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards [DoLS] to ensure that when people were assessed as lacking capacity to make informed decisions themselves or when they were deprived of their liberty, actions were taken in their best interest.
We looked at a selection of documentation pertaining to the management and running of the service. This included staff training records, policies and procedures, audits and internal quality assurance systems, stakeholder surveys, recruitment information for three staff members and records of maintenance carried out on equipment and the premises. We also undertook a tour of the premises.
Updated
18 January 2016
This inspection was undertaken on 10 December 2015, and was unannounced. The service was last inspected on 23 September 2013, at that inspection the service was compliant with all of the regulations that we assessed.
Nicholson House is situated in the east of Hull close to local shops and amenities and access to public transport. Nicholson House is registered to provide care and accommodation for a maximum of 29 older people who may have dementia.
At the time of our inspection there were twelve people living at the service and two people receiving respite care.
At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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.
The service was purpose built to support people who were living with a physical disability, with wide doorways and corridors, overhead tracking in bedrooms and bathrooms, specialist baths and a lift to the first floor. Accommodation was provided over two floors and comprised of twenty nine single bedrooms, three bathrooms, three shower rooms, seven lounges and two dining rooms.
People who used the service had their assessed needs met by attentive and caring staff who had a good understanding of their individual requirements. We observed staff during interactions with people who used the service and found them to treat people with dignity and respect.
People who used the service were supported to make their own decisions about aspects of their daily lives. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.
The CQC monitors the operation of the Deprivation of Liberty Safeguards [DoLS] which applies to care homes. The registered provider had followed the correct process to submit an application to the local authority for a DoLS where it was identified this was required to keep people safe. At the time of the inspection there had been four applications submitted and the service was waiting for assessment and approval of these.
Staff had completed a range of training pertinent to their role which enabled them to effectively meet the needs of the people who used the service. Staff told us they received regular supervision, support and professional development.
Systems were in place to manage medicines effectively. Staff who administered medicines had completed relevant training to enable them to do so safely.
We found people’s health and nutritional needs were met and saw professional advice and treatment from community services was accessed when required. People who used the service received support in a person-centred way with care plans describing their preferences for care and staff following this guidance.
Staff were recruited, trained and supported to meet people’s needs appropriately. We found there was enough staff on each shift to meet people’s needs. Staff told us they felt well supported, they could raise any concerns with the registered manager and that they were listened to. Support systems were found to be in place for staff and an open-door policy adopted by the registered manager which enabled them to raise concerns.
There was a complaints policy and procedure and people felt able to raise concerns and they would be taken seriously.
There was a quality monitoring system that consisted of audits, spot checks and surveys. When shortfalls were identified, these were addressed and people were notified of the action that had been taken.
The registered manager and registered provider were aware of their responsibilities in notifying the Care Quality Commission of incidents that affected the safety and welfare of people who used the service.
A pre admission assessment was completed, prior to anyone being offered a placement at the service. The assessment along with relevant information from the placing authority was used to develop a number of personalised support plans. Risk assessments were in place to reduce the known risks to the people who used the service.