We carried out a review of the data available to us about Nightingale 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, you can give feedback on this service.
Nightingale is a residential care home that provides accommodation and personal care for adults with a range of care and support needs. This includes adults who are living with dementia. The home can accommodate up to 40 people in one adapted building over two floors. At the time of this inspection there were 39 people using the service.
People’s experience of using this service and what we found
The registered manager placed people at the heart of the service and demonstrated exceptional leadership skills. The registered manager had forged excellent links with other services and organisations in the community. This led to people receiving coordinated, effective support and afforded people excellent opportunities to take part in a wide range of activities.
People had access to numerous social opportunities, both within the home and in the local community. This had a positive impact on their well-being. The provider and registered manager maximised people's opportunities to be involved in the development of the home and we found their ideas were acted upon. Staff listened to people and proactively supported them to take part in things they had not experienced before.
The provider, registered manager and staff were all driven to provide high-quality, person-centred care. We observed a positive, welcoming and inclusive culture within the home. Adaptations had been made to the home, to meet the needs of people living with dementia. The home was well-maintained, and people had been supported to personalise their rooms. This supported people to navigate to their own bedroom and feel truly at home.
People were safe, and they received effective care from the staff team. There were enough staff available to ensure people’s needs were met in a timely manner. People’s medicines were managed safely. Risks to people were mitigated and staff knew how to protect people from abuse.
People received support from staff who were kind, caring and well-trained. People were treated with dignity and respect. Staff delivered care which met people's needs and respected people’s preferences. Staff knew people very well and delivered personalised care to people. Staff encouraged people to remain as independent as possible.
Staff understood the importance of supporting people to remain involved in decisions about their care. 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 and their relatives knew how to raise any concerns or complaints about the home. They were confident staff would act on any concerns.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 21 June 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This inspection took place on 6 April 2017 and was unannounced. This meant the people who lived at Nightingale and the staff who worked there did not know we were coming. On the day of our inspection there were 39 people living at the home.
There was no registered manager at the time of this inspection. The previous registered manager had left and the provider had appointed a new manager, who had started the process of applying to be registered with CQC. 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 and associated Regulations about how the service is run.
Our last inspection at Nightingale took place in May 2016. At that time we found two breaches of the Health and Social Care Act 2008 regulations in regard to staffing, and person-centred care. At this inspection we saw that the provider had made real improvements in these areas, in that there were enough staff to meet everyone’s needs. Staff received regular supervision and appraisal. People’s needs were being considered and met and they were being offered a good choice of food and drinks.
We found that people were protected from abuse. Staff we spoke with had a good understanding of safeguarding people.
People told us they liked living at Nightingale.
Thorough staff recruitment procedures were in place, which meant that people were cared for by suitably qualified staff who had been assessed as safe to work with vulnerable people.
The service had systems in place for the safe storage and administration of medicines.
We found the service to be meeting the requirements of the Mental Capacity Act. The provider had ensured that applications were made to the Local Authority for Deprivation of Liberty Safeguards (DoLS) to be authorised when appropriate.
People were supported to maintain good health, have access to healthcare services and they received on going healthcare support.
Care records were personalised and contained relevant information to enable staff to provide person-centred care and support. People and their advocates had been involved in their care and support planning.
The care records we looked at included risk assessments, which identified any risks, associated with people’s care. Detailed plans were in place to support people to minimise these risks.
There was an activities coordinator and a varied programme of activities and entertainment was made available to people.
The provider had a complaints procedure in place. People felt they could speak with the manager if they had a concern and get a good response.
People living at Nightingale and staff working there, told us the new manager was approachable and responsive to any concerns they had.
There were effective systems in place to monitor and improve the quality of the service provided.
Staff, people who lived at the home and their relatives were regularly asked for their thoughts and opinions of the home, and were given opportunities to give suggestions to improve the home.
There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.
Our last inspection at Nightingale took place on 5 November 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.
