St Nicholas is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Nicholas accommodates up to 39 people, some of whom may be living with dementia, in one adapted building. At the time of our comprehensive unannounced inspection on 20 November 2018 there were 17 people living in the home.

A new manager had been appointed in September 2018 and they were in the process of applying to become registered manager. 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 found the provider failed to comply with six of the regulations as required under the HSCA 2008 (Regulated Activities) Regulations 2014. The provider continued to fail to make and sustain improvements within the service. After this inspection we asked the provider what immediate action they would take in response to the concerns we found. They provided us with an action plan which detailed the action they would be taking to ensure the safety of people living in the home.

During this inspection we found that good practice had not been maintained in relation to the safe management of people’s medicines. Administration records for people’s medicines were not complete and medicines stored within the service were not accurately accounted for.

Risk assessments for people’s individual care needs were not accurate and lacked detail. There were no environmental risk assessments for different areas of the home. Personal emergency evacuation plans for people did not accurately reflect the support they required to evacuate the building in the event of a fire. Therefore, there were insufficient measures in place to identify, manage and mitigate risks both to people and within the environment.

Some areas of the home were not clean and staff did not follow guidance to protect people from the risk of infection as they did not always wear the correct personal protective equipment.

Safeguarding incidents had not been identified and reported to the appropriate authorities. Accidents and incidents were not fully documented and follow up of people’s health and wellbeing post incident did not take place.

There were not enough staff to be responsive to people’s needs and to ensure their safety was maintained. These findings meant that the provider remained in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not involved in day to day decisions about their care and treatment and staff lacked knowledge about the importance and guidance around making a decision in a person’s best interest. Where people were deprived of their liberty, records relating to this had been not completed in line with the Mental Capacity Act 2005. Therefore, the provider remained in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff did not support people to maintain a healthy nutritional intake and did not follow health professional’s guidance relating to people’s food and fluid intake. This meant the provider remained in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider remained in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people were not treated with respect and their dignity was not upheld. Staff did not have enough time to spend with people other than when they were performing care tasks.

People’s care plans and associated records did not detail their most current care needs and some docum

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

St Nicholas Care Home is registered to accommodate a maximum of 39 people, some of whom may be living with dementia. There were 12 people using the service when we inspected. The care home is one large adapted building, with bedrooms arranged over two floors and a number of communal areas.

We inspected on 5 and 6 February 2018 and the first day of our inspection was unannounced.

A new manager had been appointed at the service in November 2017 and was in the process of becoming registered with CQC. 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 (HSCA) 2008 and associated Regulations about how the service is run.

During this inspection, we found that the provider was in breach of seven regulations. You can see what action we told the provider to take at the back of the full version of this report.

The provider had failed to comply with a number of the regulations as required under the HSCA 2008 (Regulated Activities) Regulations 2014. In addition, the provider had consistently failed to sustain improvements where breaches of regulations had been identified during previous inspections.

We found that sufficient improvements had been made with regard to the safe storage, administration and management of medicines. However, there were still shortfalls in other areas relating to people’s safety, which meant the provider was still in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Systems to monitor the service were not accurate or effective, which meant the provider was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Where people lacked the mental capacity to make a specific decision, the provider had not made sufficient improvements to act in accordance with the requirements of the Mental Capacity Act 2005. Therefore the provider was still in breach regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements were still required in respect of providing person-centred care and records relating to people’s care were still not consistently written in a person-centred way. Therefore the provider was still in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that that people’s dignity was not consistently ensured and people were not always treated with respect. The provider was found to be in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s nutritional and hydration needs of people were not always being met. The provider was found to be in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Individual risks to people were identified but risks assessments were not always in place for known risks or, those that were in place, did not always contain sufficient detail about how to manage the risk. Risks within the environment were also not always managed and mitigated.

The provider had a business continuity plan which detailed what should be done in an adverse event such as loss of utilities or fire. People living in the home also had personal emergency evacuation plans in place.

There were mixed feelings regarding staffing levels, particularly around mealtimes, and staff were not always deployed appropriately.

