About the service:

St Nicholas House is a care home for older people situated in a residential area of Dereham. The accommodation is located over two floors and people with dementia related needs were cared for in a separate wing. There were 28 people living at the service on the day of inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

¿ People and their relatives made positive comments about the care provided at St Nicholas House. Comments included, “I didn’t know there were places like this. I have decided not to go home as I love it here. I am amazed the place is as nice as it is.” And, “The people, not just the staff are so friendly and helpful, I am very impressed.”

¿ Some environmental risks in the service had not been identified and systems required improvement to ensure the environment was consistently safe.

¿ Staff were recruited safely, were visible in the service and responded to people quickly.

¿ People were given choice and supported to be independent. They were treated with dignity and respect.

¿ Staff knew people well and had developed meaningful relationships with them.

¿ People could take part in a range of activities which promoted their wellbeing.

¿ People's health was well managed and there were positive links with other services to ensure that individual health and nutritional needs were met.

¿ People received their medicines when they needed them.

¿ End of life planning required further development. We have made a recommendation that the service consults a reputable source to further develop end of life planning.

¿ People, their relatives and professionals made positive comments about the management team at St Nicholas House.

Rating at last inspection: Good (report published 22 April 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

This inspection was unannounced and took place on 8 March 2016.

At the last inspection in August 2015, we found the provider in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the management of risk and the monitoring the quality of the service. The provider sent us an action plan to say they would be meeting the relevant legal requirements by 31 October 2015. Other improvements were also required in relation to the number of staff available to meet people’s needs and preferences, staff knowledge of the requirements of the Mental Capacity Act 2005 (MCA) and the completion of staff training. We found that the necessary improvements had been made and that the provider was no longer in breach of these Regulations.

St Nicholas House is a care home that provides accommodation and care for up to 39 older people, some of whom may be living with dementia. There are two units operating within the home, a residential unit and a dementia unit. On the day of our inspection, there were 33 people living in the residential unit and three people in the dementia unit.

There was a manager working at the home. They were not registered with us at the time of our inspection but we had received an application from them in respect of this, which is currently being processed. 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 and associated Regulations about how the service is run.

People who lived in the home were safe. Risks to their safety had been assessed and actions taken to reduce any risks that had been identified.

There were enough staff available to meet people’s needs, preferences and to keep them safe. These staff had received appropriate training and supervision to enable them to provide people with safe and effective care.

People received their medicines when they needed them and the premises they lived in was well maintained. People received enough food and drink to meet their needs and the staff supported them to maintain their health.

People were cared for by kind, compassionate and caring staff who knew them well. People’s individual needs were met and they were happy living in St Nicholas House. The staff were polite and treated people with dignity and respect.

People had a choice about how they wanted to live their lives and the staff promoted this. People were encouraged to maintain their independence and to participate in activities that complemented their hobbies, interests and that promoted their wellbeing.

The home had an open and transparent culture. People were listened to and felt able to raise any concerns without hesitation. Concerns that were raised were dealt with quickly. The staff were happy working in the home. They were supported by a management team who were good leaders and who promoted care that was based on people’s individual needs and choices. Communication within the home was good and therefore, the staff understood their individual roles and responsibilities which contributed to the provision of good quality care.

There were effective systems in place to assess and monitor the quality and safety of the care that was provided. It was clear that the provider, managers and the staff at the home had worked hard to improve the quality of care that people received.

This inspection was unannounced and took place on 06 August 2015.

At the last inspection in October 2014, we asked the provider to make improvements in relation to staffing levels, monitoring the quality of the service and the accuracy of records. The provider sent us an action plan to say that they would be meeting the relevant legal requirements by 28 February 2015. Other improvements were also required in relation to the management of people’s medicines, staff knowledge of the requirements of the Mental Capacity Act 2005 (MCA), access to activities that complemented people’s hobbies and interests and the completion of staff training. We found that some improvements had been made but that further improvements were required.

St Nicholas House is a service that provides accommodation and care to older people and is registered for up to 39 people. There are two units operating at the service, a residential unit and a dementia care unit. On the day of our inspection, there were 30 people living in the residential unit and five people in the dementia care unit.

There was a registered manager working at the home who had been registered with us since 5 June 2015. 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 and associated Regulations about how the service is run.

We found that some improvements had been made to how people’s medicines were managed, staff knowledge in respect of the MCA 2005 and in the provision of activities that complemented people’s hobbies and interests. However, staffing levels were not adequate on the day of the inspection to provide people with safe care or that met their individual preferences, although it is acknowledged that the service had tried to cover the staff absences but had not been successful due to an agency staff member not turning up for their shift.

Actions to mitigate risks to people’s safety were not always being taken and the systems in place to monitor the quality of the service and accuracy of some people’s care records remained ineffective. Some staffs refresher training was overdue which meant that they may not have up to date knowledge and skills to provide people with safe care.

