Nightingale Court Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

​The provider was in breach of the legal regulation relating to good governance.​

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

People, relatives and staff told us there was an open and caring culture at Nightingale Court, where people came first. For example, 1 relative told us, “I would definitely recommend this home to anyone. The manager is very approachable; all the staff are all very caring and treat people with respect.”

Leaders and staff demonstrated a commitment to providing person-centred, high-quality care. Staff spoke of the satisfaction they gained from making a positive difference to people’s life and demonstrated pride in their work.

Leaders did not always have the skills and time to lead effectively although they were compassionate and inclusive.

We identified some concerns within the service, which are detailed in the Safe domain of this report. The registered manager had already identified some of the issues found during the inspection and told us additional time and support were needed to address them. Other areas had not been identified. A deputy manager was due to start, and both the nominated individual and registered manager were confident this additional leadership capacity would support compliance and help resolve the identified concerns.

Despite this, the registered manager demonstrated a strong commitment to providing compassionate, person-centred care and was described as highly caring and dedicated. Staff consistently spoke positively about their approach, although some expressed concern about their workload and sustainability.

Staff and relatives described the registered manager and nominated individual as approachable and caring. One relative told us, “I do believe that the manager is approachable and wants to care for my relative and me. The home offers counselling for relatives, which I think is really good as it is not always easy to discuss matters away from this home.” Relatives told us they felt their family members were receiving good care.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider had policies and processes in place to support staff to speak up, including in one-to-one supervision sessions. Staff were made aware of the provider’s whistle blowing policy during their induction. Leaders were described as having an ‘open door’ approach and were available to staff throughout the day.

Staff told us they felt confident to raise any concerns if they had any. For example, 1 staff member said, “[Registered manager]and [Nominated individual] are humble andapproachable, and wedon’tfear when we need to speak up or have any problems. Their door is alwaysopen,andthey always give you a listening ear.” Staff were also confident any concerns raised would be taken seriously and acted on.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Policies and procedures were in place to uphold equality and diversity, and the provider demonstrated awareness of their duty to respect protected characteristics and prevent discrimination. Staff had completed training and were confident everyone was treated fairly and without discrimination.

Staff told us they felt strongly valued and supported by leaders and felt they had a good understanding of their individual needs including making adaptions to the rota due to religious needs or family commitments.The provider had implemented a number of initiatives to support staff’s well-being and morale. Staff were appreciative of this.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a quality assurance process with a range of audits, including: medicines management, infection control and care plans. In addition, an external consultant was supporting the home to achieve compliance. However, the systems were not always effective in ensuring safety and quality. For example, we identified concerns with recruitment, risk management, safeguarding and maintaining a safe environment. The provider had action plans in place, but these did not always include the concerns we found at this inspection. They told us they would improve this.

The provider had not consistently submitted notifications to CQC as required by law. This demonstrates gaps in governance and oversight.

Other quality assurances measures such as reviews, meetings and surveys demonstrated people, and their relatives were happy with the service people received.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service worked effectively with health colleagues to ensure people’s needs were recognised and understood. Information was shared promptly and appropriately with GPs and community services and advice provided was acted upon.

Relatives were positive about how the service included and worked with them. For example, 1 relative said, “Any sign that my relative is not well, they contact me and monitor my relative very well whilst keeping me updated, which is very reassuring.”

The provider had worked proactively to build strong, meaningful relationships within the local community. This included established partnerships with local schools, encouraging regular visits from children, and close links with local church groups to support spiritual connection and reduce isolation.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system.

The provider did not have a clear process to focus on continuous learning and improvement from incidents. For example, It was not always clear that the necessary action had been taken in response to incidents and care plans had not always been updated with sufficient detail. The provider had action plans, but these did not contain relevant information to ensure compliance.

The provider had some systems to listen to people and make improvements. These included the use of digital platforms. However, meetings with people, relatives and staff and formal feedback surveys were not always carried out frequently.These approaches undertaken regularly can provide a more accurate understanding of people’s views and highlight areas for improvement within the service.

Some improvement had been undertaken since our last inspection which included better monitoring of people’s fluid intake and medicine records. However other areas had not been sufficiently improved such as recruitment and implementing an effective quality assurance system.

Despite this, the registered manager and nominated individual demonstrated passion for providing high-quality care, and in particular, excellent dementia care. They had plans to visit different dementia services across the world. The registered manager explained this would enable them to share knowledge and learn from centres of excellence. They had also booked some staff to under a dementia interpreter course which enables staff to better understand communication styles that people with dementia may have.

The registered manager and nominated individual attended upskilling events on a regular basis. They told us this often provided them with ideas which they implemented in the home. They also told us they made improvements based on people’s feedback such as the development of a post office area in the home and an enhanced garden.

The manager shared some success stories to note how they supported people to improve their health and wellbeing that positively affected their lives.