CQC report explained · a nursing home
What the CQC found at St Nicholas Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, October 2023
Rated Inadequate and placed in special measures; inspectors found serious shortfalls in personalised care, leadership, staffing and support for people’s rights.
Inspectors visited without notice on 3, 15 and 17 August 2023. They spoke with people, relatives, staff and visiting professionals. They observed care and reviewed care plans, medicine records, staff files and management records.
The home was not consistently meeting people’s needs. Inspectors found poor personalised care, limited activities and community access, weak communication support and unnecessary restrictions on people’s freedom. Staff did not always have the right skills, particularly in the unit for people with learning disabilities and autistic people.
There were also problems with the Mental Capacity Act, learning from accidents, care records and checks on the quality of care. Some medicines, health appointments, safety checks, family visits and welcoming bedrooms were good. However, these strengths did not outweigh the serious and repeated failures.
The overall rating fell from Requires Improvement to Inadequate. Safe, Effective and Caring were rated Requires Improvement. Responsive and Well-led were rated Inadequate. The home was placed in special measures.
Medicines and health care
Inspectors found medicines were safely managed and people were supported to attend medical appointments when needed.
“People received their medicines as prescribed and were supported to attend medical appointments when needed.” from the report
Building safety
Routine checks of the building and equipment were up to date, with certificates available.
“Regular checks were made on the building and equipment to ensure they were safe to use.” from the report
Family contact
People received visits from family and friends during the inspection.
“We observed people receiving visits from family and friends and people's bedrooms were welcoming and could be personalised to their taste.” from the report
Openness during inspection
The new management team responded openly to the issues inspectors identified and listened to relatives’ feedback.
“Throughout our inspection, the new management team was open and transparent when responding to all the issues we identified.” from the report
Poor personalised activities
seriousPeople in Brocklebank House had limited meaningful activities and little opportunity to access the local community. This created a risk of social isolation.
“Systems had not been established to support people to follow interests and to take part in activities that are socially and culturally relevant to them.” from the report
Weak leadership and checks
seriousManagement changes and incomplete audits meant that repeated problems were not reliably found or fixed. The provider remained in breach of good governance requirements.
“Systems had not been established to ensure governance systems were robust enough to monitor the quality of the service.” from the report
Staff skills and deployment
seriousThere were not enough suitably skilled staff for all people’s needs, especially in Brocklebank House. Agency staff did not always know the people they were supporting.
“Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not deployed to meet the needs of people who used the service.” from the report
Restrictions and legal safeguards
seriousPeople could not always access parts of their own home, and DoLS records were incomplete or out of date. One authorisation had expired without a timely reapplication.
“Restrictions were imposed on the environment which were not always necessary and restricted people's freedom of movement and access to areas within the home.” from the report
Dignity and communication
seriousInspectors saw limited positive interaction and found language in conversations and care records that was not respectful. Communication needs were not always properly recorded or supported.
“People who used the service were not always treated with dignity or respect.” from the report
- 01What specific changes have been made to provide regular community access and meaningful activities for people in Brocklebank House?
- 02How are you ensuring agency staff understand each person’s care needs before providing care?
- 03How are DoLS applications, restrictions such as locked areas and bedroom access being checked for each person?
- 04How are care plans being updated to reflect people’s communication needs, personal history, preferences and changing risks?
- 05What evidence can you show that accidents and incidents are now analysed and that lessons are acted on?
This was an unannounced inspection covering all five key questions and infection prevention and control; the report compares the findings with the previous inspection published on 23 March 2023. This explanation was written from the published report of 19 October 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2023
St Nicholas Care Home was rated Requires Improvement; inspectors found risks with medicines, risk assessments and oversight, although people were treated kindly and felt safe.
This was an unannounced inspection on 31 January and 3 February 2023. Inspectors spoke with people, relatives and staff, observed care, and checked care, medicine, staffing and management records. Some records were reviewed remotely on the second day.
The home was clean, there were enough staff on duty, recruitment checks were completed, and people said they felt safe. Care was described as person-centred in the unit for people with a learning disability, with support for dignity, choice and community activities.
However, some risks were not assessed in enough detail. Medicine records were not always clear, PRN medicine instructions were missing, and records about incidents, wounds and repositioning were incomplete. The overall rating changed from Good at the previous inspection to Requires Improvement. The safe and well-led ratings were both Requires Improvement.
People felt safe
People told inspectors they felt safe living at the home. Relatives also gave positive comments about safety.
“People said they felt safe living in the home.” from the report
Clean home and infection control
The home was visibly clean. Staff understood when to use protective equipment, and visiting was being facilitated without restrictions.
“Infection prevention and control procedures were effectively managed.” from the report
Kind and person-centred care
Inspectors found a strong commitment to individualised care in the learning disability unit. People were supported with dignity, privacy, choice and meaningful activities.
“Care was person-centred and promoted people's dignity, privacy and human rights” from the report
Staffing and recruitment
Inspectors found enough staff on duty to meet people's needs and found that recruitment checks were completed before staff started.
“There was enough staff on duty to make sure people's needs were met.” from the report
Risk assessments and repositioning
seriousSome assessments did not explain clearly enough how staff should reduce risks, including choking and distress. Repositioning was not always completed, putting people at risk of further pressure area damage.
“Some risks were not always effectively assessed or mitigated. This meant people were exposed to unnecessary harm.” from the report
Medicine records
seriousElectronic medicine records contained incorrect codes, so inspectors could not always tell whether medicines had been given. Instructions for medicines given when needed were missing.
“There were no protocols in place for medicines that were prescribed as and when required.” from the report
Learning from incidents
needs fixingThe home did not always record or analyse accidents and incidents well enough to show what had been learned or how repeat incidents would be prevented.
“We could not be certain that learning was being taken from accidents and incidents that occurred within the home.” from the report
Management checks and records
needs fixingAudits and other management checks did not identify all the shortfalls. Some wound care, daily care and repositioning records were incomplete or inaccurate.
“Some audits did not identify shortfalls in service provision.” from the report
- 01What has been changed to make sure electronic medicine records are accurate and staff record every dose correctly?
- 02Where are the PRN medicine protocols now, and how do staff know when and how to give these medicines?
- 03How are choking risks, wound care and two-hourly repositioning now assessed, recorded and checked?
- 04What action was taken after the choking incident and other accidents, and how is the home checking that lessons have been learned?
- 05Who is currently responsible for the home, and what is the progress of the manager's CQC registration?
This was an unannounced focused inspection prompted by concerns about pressure area management and person-to-person injury; only Safe and Well-led were rated, while the other key question ratings were not given in this report. This explanation was written from the published report of 23 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of St Nicholas Care Home
4 rated inspections over 4 years: the service has slipped, from Requires improvement to Inadequate.
- October 2023Inadequatecurrent ratingdown from Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- March 2023Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- November 2021Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2019Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2019
Registered with the Care Quality Commission on 25 February 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
38 live-in carers within about an hour of Sefton
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,270 a week. 34 can care for a couple. 11 years' experience on average.
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.