Some staff training updates were overdue, although the manager took action, when

This inspection took place on 19 June 2017 and was unannounced. It was carried out in order to follow up enforcement action we took following our inspection of 30 January and 1 February 2017, where we found significant concerns and risks to people’s health and welfare.

St Nicholas Nursing Home is not a nursing home and does not provide nursing care to people. The provider has not amended the name of their service on their registration since they ceased to provide nursing care. St Nicholas’ provides accommodation and care for up to 39 people, some of whom may be living with dementia. At the time of our inspection visit 13 people were living in the home.

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. There was not a registered manager in post, however a manager was in the process of registering with CQC and will be referred to as ‘manager’ throughout this report. The providers had also employed a consultant to support them in making improvements to the home. Both were present during the inspection.

At our inspection on 30 January and 1 February 2017 we found breaches of nine regulations. We found serious and widespread concerns. There were significant shortfalls in the care and service provided to people. During this inspection on 19 June 2017, we found whilst improvements to the service had been made the provider was still in breach of four regulations. You can see what action we told the provider to take at the back of the full version of this report.

The management and leadership were improving however it had not yet been sustained over a period of time. Systems had not yet been implemented to monitor the service, and therefore we could not judge their effectiveness and sustainability. Some issues which we found previously in our inspection in January and February 2017 had not been fully resolved. Therefore the provider was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, concerns had been identified and the manager had worked closely with the external consultant to devise and begin to implement a suitable action plan in order to resolve the concerns associated with this service.

There was not always adequate guidance in place for staff to administer medicines to ensure they were not used inappropriately. Improvements were needed to the risk assessment of medicines people administered themselves, and oversight of medicines administration. This meant the provider remained in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People did not always receive care that was individualised and met their specific health needs, and staff had not always followed recommendations from healthcare professionals. This meant that the provider remained in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff had not always fully assessed people’s capacity to make specific decisions, and recorded how decisions had been made in people’s best interests. This meant that the provider was still in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people’s welfare had not always been identified. Risk assessments were sometimes generic and not specific to individuals. There was not always clear guidance provided to staff about how to mitigate risks to people. However, we found at this inspection that the management of some risks had improved and staff were aware of risks to individual people and how to manage these.

Staff had received further training and supervision and there were enough staff to meet people’s n

This inspection took place on 30 January and 1 February 2017 and was unannounced. It was carried out in response to concerns we had received about the service.

St Nicholas Nursing Home is not a nursing home and does not provide nursing care to people. The provider has not amended the name of their service on their registration since they ceased to provide nursing care. St Nicholas’ provides accommodation and care for up to 39 people, some of whom may be living with dementia. At the time of our inspection visit 21 people were living in the home, with two people in hospital.

A registered manager was in post. They were in the process of handing over the management of the service to a new manager who was in post as the acting manager. Both were present during the inspection. The registered manager told us that they are at the service most days in the week. They had been promoted to the role of operations manager for the provider who has five services in total. An acting manager was in post and was being trained with a view to applying for registration as the manager.

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.

This inspection found breaches of nine regulations. We found serious and widespread concerns at this service. There were significant shortfalls in the care and service provided to people.

Risks to people’s welfare had not always been identified. Risk assessments were sometimes generic and not specific to individuals. There was not always clear guidance provided to staff about how to mitigate risks to people.

We observed poor practice that put people’s safety and wellbeing at risk. Whilst records showed that staff had received training it was either not being put into practice or the training was not of a suitable standard.

On occasions people were not always referred to healthcare professionals when necessary and staff had failed to implement guidance they had received from healthcare professionals.

There were not enough care staff on duty to keep people safe or to meet their needs in a timely way. There was not enough housekeeping time allocated to ensure the home was kept clean at all times. There was not enough laundry time allocated to ensure that people’s clothing was effectively laundered.

People were positive about the food they received. However, we were concerned that some people, who required higher levels of support with their meals, did not receive this. Relatives and health professionals had also raised concerns about people not being supported with eating and drinking.

In their direct dealings with people we saw that most staff were kind and caring. However, some staff didn’t engage appropriately with people. We found practices in the home which showed a lack of respect and compassion for the people who lived there. People were not receiving person centred care which met their needs or preferences.

