St Nicholas Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. There was a system in place to record and monitor accidents and incidents. This had improved since our last inspection. Staff understood the process for reporting and recording events which occurred and told us learning was communicated across the staff team. A staff member said, “I attend weekly clinical meetings when information is shared then I share it with the staff team. We also share any information at handover meetings each day.” Events which occurred were reviewed on a regular basis by the registered manager. This enabled them to analyse trends and identify any lessons learnt.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. A professional visiting a person who had recently moved to the service told us, “[Name] is looking fantastic. [Name] is relaxed and happy here.” We received feedback some people had moved within the service to different households and people and their family members had not been informed nor consulted. We spoke with family members; most of whom told us decisions had been communicated at the time. One family member explained the reasons for the move and said, “We have been informed all the way. The staff have been fantastic.” One family member told us they had not been consulted and gave some personal examples of some aspects of care they were currently unhappy with. We raised this with the registered manager who provided evidence discussions had taken place prior to the move. The registered manager told us they would contact the individual to discuss their concerns further.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Systems were in place to protect people from the risk of abuse. Staff received training and understood the actions they must take if they felt someone was being harmed or abused. Referrals had been made to the local authority safeguarding team when abuse had been suspected, and investigations had been completed. People told us they felt safe. Comments included, “Yes I feel safe here” and “Definitely safe, and I am very well treated.” A family member added, “I can’t speak more highly of the regular staff.” Information explaining how people could raise concerns if they felt someone was being abused was clearly displayed.

The provider did not always work well with people to understand and manage risks. Risk assessments had been completed, and care plans had been developed to minimise any risk to people’s health and wellbeing. However, for one person these had not been updated when they moved between households. This meant staff did not always have accurate information to support the person based on their current needs and living environment. Another person had information about how they may display distress through physical behaviour, however, the best way to support them through these periods lacked detail. We raised these shortfalls with the unit managers who told us these care plans would be reviewed. Throughout our assessment, we observed safe working practices, such as moving and handling of people. People had the necessary equipment they needed to be supported safely.

The provider detected and controlled potential risks in the care environment. Routine checks on the environment and equipment were up to date and certificates were in place to demonstrate this. Redecoration and replacement of flooring in communal areas was underway, and ongoing. However, some bedrooms and bedroom furniture were displaying signs of wear and were tired in appearance. Although issues were addressed once we highlighted them, ongoing improvements were needed. Other parts of the service had undergone a full scheme of refurbishment and had been designed to promote a more homely environment and people’s independence. Garden areas were easily accessible to people, and we observed people using them both with support and independently.

Staff were suitably qualified, skilled and experienced. Staff were safely recruited and inducted; appropriate checks had been made before applicants were offered employment. Staff told us, “We get all the training we need and can ask for other training if we think we need it” and “I had an induction and do training online, I find the training very good.” Staff also received training to effectively support people with a learning disability and autistic people. Some frustration was expressed about the turnover of staff at the service and ongoing use of agency workers, which some people felt impacted on continuity and quality of care. One person told us “A lot of the staff have left because they were unhappy.” Comments from family members included, “I wish [the registered manager] could get staff to stay as consistency is the key” and “It’s sad we have lost some good staff. They were being moved around, and it wasn’t fair on the residents.” A staff member we spoke with supported the changes in staffing at the home and told us, “A few staff have left which has had a positive impact. [The registered manager] has staff moving round but this is necessary to cover sickness, so we don’t use agency.” Another family member supported this and said, “The home is better. Staff wise and everything.” We found safe staffing levels across the service.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The home was clean and well maintained. A family member told us, “I have no concerns about cleanliness. Its spot on.” There was enough personal protective equipment (PPE) throughout the service for staff to use when needed.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. One person told us, “I have no concerns about my medication.” Records of administration were maintained and in line with best practice. This included when people were prescribed creams. Guidance was in place for all prescribed medicines administered on an ‘as required’ basis. This helped staff to understand why certain medicines were prescribed; and under what circumstances they should be offered to a person. We discussed some of the protocols could be further developed to include information about how people unable to verbalise expressed pain. The management team told us they would complete a review of these records. Medicines were stored securely and only administered by staff who were suitably trained.