St Nicholas Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The registered manager demonstrated an understanding of their responsibilities under duty of candour. There was a much clearer understanding of how to support the needs of autistic people and people with a learning disability who lived at the service. The registered manager had been new in post at the last inspection and had taken the lead on driving the improvements at the service. Staff told us they felt the culture within the home had improved, particularly in recent months. One staff member told us, [The registered manager] is approachable and has made changes for the better.” The registered manager told us they felt supported by the provider and could access support and additional resources for the services whenever they needed.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. We received feedback prior to and during the assessment by some people who had worked at the service who raised concerns about the management team and about the changes which had been made since our last inspection. These included changes to staff working practices and the physical environment. However, staff we spoke with who currently worked at the service felt well supported and were supportive of the changes. Comments included, “The provider is great. [The registered manager] has been really supportive and understanding of my personal situation” and “So much support, couldn’t ask for better.” Staff spoke openly about challenges they had faced as a team and told us how they respected the registered manager. One staff member told us, “It’s been difficult for [the registered manager]. They have had an awful lot to contend with. Just for wanting change. It’s a lot better now.” Another staff member said, “Some staff did not understand change was needed. I have no problems with the current manager, they have had a very bad time of it.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Systems were in place to ensure people who spoke up were supported and identity was protected. A staff member told us, “I have no worries talking to [the management team] about anything. I have raised concerns in the past and they were very supportive.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Policies were in place to support this. Staff gave examples of how the provider and registered manager had responded to helping staff through personal circumstances and challenges.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. The manager understood their responsibility for notifying the CQC and other agencies of events which occurred within the service and accurate records were maintained. Effective systems were in place to monitor and review the quality of care and experiences of people. Staff confirmed weekly meetings were facilitated by the registered manager to do this. Some governance systems needed to be further improved to fully demonstrate the improvements which had been made to St Nicholas Nursing Home could be sustained. For example, regular audits were completed and demonstrated a commitment to continuous learning and improving care, however care plan audits needed to be more robust to ensure they picked up the shortfalls we identified during our assessment. The registered manager completed a walk round of the service daily. However, these were not always recorded so we could not always see the registered manager had picked up, or been informed of, the environmental improvements we identified.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. Information contained within care plans demonstrated staff worked in partnership with other agencies. Partners we spoke with supported this and told us this had improved since our last inspection. One visiting professional told us, “[Nurse] is very standards driven. Communication is good. Staff react to resident's needs.” However, further work was needed to embed these improvements to build up full trust and confidence with some people and their family members. For example, continuing turnover of staff at the home had left some family members frustrated. One told us they felt they still had to push staff to chase referrals up for one person and had to stay fully aware of the progress of their loved one’s care needs in the event of further staff changes. Whilst most people who lived in the service told us care had improved, we still received feedback from one person this was not the case. They told us, “They used to have more staff but now there is no continuity.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. This was reflected in the changes in both the environment and approach to supporting people who had a learning disability and autistic people who lived at St Nicholas Care Home. People had many more opportunities to access the local community and engage in activities which they were interested in. People were also encouraged to pursue learning opportunities at home within a new ‘cookery kitchen’ and externally, for example local college courses. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. The registered manager sought the views of people who lived at the home, family members/other visitors and staff, through regular meetings. Records were maintained of any actions taken in response to feedback they received.