Nightingales Residential Home

We found the following examples of good practice.

At the time of our visit the home had never had a resident that had contracted Covid-19 and 100% of residents had received their first vaccine for Covid-19.

The home was clean and free from clutter. Cleaning schedules were in place for day to day cleaning.

The service provided safe and effective ways for people to visit their relatives during the Covid-19 pandemic. The home’s front porch was used as a testing area and personal protective equipment (PPE) donning area for visitors. Staff always answered the door to visitors and prompted them to use hand sanitiser and don PPE.

Visiting arrangements were in accordance with Public Health England guidance. The registered manager had emailed families and carers and spoken with them about the home’s social distancing and visiting arrangements. At the time of inspection one resident was being supported to spend time safely with their family at a time that suited them. Other residents’ families had decided not to visit the home, to minimise the potential risk of infection transmission.

The home offered families and carers video calls from a range of video calling providers at a time that suited them. The home also provided telephone calls for families and carers at any time.

The home had reduced their full capacity for the duration of the pandemic from 11 resident to nine. The home’s shared rooms were changed to single occupancy for the duration of the pandemic. The home had a contingency plan for safe zoning and cohorting of residents in the event of a Covid-19 outbreak. The home had a downstairs extension that could be utilised in the event of residents needing to isolate from the rest of the home.

The service participated in the whole home testing programme, this meant staff were tested for Covid-19 weekly and residents were tested every 28 days.

Systems were in place to ensure staff isolated for the required period should they test positive for Covid-19. Staff breaks whilst at work were staggered for social distancing purposes. The home’s administrator worked from home during the pandemic to minimise the number of staff on the home’s premises.

Risk assessments had been completed for staff that were more at risk if they contracted the virus.

Staff had received additional training in infection prevention and control (IPC) and Covid-19 to ensure they understood what actions to take in the event of themselves or residents becoming symptomatic and how to provide care safely.

The home’s IPC policy and IPC audits were satisfactory. IPC audits were carried out monthly and included extra measures the home had put in place due to Covid-19. Any shortfalls identified during the IPC audits were immediately addressed.

The service is a care home. The care home provides care and support for up to 11 people, some who are living with dementia. On the day we visited 10 people where living at the service.

People’s experience of using this service and what we found

People said they were happy with the service provided. One said; “They are very kind to me.” A relative said; “This place is brilliant!”

People able to said they felt safe with the staff supporting them. Systems were in place to safeguard people. Risks to them were identified and managed. The support required with medicines was assessed, agreed and provided to people. Infection control measures were in place to prevent cross infection. Staff were suitably recruited. People were supported by a mostly long serving staff team. Staffing levels were flexible to enable the service to provide a bespoke service to people to meet their needs.

People were supported by staff who completed an induction, training and were supervised. The support required by people with health and nutritional needs was identified and provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People confirmed staff were kind and caring. Their privacy and dignity were promoted. Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to.

People had person centred care plans in place. They were actively involved in their care when possible. People contributed to the development of care plans and reviews. People’s communication needs were identified, and some people had end of life wishes explored and recorded.

People were supported by a service that was well managed. Records were accessible and up to date. The service was audited, and action taken to address any areas identified that needed improving. People, staff, relatives and professionals were complimentary of the registered manager and comments included; “They (named registered manager) are brilliant.” Staff were committed to providing good outcomes for people.

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 21 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Nightingales is a small care home providing accommodation and personal care for up to 11 people. There were 11 people living in the home on the day of the inspection. Some people using the service are living with dementia. Two of the bedrooms in Nightingales are shared rooms.

There was a registered manager 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.

People are 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 support this practice.

Staff knew how to keep people safe and understood how to protect people and report abuse when necessary.

Risks were appropriately assessed and staff understood how to ensure people were supported to maintain as much independence as possible.

There were enough staff with the right skills and knowledge in the home to meet people’s day to day needs.

Medicines were safely managed. People received their medicines when they needed them by staff that had been appropriately trained.

Staff received the training and support they needed to ensure that they understood their role and responsibilities. Training was also tailored to staff development needs.

Staff understood the needs of the Mental Capacity Act and how to ensure consent was sought day to day. Appropriate support and guidance was sought when people did not have capacity to make big decisions in their lives.

