Nightingale Court Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

​The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were not always learnt to continually identify and embed good practice.

There was an inconsistent approach to investigating and reviewing incidents. While some incidents were thoroughly investigated, with learning identified and shared with staff, other incidents did not receive the same level of review. During our inspection, we identified examples where risks for 2 people could continue following incidents. This demonstrated lessons had not been sufficiently learnt and increased the risk of inconsistent support and harm to people.

However, referrals had been made to external health professionals to ensure people received appropriate specialist support. Relatives and staff told us they felt people were kept safe and that concerns raised within the home were listened to and acted upon.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Assessments were completed prior to people being admitted to the home. Staff told us they had access to these assessments and worked with people, their families and other professionals to develop care plans following admission. A ‘hospital passport’ was in place for each person which contained important information about people to support good continuity of care if they needed to go to hospital.

The provider did not always work well with people to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from harassment, abuse and avoidable harm. The provider did not always share concerns quickly and appropriately.

Policies and procedures were in place, and staff had received safeguarding training. Staff were able to describe how to identify and report safeguarding concerns and told us they felt confident raising concerns with management.

However, not all safeguarding incidents had been reported to the local authority safeguarding team or CQC as required. This reduced external oversight and increased the risk that concerns were not fully reviewed, learned from or addressed in a timely way. The registered manager told us of their plans to improve their processes around this. Despite these omissions, the provider worked with health professionals external to the service to support people’s safety.

People and their relatives told us people received safe care. For example, 1 person said, “I do [feel safe] yes, I always have someone to call on”. A relative said, “My relative has multiple health needs and recognised that they could no longer live independently, we came to visit this home, and I could see my relative relax and knew they felt safe here”.

We observed people appeared relaxed and comfortable with staff. The atmosphere within the home was positive and welcoming.

Where people needed to be deprived of their liberty to keep them safe, the service ensured a deprivation of liberty safeguard (DoLS) was applied for through the relevant local authority.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff's knowledge about how to monitor and mitigate risks for people was variable.

Some people had limited mobility, which increased their risk of developing contractures. A staff member told us, “We do have some people who are a bit contracted.” Contractures can restrict movement and cause pain. Although most staff were aware of this risk, there were no risk assessments in place to guide care. This meant measures to reduce or manage contractures may not be consistently planned or delivered.

Care plans were in place for people who experienced emotional distress; however, they lacked sufficient detail to guide consistent staff practice. We were also not assured all measures to reduce harm were effectively in place.

We observed 2 people to spill drinks over themselves. Although staff told us they did not make drinks too hot, we were not assured the risk of scalds from drinks had been robustly assessed.

At our last inspection, we identified risk assessments relating to moving and handling equipment did not detail person specific information such as what equipment was needed, sling size, type or positioning to ensure staff were aware of how to move people safely. At this inspection, further detail was still needed, and staff provided different responses about how to use 1 person’s moving and handling equipment. This increased the risk of injury. Prior to our inspection, a health professional had contacted us about incorrect moving and handling procedures. During our inspection we observed 2 moving and handling procedures that were not in line with safe practice and could increase the risk of injury.

We discussed our concerns with the registered manager and nominated individual who promptly took action to make some of the necessary improvements and had plans in place to improve the remaining areas.

Other risks were managed well, including for people at risk of skin breakdown, choking and malnutrition.

Relatives told us risks associated with people’s support needs were well managed. One relative said, “My relative had a fall and straight away there was a pressure mat in their room in case my relative had another fall. They are definitely very proactive.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment and facilities supported the delivery of safe care.

Environmental risks had not always been considered for those that lived there. For example, although the provider told us bed rails were not used for some people, these remained on people’s beds. These can increase the risk of limb entrapment and injury and guidance states these should be removed if they are not in use. One room contained items that could pose a risk to people, and this was accessible. Other rooms such as the medication room which should only be accessible to specified staff members had the code on the door. This meant other people could enter. When we brought these concerns to the providers attention, they took prompt action to ensure safety. The temperature of the home was very hot at times, although a staff member told us the temperature was set according to people’s needs, this was not evidenced and 2 people told us it negatively impacted them. Staff told us they did not test the temperature of people’s bath or shower water which put them of risk of scalding.Leaders and staff told us of their plans to address these issues and began making improvements at the time of the inspection.

Most checks to ensure safety in relation to areas such as fire, legionnaires and lifting equipment were in place. A new maintenance lead had recently been appointed who was in the process of ensuring these were complete and robust.

The environment was decorated to a high standard, and the nominated individual told us how they were continually refurbishing the home to ensure the environment met people’s needs. Improvements had been made to make the home more dementia friendly which included a post office area, signage and using technology to utilise colours that supported people with dementia. They had plans to continue with this such as a making the bathrooms more dementia friendly and implementing a sensory room.

Recruitment processes for staff, including agency staff and volunteers were not always safe. For example, DBS (criminal) checks had not always been undertaken before staff started working in the service and gaps in previous employment had not always been explored. The registered manager and nominated individual were aware of these shortfalls and had an action plan in place to ensure all checks were carried out to ensure staff were safe to work with vulnerable adults.

People, relatives and staff told us there were enough staff to meet their assessed needs. Our observations mostly confirmed this although there were instances where people could have benefited from support that was not readily available.

Staff received a variety of training, this included via e-learning, face to face and an immersive experience of what it may be like to live with dementia. Staff were positive about the training they had received. However, we identified gaps in some staff members’ understanding of aspects of their role, which had the potential to impact the safety and consistency of care provided to people living at Nightingale Court.

Assessments to check staff’s competency and understanding of their training had not been regularly undertaken. The registered manager had begun to undertake these and told us of their plans to improve this.

Relatives told us staff were effective and provided people with the right support. For example, 1 relative said, “The staff are definitely effective. My relative was struggling to eat before they came here but the staff have taken their time with my relative and got them eating again.” Another said, “I really believe that my relative is getting the help they need here.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

The home was clean overall, and people and relatives were complimentary about the cleanliness of the home. For example, A relative told us, “Every time I go in the home itself is always beautiful and clean, my relative’s room is kept very clean as is my relative.”

We observed good infection prevention and control (IPC) practice in areas. For example, alcohol hand gel dispensers were available throughout the premises and were touch-free, hand washing facilities and signage were in place at the entrance to the home to encourage people and visitors to wash their hands on arrival and departure and personal protective equipment (PPE) was readily accessible, and staff were observed using it appropriately.

However, we also noted some areas for improvement such as the organisation of the laundry room, the cleanliness and organisation of the kitchenette and people’s toiletries were stored in communal areas. We also identified a stained pressure cushion and there was no evidence of checks being undertaken for these. This increased the risk of infection. The provider took prompt action to address these issues and were additionally in the process of redesigning and reorganising the laundry arrangements at the time of our inspection.

Some cleaning schedules did not evidence cleaning in line with the provider’s schedule. However, the home was overall clean.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines as prescribed. PRN (as and when required) protocols were in place to guide staff on when to administer these medicines. People were supported to have regular reviews of their medicines with their GP. The provider was working in line with published guidance to ensure people were not over-medicated. The provider acted promptly when we highlighted an area relating to transdermal medication to ensure safe practice.

Staff had completed training, and their knowledge and practice were regularly checked. Medicines audits were caried out and were used effectively to identify shortfalls.

Relatives were positive about the support people received with their medicines. For example, 1 relative said, “There have been changes to my relative’s medication, with some being stopped and some being increased with the overall effect that my relative is settled and content.”