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Nightingale Lodge Outstanding

Reports


Inspection carried out on 8 February 2021

During an inspection looking at part of the service

Nightingale Lodge is a residential care home providing accommodation and personal care to 26 people aged 65 and over at the time of the inspection.

We found the following examples of good practice.

• The provider had developed ways of recording observations about people's health. These were shared with healthcare professionals during regular telephone reviews. People were screened twice a day for COVID-19 symptoms.

• The provider was following best practice guidance in terms of ensuring visitors to the home did not introduce and spread COVID-19. All staff and visitors had their temperature measured, reviewed and recorded on entry. Where any concerns were raised, visitors were provided with advice and guidance by the home management team.

• Staff and people living in the home were tested regularly for COVID-19 infection. Visitors were also tested for infection with a lateral flow test.

• Visitors entered into an agreement with the service to abide by infection prevention and control rules and their contact details recorded. Information and instructions for visitors were clearly displayed and explained in person.

• Staff were adhering to personal protective equipment (PPE) and social distancing guidance.

• The provider had purchased anti-microbial air purifiers for use in visiting areas, other high occupancy areas and in people's accommodation if they were isolating. The provider also arranged antibacterial ‘fogging’ monthly and as part of the services deep cleaning process.

• People were supported to speak to their families on the phone or via video call. Garden visits and window visits were also available with risk reduction measures in place.

• The service had invested in an electronic screen which provided a protective barrier in the visiting room, allowing visits to take place indoors. However, during the current lockdown restrictions, this facility was not able to be deployed.

• The service had strict arrangements to facilitate indoor visits for people at the end of their life.

• The provider had robust isolation arrangements in place for people who were infected with COVID-19, or for people who had been admitted to the home from hospital or the community. There was clear information and procedures for staff to care for people who were isolating. This effectively reduced the risks of transmission of COVID-19 within the home.

• To ensure reduced risk of transmission of COVID-19, staff had breaks scheduled so that they were on their own and not mixing with others.

• The provider had ensured risk assessments had been carried out for any staff at higher risk of vulnerability to COVID-19 and made appropriate arrangements to protect staff and people.

Inspection carried out on 23 September 2019

During a routine inspection

About the service

Nightingale Lodge is a residential care home providing accommodation and personal care to 26 people aged 65 and over at the time of the inspection. The service can support up to 29 people in one adapted and modernised building.

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

People living at Nightingale Lodge received exceptionally kind and compassionate care. Person centred care was a cornerstone of the service, which the registered manager put at the heart of everything they did. People's independence was actively encouraged and promoted by a staff team who sought creative ways to problem solve and find solutions to meet peoples hopes, wishes and preferences.

People were able to enjoy care that was very responsive to their needs. Staff worked hard to establish what would improve and enhance peoples lives and rose to the challenge in delivering this. Managers and staff had a ‘can do’ attitude in meeting people’s aspirations, this responsive approach had in some cases delivered exceptional outcomes for people, including helping people return to good health when they had arrived at the home for palliative care.

People being cared for at the end of their lives were supported by competent and confident staff who were compassionate in ensuring that people were treated with dignity and respect and experienced a peaceful death.

People told us they felt safe living at the home. Relatives told us that they felt reassured by the high quality of care provided by Nightingale Lodge and had no concerns for the safety of loved ones. The environment was safe, and people had access to appropriate equipment where needed. People were supported to take their medicines safely.

Staff had received appropriate training and support to enable them to carry out their role safely. Support was provided to people so that their health was well managed, and staff had positive links with healthcare professionals which promoted wellbeing for them.

People received enough to eat and drink, where people were at risk of dehydration or weight loss, this was monitored closely, with staff striving hard to find alternative ways for people to remain healthy through good nutrition.

People reported staff were competent and knew how to do their jobs. Staff also told us they received sufficient training to carry out their roles.

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. Staff sought peoples consent before providing them with care and worked within the guidelines of the Mental Capacity Act 2005.

Care files contained personalised information about the people who lived at the home and how they wished to be supported and cared for. People and relatives told us they were involved in care planning and reviews.