Staff were seen asking people for their consent before providing them with care. However, the principles of the MCA 2005 had not always been followed when decisions had been made on behalf of people who lacked the capacity to consent to some aspects of their care.

The provider had systems in place to reduce the risk of people experiencing abuse. When concerns were raised, the registered manager had investigated these thoroughly and action had been taken to protect people when necessary. New staff were checked before they started working at the home to make sure that they were safe to do so. The premises where people lived and the equipment they used was well maintained and safe.

Staff knew the people they cared for well and treated them with kindness, compassion, dignity and respect. People had access to plenty of food and drink and saw healthcare professionals for specialist advice when they needed to help them maintain their health.

People and relatives were listened to and their opinions were respected. There was a system in place to fully investigate any complaints or concerns that were received.

The service had an open culture where people and staff could raise concerns without fear of recrimination. People who lived in the home and the staff were encouraged to make suggestions on how to improve the care that was provided and these were acted upon.

The managers and staff at the home acknowledged that there were issues with staffing levels that had impacted on their ability to sometimes provide people with safe care that met their individual needs. However, they demonstrated to us that they were working hard to correct this and were pro-active in trying to improve the quality of life of the people living at St Nicholas House.

There were some of breaches of the Health and Social Care Act 2008 [Regulated Activities] 2014 and you can see what action we told the provider to take at the back of the full version of the report.

We have made a recommendation about following the principles of the Mental Capacity Act 2005 when making best interest decisions on behalf of people.

This inspection was unannounced and took place on 15 October 2014.

St Nicholas House is a service that provides accommodation and care to older people and is registered for up to 39 people. There are two units operating at the service, a residential unit and a dementia care unit. On the day of our inspection, there were 31 people living in the residential unit and six people in the dementia care unit.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run.

People felt safe and the staff were kind and caring. Staff treated people with respect and were compassionate towards them and people received their medicines when they needed them.

People’s privacy and dignity was respected. People were happy to raise any concerns they had with staff and were confident that these would be dealt with. There were enough staff to provide people with assistance within the dementia unit and they had access to activities that they found interesting. However, this was not always the case within the residential unit.

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. We found that the service was meeting the requirements of DoLS.

Staff asked people for their consent when supporting them with tasks. Staff working within the dementia unit understood the principles of the MCA or DoLS. However, staff working on the residential unit did not. Therefore, we could not be sure that people living within the residential unit who lacked capacity to make their own decisions consistently had their rights protected.

The provider did not have effective systems in place to monitor the completion of staff training or the staffing levels required within the residential unit and some people’s care records were inaccurate or incomplete.

People received sufficient food and drink to meet their needs and had access to healthcare professionals when they became unwell or required specialist help with an existing medical condition.

The provider had made sure that the premises were well maintained and that the required safety checks had been carried out. Equipment used to assist people to move had been regularly serviced to ensure that it was safe to use.

All of the staff spoken with felt supported by their immediate management team. The management team were approachable where staff could openly raise concerns if they needed to. The provider had learnt from any accidents or incidents that had occurred.

There were some of breaches of the Health and Social Care Act 2008 [Regulated Activities] 2010 and you can see what action we told the provider to take at the back of the full version of the report.

At this inspection we spoke with six people who lived in this home to ensure they were involved and could consent to the care they were being supported with. We received comments such as, “I have my care plan talked through with me and know what my aims are for the future.” “I talk regularly with the staff about my care so I know they will help me when I need it.” One person, who was in the home for a respite stay, told us how they were fully in agreement with the plans being made for them to return home.

Care plans looked at and the people spoken with confirmed that the people living in this home were supported and cared for safely and appropriately and had their individual care needs met.

We saw infection control practices being carried out during our inspection. Staff told us that they were supported with their knowledge and training to understand measures that would help prevent the spread of infections.

We found that staffing levels in the home were adequate and that staff had the skills and knowledge required to support people effectively. We concluded that the deployment of staff around the building could help improve the way people’s social needs were met

Complaints were listened to, acted upon and records were held on the outcomes of any concerns or complaints logged with the home.

Throughout this inspection visit we received nothing but positive comments from all the people we spoke with. "I can have a full life in this home with choices that I can make that suit me." Another person said "I am very able to voice my views and the staff help me to live my life as best I can."

The visitor we spoke with told us that staff were always polite, kept them well informed and included them as part of the home, making them feel welcome. They said, "Not only do they respect my ------- but they also respect the family as well."

We witnessed good practices of care that showed respect throughout and that dignity was preserved, we saw care was appropriate and that records were in place.

Staff were well supported to ensure they carried out their job safely with good training and in house support.

We saw evidence and discussed in detail the methods used to check the quality of all aspects of the service provided to ensure the service was safe and delivered to an acceptable standard.