We found there was a lack of effective management and leadership. This coupled with ineffective quality assurance systems meant that the issues we found had not been identified or resolved.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will take action in line wit

This inspection took place on 28 May 2015 and was unannounced.

St Nicholas Nursing Home provides accommodation and care for up to 11 older people, some of whom may be living with dementia. It no longer provides nursing care.

There is a manager in place who has applied to the Care Quality Commission (CQC) for registration. A registered manager is a person who has registered with the 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.

During inspections in December 2014 we identified serious concerns about the safety and welfare of people living in the home. We took action to ensure the service no longer delivered nursing care and imposed a restriction the numbers of people who could live at the home so that risks to their welfare were reduced. At inspection in February 2015 there were continued concerns about the safety and effectiveness of the service. We took enforcement action to ensure that the provider made improvements to systems for assessing, monitoring and improving the safety of the service and for managing risks. There were also concerns that risks to people’s safety in an emergency had not been properly assessed and medicines were not managed safely. The principles of the Mental Capacity Act 2005 and associated codes of practice had not been properly applied. At this inspection, in May 2015, we found that there were significant improvements in all of these areas.

Risks to people’s safety in an emergency had been assessed with plans in place to mitigate these. People’s care needs were clearly identified, taking into account risks to which they were exposed. These were regularly reviewed to ensure that their plans of care provided up to date guidance for staff about supporting people. Improvements had been made to ensure people’s medicines were managed safely.

Staff understood the importance of supporting people to make decisions and choices. The ability of people to make informed decisions about their care was assessed so that any action taken reflected their best interests. However, the process was not always recorded fully. The manager understood when an application to deprive someone of their liberty under the Deprivation of Liberty Safeguards should be considered and acted upon, to ensure people’s rights were protected.

The quality and safety of the service was monitored and checked on a regular basis. Action plans took into account where improvements could be made and ensured risks were properly addressed and managed. People living in the home and their visitors recognised that the quality of the service had improved considerably since our last inspection.

Staff knew the importance of recognising signs that might suggest a person had been abused or harmed in some way and of reporting any concerns promptly. People were supported by enough competent staff who had been properly recruited to ensure they were suitable to work in care.

People had a choice of enough to eat and drink and enjoyed their meal times. Staff assisted them where it was necessary. People were referred promptly to other health professionals, such as the dietician or doctor, where this was needed to ensure their health or well-being.

Staff responded to people in a kind and caring manner and attended to requests for assistance promptly. They were knowledgeable about how they should support people with their personal or health care. Staff were respectful of people’s privacy and dignity and knew about people’s likes and dislikes. People had opportunities to join in activities which they enjoyed, including occasional outings.

People and their relatives were more confident that the manager would listen to their concerns and respond to complaints properly.

This inspection took place on 3 February 2015 and was unannounced. We had carried out an inspection in November 2014 where breaches were found of twelve regulations. Three further inspections of this service were carried out on 19, 21 and 29 December 2014 to establish whether people were safe living in the home. During the inspections of 19 and 21 December further serious concerns had been identified. The decision was taken by commissioners to relocate people with high care needs to other homes where a safe standard of nursing care could be provided for them. The Care Quality Commission (CQC) carried out urgent enforcement action under Section 31 of the Health and Social Care Act 2008 on Tuesday 23 December 2014. This meant that with effect from this date the providers were not allowed to provide nursing care at the home. On 29 December 2014 we carried out an inspection and were satisfied that people remaining living at the home were safe. This comprehensive February 2015 inspection was carried out to establish whether appropriate action had been taken to ensure the service complied with the regulations.

St Nicholas Nursing Home is a residential care home that provides accommodation, care and support for up to 11 older people. On the day of our inspection one person was in hospital.

The provider is required to have a registered manager in post. A registered manager is a person who has registered with the 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 registered manager had left the home in December 2014. At the time of this inspection the provider had recruited a new permanent manager who had been in post for a week and was undertaking their induction. A manager from one of the provider’s other homes was managing the service on a temporary basis. The intention was that the interim manager would support the new manager and hand the service over gradually to them, at which point they would apply for registration as the home’s manager.