Peoples' social and recreational needs were met through a comprehensive activity schedule. This included regular access to the local community either individually or as a group. People had developed positive relationships with staff, who knew them well and how best to care for them.

Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received. Staff were motivated and enjoyed strong team work, they felt well supported by the registered manager. People and their relatives told us the registered manager and provider were visible, open and approachable.

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 6 January 2017). The overall rating for the service has changed from Good to Outstanding. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor in

Inspection carried out on 12 October 2016

During a routine inspection

This inspection took place on 12 October 2016 and was unannounced. Nightingale Lodge is a care home providing personal care for up to 29 people, some whom live with dementia. On the day of our visit 19 people were living at the service.

The home has had the current registered manager in post for 18 years. 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 were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and action was taken to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been obtained before new staff members started work.

Medicines were securely stored. Medicines were safely administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity, best interest decisions had been made.

People enjoyed their meals and were able to choose what they ate and drank. Staff members contacted health professionals to make sure people received advice and treatment quickly.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and support was always available. Care plans contained enough information to support individual people with their needs. They did not always provide staff with enough guidance about behaviour that may challenge or upset others. Visitors said that their relatives were happy at the home and that they were able to be as independent as possible.

A complaints procedure was available and people were happy that they did not need to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with her at any time.

The provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

Inspection carried out on 8 April 2013

During a routine inspection

People received care and support that was based upon their assessed care needs. People were supported to maintain their independence but only where this was safe to do so.

People were provided with a choice of food at meal times. People could be assured that they would be provided with a balanced and nutritious diet. People's health was monitored on a regular basis to ensure that they were not losing weight.

People were prescribed medication and this was administered safely by staff who had been assessed as being competent to administer medication.

Staff felt confident to speak with the provider's managers and they would be supported whenever this was required. People told us that they felt the staff were competent and confident in providing their care.

Views from people who used the service, staff and relatives were used to improve the service wherever this was practicable. The provider used a variety of methods to identify ways to improve the service.

Inspection carried out on 18 May 2012

During a routine inspection

On the day of our visit on 18 May 2012 we were told that staff did provide support and assistance when needed. Three people told us that staff were very good but they would like to have more time to talk with staff. We saw staff providing support and assistance with due consideration for the dignity and choice of the individual. One person told us that Nightingale Lodge was one of the best homes in the area.

People were happy with the care they received but thought staff were often rushed and kept very busy. They liked the meals that were now being provided and explained that the provider had listened when they had previously thought the food was not very good.

We saw that staff did work in a relaxed way and they were laughing and talking with people on our arrival at the home. People told us that they thought staff were helpful and caring. People living in the home felt they would be taken seriously if anything was troubling or worrying them, but again said that staff often did not have time to talk with them at length.

Inspection carried out on 30, 31 May 2011

During a routine inspection

People with whom we spoke told us that they felt their needs were appropriately assessed and met.

People felt that a particular advantage for them was the option to walk out of the home and reach the sea side at the bottom of the road. One person stated that they go out �almost every day�. They explained that the only condition for going out was to inform staff before they go and to tell them the rough time they would be back.

Everyone was very complimentary regarding the staff and stated that staff were excellent.

People were satisfied and stated that they had all that they needed in their bedrooms and that they liked the communal areas. �We can sit together and talk, it is never boring here�, as one person commented.

Several people commented that they would quite like to have a shower in addition to baths provided in the home.

They all liked the food and were happy with the choice and quality of food provided. One person explained that they could choose what to eat for breakfast and lunch and added that supper was always a cooked meal.

People stated that they could see a doctor or a nurse or any other health professional if they needed to. One person explained that some people go to the surgery that is very close by, some are taken there in a wheelchair, while a GP also visits if someone cannot go to the local surgery.

People knew about their medication and were happy for staff to look after it. A person with whom we spoke stated that they knew all their medication, for Parkinson�s disease, and that they discussed medication with the GP.

Reports under our old system of regulation (including those from before CQC was created)