We carried out a review of the data available to us about Nightingale House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Nightingale House, you can give feedback on this service.
Nightingale House is registered to provide accommodation to 43 older people who may have dementia and requiring nursing or personal care. At the time of our visit, there were 32 people using the service.
People’s experience of using this service and what we found
People were positive about the care and support they received from staff. There were systems to reduce the risk of abuse and to assess and monitor potential risks to people who used the service. People were protected by safe recruitment procedures. There were enough staff to meet their care and support needs. The provider had a system in place to record and monitor accidents and incidents. Medicines were managed in a safe way. People were protected from the risks associated with the spread of infection.
People were supported by staff who had received appropriate training and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice. People's needs were assessed before they started to use the service. People were encouraged to have a healthy diet.
Staff knew people who used the service well and they provided care and support to them in a kind and compassionate way. People were treated with respect and were given information regarding their care and their views were taken into account. Staff were aware that people's information should be treated confidentially. People received care and support in accordance with their preferences, interests and diverse needs.
People received personalised care and support that was tailored to their individual needs. Care plans were informative and had sufficient instructions for staff on how to deliver care and support to people, in accordance with their wishes. Care plans were reviewed and updated in a timely manner. People were supported to engage in meaningful activities of their choice and were involved in the local community. People and their relatives knew they could speak with staff or the management team if they had any concerns.
There was an open culture within the service, which was focussed on people. Staff were clear about their roles and responsibilities and had access to policies and procedures to inform and guide them. The provider had system in place to assess, monitor and improve the quality and safety of the services provided. The provider continually sought feedback about the service from people, relatives, staff and other professionals. The management team worked closely with other health and social care professionals to ensure the people received the care and support they needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 30 July 2022) and there were breaches of Regulations 12 (safe care and treatment) and 17 (good governance). As a result, we served a warning notice to ensure the service was compliant in these areas.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Nightingale House is registered to provide accommodation to 43 older people who may have dementia and requiring nursing or personal care. At the time of our visit, there were 36 people using the service.
People’s experience of using this service and what we found
People’s medicines were not always managed safely because we found shortfalls around the provider’s arrangements to make sure people received their medicines as prescribed. Risks associated with people’s care and support were not always reviewed. Accidents and incidents were recorded but not monitored to identify how the risks of reoccurrence could be minimised in future.
There was a risk of the water could become contaminated as the shower heads in two shower rooms could drop below the water level when the showers were in use. People were protected by safe recruitment procedures and there were enough staff to meet their needs. They were protected from the risks associated with the spread of infection. However, some of the flooring needed cleaning or replacing.
The needs of people were not always fully assessed before they used the service. Staff received training, supervision and support to give them the necessary skills and knowledge to help them care and support people effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice. People maintained good physical and mental health because the management team worked closely with other health and social care professionals.
Care and support were delivered in such a way as to maintain people’s privacy and dignity. People received care and support in accordance with their interests and diverse needs. They were encouraged to maintain their independence as much as possible.
People’s confidential information was not always kept securely and not all information was kept up to date in people’s care records. Some people’s care records had not been reviewed since January 2022 and there were some inconsistencies between paper care plans and the electronic system. People’s communication needs were recorded.
The provider took account of complaints and comments to improve the service. Informal concerns raised by people were addressed through discussion with staff on a day to day basis. People were supported to access activities which were tailored to their individual needs.
There were quality assurance and governance systems in place to drive continuous improvement. However, the systems were not always working effectively because the provider had not identified and improved some of the issues we found during the inspection. The provider failed to keep us informed about matters that affected the service. For example, they had not reported certain incidents/accidents to the Care Quality Commission (CQC).
Staff were aware of who they were accountable to and understood their roles and responsibilities in ensuring people’s needs were met. There was an open and inclusive culture in the service, with staff, people, relatives and other external professionals encouraged to help improve the service. The registered manager had good links with a number of health and social care professionals and this helped to ensure people's needs were met.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 02 September 2020).
Why we inspected
We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
We have identified breaches in relations to safe care and treatment and good governance.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
¿ The service was booking visitors in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. Visits took place in the garden to help maintain social distancing. The provider had made arrangements in line with government guidance for staff and visitors to the home to have their temperature checked on arrival. People were supported to maintain contact electronically with family and friends when they were not able to meet with them in person.
¿ Staff were provided with Personal Protective Equipment and were seen to be using it throughout the inspection, in line with government guidance.
¿ Where people had tested positive for Covid-19, the provider had been able to follow best practice and ensure that people self-isolated in their room. Due to issues of mental capacity, Deprivation of Liberty Safeguards authorisations were used to help ensure the safety of other people and staff at the service.
¿ There was an enhanced cleaning regime at the service, in line with the providers policy and best practice guidance from Public Health England, with surfaces and door handles frequently being cleaned.
Nightingale House is registered to provide accommodation to 43 older people who may have dementia and/or requiring nursing or personal care. At the time of our visit, there were 36 people using the service.
People’s experience of using this service:
¿People who used the service were protected from the risk of abuse because the provider had taken steps to identify the possibility of abuse and prevent abuse from happening.
¿Risks to people had been assessed and identified as part of the care planning process. Medicines were managed safely and stored securely at the service.
¿People were supported to access routine medical support from healthcare professionals such as general practitioners and dentists, to ensure their health and wellbeing was maintained. Staff supported people to eat and drink sufficient quantities.