Since December 2014 efforts had been focused on improving the standard of day to day care people received. The provider had spent considerable time obtaining the views of people to confirm improvements that had been made over a period of less than three weeks and had provided questionnaires people had completed in support of this to CQC. 

Risks to people were planned for and managed at an individual level. We saw this from people’s care planning and the observations we made of the way in which people were supported. However, some risks to individuals from the way the service was operated had not been identified or mitigated by the provider or interim manager. Substantial gaps were found which put people at direct risk of receiving unsafe care. This included the absence of emergency planning and the lack of an effective management system to identify and remedy areas of concern. You can see what action we told the provider to take at the back of the full version of the report.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The interim manager hadn’t reviewed the status of people living in the home to determine whether applications needed to be made to the local authority. Training on mental capacity was required by several staff members.

The management of people’s medicines required improvement to ensure that all medicines could be accounted for and disposed of in an effective and secure manner. You can see what action we told the provider to take at the back of the full version of the report.

People were happy with the care they received at the home and were positive about the changes in the home. They told us they felt safe and well cared for by staff that treated them with kindness and consideration. Good channels of communication had been developed with people and their relatives.

Adequate numbers of staff were able to support people in a timely manner which also allowed staff to spend time with people when tasks were not being carried out. People felt valued by this level of interest and attention to them. Recruitment and vetting procedures were in place that ensured that the likelihood of employing unsuitable staff was minimised as far as possible.

People’s day to day needs were responded to effectively and promptly. Support and advice was obtained from health care professionals when needed. Staff members knew people’s needs and preferences well and assisted people the way they wished to be cared for.

As a result of our previous inspection carried out on 14 and 18 March 2014 warning notices were issued to the provider and the manager in respect of staffing levels and the standard of care and welfare provided to people living in the home. The purpose of this inspection was to identify what progress had been made in relation to specific concerns identified at the March inspection which had resulted in the warning notices being issued.

A further inspection will be carried out in coming months to establish what progress has been made in other areas outstanding from the March inspection and to follow up concerns identified during this inspection. People’s views will be required to support this next inspection.

We reviewed the evidence we had obtained during this inspection and used this to answer five key questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

We were satisfied that substantial progress had been made in ensuring that people’s care was delivered in accordance with their care plans. Risks to people’s health were appropriately managed by staff.

The service had increased the care staff number by one for both daytime shifts. Currently the service wasn’t always able to sustain this number of staff on duty because the pool of staff available was insufficient. Further care staff were due to commence duties soon. However, we were satisfied that the provider had taken action to increase the number of staff on duty to better meet people's needs.

During this inspection we spent time looking around the premises. We found that several areas of the home had not been adequately cleaned which put people at unnecessary risk of cross infection. The manager and provider agreed that these areas needed prompt attention.

Is the service effective?

We found from reviewing people’s care records that where concerns to their welfare had been identified, advice was sought from various healthcare professionals. We noted the involvement of several health specialists including physiotherapists, speech and language therapists, dieticians, and the community mental health team. People could be sure that when necessary, staff would obtain the services of other health professionals to ensure their welfare.

Is the service caring?

Throughout our inspection we observed staff speaking with people in a supportive, relaxed and friendly manner. We noted one staff member gently re-assuring one person who had become anxious. The staff member had sat with the person to be at the same level as them, touched their arm, smiled and spoke calmly with them. This person soon settled as a result of this intervention.

Is the service responsive?

The service had made organisational changes to better support the needs of people living the home. Night staff duties had changed which allowed morning staff a bit more time to get people up and out of bed if they wished. We had previously been told by some relatives that their family members hadn’t been ready to go out when they arrived at the home. During this inspection one relative telephoned with a request for their family member to be ready for a particular time later that day. This was carried out promptly.

Improved staffing levels will reflect favourably on the service's ability to respond to people’s needs. On the day of our inspection six care staff were on duty. We noted that staff were busy, but not overly rushed as we had seen on previous occasions when there had been fewer staff.

Is the service well led?

