The Care Quality Commission (CQC) has rated St Nicholas Care Home in Bootle, Merseyside, inadequate, and placed it in special measures following an inspection in August 2023.
St Nicholas Care Home is a residential care home providing personal and nursing care up to 176 people within six buildings. At the time of the inspection however, two of the buildings were not in use. One of the four buildings operating, Brockleback House, provides specialist nursing care to autistic people and people with a learning disability.
The inspection was prompted in part due to concerns received about how people’s safety was being managed.
Following the inspection, the overall rating for the home, as well as the areas of responsive and well-led, have moved down from requires improvement to inadequate. Effective and caring domains have moved from good to requires improvement, and how safe the service is remains as requires improvement.
The service has been placed in special measures which means it will be kept under close review to make sure people are safe, and there will be a re-inspection to check for significant improvements.
Rebecca Bushell-Bauers, director for people with a learning disability and autistic people, said:
“When we inspected St Nicholas Care Home, it was disappointing that actions from previous inspections hadn’t been properly addressed to ensure people were getting the level of care they deserve. Leaders need to prioritise making swift improvements, particularly around the overall management of the service to ensure people’s needs are properly met.
“We were particularly concerned that nurses who held a specialist qualification in working with autistic people and people with a learning disability only worked night shifts, meaning daytime shifts weren’t covered by suitably trained staff.
“We saw that during the day, this meant people weren’t involved in the development and review of their care plans and we saw people not being given the opportunity to lead fulfilled and valued lives. The activities available were of poor quality and care staff didn’t recognise planning social and leisure activities as part of their role.
“It was also concerning that there was a high reliance on agency staff, most of whom didn’t know the person they were providing care to. Many didn’t even know the name of the person they were supporting, and we heard some inappropriate and derogatory language being used towards people which is totally unacceptable.
“However, we did see some positive areas of care. We observed people receiving visits from family and friends and people's bedrooms were welcoming personalised to their taste. Staff members told us they felt supported in their role and all the people we spoke with had confidence in the new manager who had recently been appointed.
"The provider listened to our concerns and demonstrated a commitment to making the necessary improvements following the inspection.
“We will continue to monitor the service closely to ensure significant improvements are made. If we are not assured people are receiving safe care, we will not hesitate to take further enforcement action to ensure people are receiving the high standard of care they deserve.”
Inspectors found:
- People weren’t always supported to make informed decisions about their care
- There was a lack of positive interaction between staff and people who used the service
- Some care plans were brief and did not include information how to best support people
- Care was not person centred and people weren’t always consulted before being provided with support
- Conversations with staff demonstrated a lack of knowledge about best practice approaches when working with autistic people and people with a learning disability. and autistic people
- There was a lack of effective system in place to learn from events and incidents
- Frequent changes in management had impacted on the quality of the care delivered across the service in general.
However:
- Routine checks on the environment and equipment were up to date and certificates were in place to demonstrate this
- Medicines were stored securely and only administered by staff who were suitably trained
- Staff were knowledgeable about safe systems of work to follow in the event of an infectious outbreak at the service
- The manager had received some support and guidance from the local health protection team. Their feedback demonstrated standards were steadily improving
- Records confirmed people were supported to access their GP and other health services when required.