People were supported to eat and drink enough to maintain their wellbeing. Where people needed additional nutritional support appropriate guidance was sought and acted upon.

People’s healthcare needs were met in a timely way and guidance from healthcare professionals was sought and acted upon.

People had developed positive caring relationships with staff.

People were supported to express their views. Relatives and other visitors to the home were also asked for their views.

Staff understood the importance of respecting people’s wishes and maintaining their dignity.

Care was personalised to individual needs and activities formed part of daily life either on an individual basis or as part of a small group.

The provider and registered manager had developed a positive culture centred on each person’s individual needs. Staff understood this culture and actively ensured it was met.

The registered manager provided strong leadership and staff respected their actions.

The registered manager and provider worked together to develop a service that listened to the people it supported and acted on comments to continue to develop a quality service.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

There were 11 people living at Nightingales Residential Home on the day of our inspection. We spoke with five people, two relatives, the registered manager and two members of staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People we spoke with during the inspection had no concerns or complaints about the care and support they received. One person told us, "I absolutely love it, if I could give it 5 stars I would."

Staff records contained all the information required by the Health and Social Care Act 2008. This meant the provider employed staff who were suitable and had the skills and experience needed to support the people living in the home.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and report on what we find. The provider sought consent from people and or their relatives in relation to their care and was reviewing procedures under the Mental Capacity Act. The manager was aware of what constituted a deprivation of liberty. They were aware of the new Supreme Court ruling and had submitted DoLS applications for people living I the home.

People who lived at the home we spoke with were happy with the service that they had received. All the staff had received training in the safeguarding of vulnerable adults.

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment.

Is the service effective?

People received care and support in accordance with their care plans. Care was planned to meet people's needs. Where a need was identified a plan was in place to meet this. For example, one person's care record stated that they required assistance to change position. This plan detailed the frequency of position changes, the equipment required and the numbers of staff.

People told us that they were happy with the care they received and felt their needs had been met. One relative told us, "Mum came here from another care home. I cannot fault it, she's improved so much." We spoke with two members of staff who both demonstrated to us that they understood people's care and support needs and that they knew them well.

Results from returned satisfaction surveys from people who had stayed at Nightingales were positive about the way people had been cared for.

Is the service caring?

We found the service was caring as people were treated with dignity and respect.

People spoke positively about the care they received and that staff were kind, caring and compassionate. One person told us, "I feel safe here, its home from home. The staff are all lovely." Another person told us "The staff are nice."

People's privacy and dignity was always maintained. This was because staff respected people's privacy by respecting their private spaces and maintaining their dignity during personal care.

We saw that staff were kind and caring in their approach with people. There was information about people's personal preferences, life history and lifestyle choices. This meant that staff had information to be able to care for and support people as individuals.

Is the service responsive?

People's care needs were reviewed and their plans updated to ensure they received a service that met their current needs. Staff worked with and followed the advice of other professionals who were involved in people's care. For example, one person sometimes behaved in a way that upset others living in the home. We saw that the home had obtained professional support and guidance to ensure the safety and welfare of the person and others living in the home.

People accessed the services of healthcare professionals as required. Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, district nurses, opticians and GPs were documented.

Is the service well led?

The home had systems in place for monitoring the quality of service provided to make sure that the home was run safely. Accidents and incidents were audited so that remedial action could be taken to prevent further occurrences. Other audits included privacy and dignity, infection control, and medicines. We found that actions had been taken as a result of this monitoring. For example, a recent infection control audit highlighted the need to ensure cleaning schedules were completed. We saw that these schedules were in place during our visit.

People were able to comment on the service provided via questionnaires and meetings. People told us that they had recently attended a resident/relative meeting which enabled them to contribute to matters within the home.

We spoke with the two staff on duty, the manager and the deputy manager. One member of staff said 'It's quite relaxed here'. Another said 'The manager and staff are very friendly and supportive'.

We reviewed care records for three people who used the service. We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans kept current.

People were protected from the risks of unsafe use and management of medication because there were effective systems and processes in place.

People could choose from a varied menu and had the support they needed to help them eat and drink.

People using the service benefited from a staff team who were well trained and supported to do their job.