We observed that new arrangements to have senior care staff co-ordinating and organising the shifts were working well. A third senior carer was due to join the service in June.

We spoke with the provider, the manager and the deputy manager as part of this inspection. They told us they were committed to improving the service.

We spoke to four people living at St Nicholas'. One person told us “The staff are fantastic, they look after me well.” Another told us “It’s all okay here.” Other people we spoke with expressed concern about the length of time additional heating had been used at St Nicholas'. We spoke to people about the care they received at the home and reviewed people's care plans. Whilst most records were comprehensive some lacked personalisation and some reviews and re-assessments had not been done in the last few months.

The central heating and hot water systems had failed eight days prior to our visit and the home was without central heating and hot running water. Portable heaters were in use and a hot water urn was in operation on each floor. Whilst the home was managing, some people we spoke with expressed disappointment that a problem had been evident for some time and it appeared to them that only now the systems had failed was anything being done to deal with the problem. The manager had been in post for two weeks and had industrial plumbing and heating engineers in to quote for the work required and had submitted several quotes for the consideration of the provider.

We reviewed some staff records and found that whilst Criminal Records Bureau (CRB) checks had been carried out, there were a few gaps in other areas, for example, staff files did not always contain up to date photographs.

We found that medicines were safely stored and administered.

One person we spoke with told us that there had been lots of improvements within the home over the last couple of months.

This person said: "Surely you can see the difference, can't you? Everything's just so much better and everybody is so much happier. I couldn't ask for better care."

The person we spoke with told us that the food was lovely and that they could always have what they wanted. This person also told us that they always had enough to eat and drink and that they could have a drink whenever they wanted one.

The person we spoke with told us about the recent staffing problems in the home but also said: "The staff problems have been sorted out now. The manager is lovely and really does a good job - she can manage the home properly now the problems have been sorted."

This person also told us about the new activities coordinator and how they helped enable each person to join in with various activities and explained things clearly so people understood how to join in.

The person we spoke with said, of the activities coordinator: "They are really good. They have so much time and patience with everyone. We played a group game of hangman this morning and everybody was able to join in - I think we all won a round."

We were also told, by the person we spoke with, that the staffing levels were much better now and that there were always enough staff to help when needed. They said: "We don't have to wait long if we need anything."

People we spoke with told us that the staff were all very good. One person said, "You couldn't wish for better".

One person told us that the staff always came when they were needed, although sometimes they did have to wait a little while, if staff were busy with other people.

Another person said: "All the carers are wonderful but there is one thing I do wish; I wish I could have a bath more often. I've only had three baths - I can't remember the last time - and I've lived here for two years."

Two people we met with were reading newspapers in their rooms and both people told us that they ordered their daily papers from the staff and that these were delivered to them personally each morning. One person said: "I'd be lost if I didn't have my daily paper."

Most of the people we spoke with told us that they had regular visitors and that they could come when they wanted to. One person told us, "My relative comes every week and usually takes me out in my wheelchair chair for a wander, as long as the weather's nice. I really look forward to that".

Some of the people we spoke with told us that they preferred to have their meals in their rooms and we saw that people's choices were respected.

We spoke with a number of people, while they were in their own rooms, and everybody told us that they had everything they needed and were very happy with their rooms.

One person told us how they loved the view from their window and that they had been able to watch the memorial service from their room last November.

Two people were spoken with at length and observations were also made of activities and staff interactions.

During the course of the morning, two visitors from the local church provided people using the service with the opportunity to partake of Holy Communion in the main lounge. They also went to people in their own rooms, who were unable to attend in the lounge. Otherwise, there was music playing in the main lounge and some people were watching television. Others were talking between themselves, one person was knitting and others were reading.

We observed the interaction between people using the service and staff. It was clearly warm and friendly. Staff spoke respectfully to people and we heard plenty of laughter. Staff were happy and smiling, even when they were busy.

We carried out a comprehensive inspection of this service on 17,18 and 20 November 2014. We found multiple breaches of legal requirements were found. The provider subsequently employed a crisis manager. On 18 December 2014 we were notified by the crisis manager that they had identified significant concerns regarding the competency of three of the nursing staff. As a result we undertook focused inspections on 19, 21 and 29 December 2014. 