¿There was an on-going training programme in place for staff to ensure they were kept up to date and aware of current good practice. Staff recruitment process was robust. Staffing levels were organised so that people received appropriate support to meet their needs.
¿People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
¿Staff were kind and compassionate and respected people’s privacy and dignity. They knew people’s preferences, abilities and skills. People were fully supported to take part in their various activities.
¿ People’s needs were assessed, and care and support were planned and delivered in line with their individual care plan. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.
¿The quality of the service was monitored regularly through audit checks and receiving people’s feedback. There was system in place to handle and respond to complaints.
Rating at last inspection:
Good (report published 10 September 2016).
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Follow up:
We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.
For more details, please see the full report which is on CQC website at www.cqc.org.uk.
Nightingale House is registered to provide accommodation for up to 42 people requiring nursing or personal care. This was due to some rooms that were registered for double occupancy. However, the provider has converted all rooms to single use only. Therefore at the time of inspection, 37 people were accommodated and the home was at full occupancy. There was lift access to the first floor making it accessible to people.
At the time of the inspection there wasn’t a registered manager at the service. An interim manager has been in charge of the home since the previous manager left. They have made an application to the Care Quality Commission to become the registered manager. 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 2008 and associated Regulations about how the service is run.
Staff understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare. Medicines were managed and handled safely for people.
Arrangements were in place to keep people safe in the event of an emergency.
There were sufficient staff to meet people’s needs. Staff were attentive, respectful, patient and interacted well with people. People told us that they were happy and felt well cared for. Risk assessments were in place about how to support people in a safe manner.
Staff undertook training and received supervision to support them to carry out their roles effectively. The interim manager and the staff team followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff training records showed they had attended training in MCA and DoLS.
People were supported to maintain good health and had access to health care services when it was needed. People received a nutritionally balanced diet to maintain their health and wellbeing.
People’s needs were assessed before they moved in to the home. Care plans were person centred and were regularly reviewed. Care plans were updated when people’s needs changed.
The service had a clear management structure in place. People and staff told us they found the interim manager approachable and that they listened to them.
The provider sought feedback about the care provided and monitored the service to ensure that care and treatment was provided in a safe and effective way to meet people’s needs.
Any complaints were documented along with the actions taken. There was an effective system in place to monitor the quality of service provided.
We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We also received concerns in relation to the safety and management of the service. This focused inspection looked into those additional concerns. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Nightingale House on our website at www.cqc.org.uk
At this inspection we found that improvements to record keeping, staff supervision and appraisals had been completed and the service now met legal requirements. We found that medicine guidelines were followed and people received their medicines on time.
The service is registered to provide care for 43 older people some of whom had dementia care needs. On the day of our visit there were 38 people using the service. The service did not have a registered manager in place at the time of our inspection because the previous registered manager had left the service and was deregistered. The current manager was still in the process of completing registration with the Care Quality Commission.
A registered manager is a person who has registered with the CQC 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 2008 and associated Regulations about how the service is run.
People’s records were kept up to date and reflected their current health needs including any advice given by other healthcare professionals. Medicines were managed safely and accurately. People were supported by staff who had attended relevant training and received regular supervision and annual appraisals. This enabled staff to keep up to date with practice and deliver evidence based care. We did not find any concerns with the new leadership of the service. People and staff told us that the manager was visible and approachable.
We carried out an inspection of Nightingale House on 26 and 27 January 2015. This was an unannounced inspection . At the last inspection in July 2013 the service was found to be meeting the regulations we looked at.
Nightingale House is a residential home that provides care for up to 43 older people some of whom may be living with dementia . At the time of the inspection there were 34 people living at Nightingale House.
A registered manager was in post. 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 2008 and associated Regulations about how the service is run.
Information relating to medicines was not always recorded correctly. Information regarding people’s allergies were not recorded consistently and people’s full names were not always recorded on medicine administration sheets. This meant that people were at risk of receiving incorrect medicines or medicines that they were allergic to.
Staff did not receive regular supervision and appraisals. This meant that staff’s work was not always assessed and documented in line with their company policy.
The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).
People told us that they felt safe at Nightingale House and that staff treated them with dignity and respect at all times.
Staff received all mandatory training for example, safeguarding, infection control, basic life support, prevention and management of falls, fire safety, person centred care, Mental Capacity Act and DoLs and dementia care.
Staff treated people with dignity and respect at all times, staff were knowledgeable of the people they supported and were able to meet their needs.
The service had an open and positive culture and continually questioned the service delivery. The registered manager was keen to maintain partnership working with other health care professionals.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 now known as Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
People told us they were able to get up when they wanted. One person said "I get up when I want to and come down." We found that people were able to choose when to get up in the morning. However, we found that there were not always suitably qualified and skilled people working at the service. In particular we fund that at night there were not always staff on duty that were able to administer medication.
People told us that they liked the food, and they were provided with sufficient amounts to eat and drink. Comments included "food is very good, plenty of it" and "I am 100% happy with the food." We found that where people were at risk of malnutrition the service had involved professionals including GP's and dieticians. We found that medications were stored and administered safely.
People we spoke with told us they thought there were enough staff to meet their needs. One person told us "it's pretty quick really" when asked how long they had to wait for staff if they needed any assistance. A relative told us they felt sometimes more staff would be helpful, although we observed that staff were able to carry out their duties in a prompt manner.