This inspection took place on 30 March 2016 and was unannounced. This meant the people who lived at Nightingale and the staff who worked there did not know we were coming. On the day of our inspection there were 38 people living at the home.
We found that people were protected from abuse. Staff we spoke with had a clear understanding of safeguarding people and they were confident their managers would act appropriately to safeguard people from abuse.
People told us they liked living at Nightingale. One person told us, “I love it here.”
Thorough staff recruitment procedures were in place, which meant that people were cared for by suitably qualified staff who had been assessed as safe to work with vulnerable people.
Staff received training and some support to undertake the job they were employed to do. However, not all staffed received regular supervision or a yearly appraisal.
The service had systems in place for the safe storage and administration of medicines.
There were not enough staff to meet everyone’s needs in a timely manner. Staff we spoke with told us there weren’t enough staff available. We saw people having to wait for support to go to the toilet, and waiting when two carers were needed to support a person to move safely.
We found the service to be meeting the requirements of the Mental Capacity Act. The registered manager had applied to the Local Authority for Deprivation of Liberty Safeguards (DoLS) to be authorised for several people living at Nightingale.
People were supported to maintain good health, have access to healthcare services and receive on going healthcare support.
Care records were personalised and contained relevant information to enable staff to provide person-centred care and support. People and/or their advocates had been involved in their care and support planning.
The care records we looked at included risk assessments, which identified any risks, associated with people’s care. Detailed plans were in place to support people to minimise these risks.
People were offered a limited selection of food and drinks. People told us they would like more choice, and more drinks to be served with their meals.
There was an activities coordinator employed at Nightingale and a programme of activities available to people.
The complaints process was clear, up to date and readily available to people living at Nightingale and their visitors. We saw a record was kept of all complaints that were received, the response given to the complainant and any action taken to rectify the complaint.
People living at Nightingale and staff working there, told us the registered manager was approachable and responsive to any concerns they had.
There were effective systems in place to monitor and improve the quality of the service provided.
Staff, people who lived at the home and their relatives were regularly asked for their thoughts and opinions of the home, and were given opportunities to give suggestions to improve the home.
During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, in regard to staffing, and person-centred care. You can see what action we told the provider to take at the end of the full version of this report.
Food and drink met people's individual dietary needs. One person said, 'The food is alright, there's a choice of food. We get plenty of drinks throughout the day.'
People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with said that they felt safe and supported by the staff.
People were cared for, or supported by, suitably qualified, skilled and experienced staff.
The provider had an effective system to regularly assess and monitor the quality of service that people received.
During the observation we saw some examples of good communication skills by some staff that utilised eye contact and touch to engage people who used the service. We did see some practices by staff though that did not engage or communicate with people effectively.
People that we could communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People's comments included "the food is very good, we get a drink mid morning. We're well cared for," "they're (staff) very good, no complaints," "they're (staff) very nice, we have a chat," 'they're (staff) friendly and polite.
We spoke with one relative who was visiting the home and they confirmed that they were very happy with the care provided. They told us, "the (cleanliness) is very good. Anything I want to know the staff will help, or I'll go to the manager. They've been very good. I'm happy with everything so far."
We spoke with some relatives who said they were happy with the care received and staff were very approachable.
One person told us they were able to choose what time they got up and went to bed and they were given choice about the food they ate. However, one person told us the food was nice but there was not enough of it. They also told us they did not get involved with their care plan or reviews of their care and welfare needs. None of the other people using the service we spoke with referred to food shortages.
One relative told us that they had not been involved in the development of their relatives care plan, but this had been their choice. However, they had completed a questionnaire earlier in the year which contributed to meeting the care needs of their family member. Another relative told us they did not receive any communication from the home regarding their relatives care and had not been invited to any meetings.
One relative we spoke to told us the staff were very good, caring, and approachable. They had no complaints and would recommend the home. They also told us they are contacted by the home straight away if their family member requires any treatment. Two relatives confirmed they would talk to the manager if they had any concerns.