You can read a summary of our findings from all inspections below. 

Comprehensive inspection of 17,18 and 20 November 2014

This inspection took place over 17 and 18 November 2014 and was completed by an early evening inspection on 20 November 2014. The inspections on the 17 and 20 November were unannounced, which meant that the provider did not know that we were coming. On the 17 November we told the manager that we had not completed our inspection on that day and would be returning the next day. The inspection was carried out over all three days by the same two inspectors.

There were 32 people living in the home at the time of our inspection. Many needed nursing care and/or were living with physical disabilities. Some people were living with dementia.

During our inspection we spoke with five people living in the home and relatives of another four people. We were unable to communicate in detail with many people living in the home due to their complex needs. However, we spent time observing the day to day workings of the home and carried out a short observational framework for inspection (SOFI) to help us understand the experiences of people who could not communicate with us. SOFI is a method of observing how people using services engage with other people, their environment and the quality of staff interaction with them. 

We also spoke with the registered manager, the deputy manager, five care staff and three ancillary staff members. Health care professionals familiar with the service also gave us their views.   

A registered manager was in post. 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 found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. People and their relatives held mixed views about the service they or their family member received. Whilst some people were very happy, others were not. Our own observations, those of health care professionals and the records we looked at were not always in accordance with the positive views held by some people.

People’s safety had been compromised in a number of areas. For example, we found inadequate staffing levels, unsafe staff recruitment, hazardous cleaning materials left unsecured, poor pressure area care, inadequate monitoring of diabetes, unsafe medicines arrangements and infection prevention and control issues.  

We had considerable concerns that people weren’t being effectively supported with their nutrition or hydration needs and reported these concerns to the local authority. Meal times in the main lounge resulted in a poor experience for people who chose to eat there.  

Although staff had received training in the Mental Capacity Act 2005, staff we spoke with didn’t understand the requirements of the Act and how it affected their work on a day to day basis. The manager had not completed the necessary applications to the local authority as required by the Deprivation of Liberty Safeguards (DoLS).   

People and their relatives that we spoke with told us that most staff members were caring and trying to do a good job. We observed both good and poor examples of staff interaction with people throughout our inspection. However, we had concerns that people were not always being cared for in a way that supported their dignity or privacy.

There was a general consensus from people we spoke with who had raised concerns with the manager that their efforts had proved to be ineffective in bringing about change for the better. These people living in the home, their relatives and staff members were dissatisfied and frustrated.

There was little to occupy people’s time in St Nicholas Nursing Home. The time devoted to this was insufficient to effectively support people to maintain their own interests or occupy people living with dementia. These people needed to be engaged with meaningful social interaction to maximise the quality of their daily lives.

The service was poorly managed at both manager and provider level. This was evident from our findings throughout the inspection. There was little effective quality monitoring. We found a culture of blame within the home. When we discussed our concerns with the manager they accepted little responsibility for the failings we had identified.

Focused inspection of 19 December 2014

We found serious concerns about the safety of people living at the service, particularly those in need of nursing care. This was because following incidents under investigation sufficient numbers of competent nursing staff were not available. The provider’s staff had worked with the local authority and North Norfolk clinical commissioning group (CCG) to ensure that suitable nursing cover would be provided over the coming weekend.

Focused inspection of 21 December 2014

We carried out this inspection to establish whether suitable numbers of nursing staff were available to support people living at the service. Nursing cover was being secured on a day by day basis which wasn’t sustainable or safe. The decision was taken by commissioners to relocate people with high care needs to other homes where a safe standard of nursing care could be provided for them. This was carried out over 23 and 24 December 2014. CQC carried out urgent enforcement action under Section 31 of the Health and Social Care Act 2008 on Tuesday 23 December 2014. This meant that with immediate effect, the providers were not allowed to provide nursing care at St Nicholas Nursing Home.

Focused inspection of 29 December 2014

This inspection was carried out to establish whether the people remaining at the home were safe and supported by adequate numbers of suitable staff. We were satisfied that suitable arrangements were in place to ensure that people's needs were met.