Nightingale Group ltd. Trentham Care Centre

Nightingale Group ltd. Trentham Care Centre is a care home providing personal and nursing care to 96 people at the time of the inspection, some of whom were living with dementia. The service can support up to 155 people. People who used the service were both younger and older adults who had mental health needs such as dementia, and physical disabilities. Nightingale Group ltd, Trentham Care Centre accommodates people across 5 different units, each of which had their own purpose-built facilities. At the time of this inspection 4 of the units were in operation.

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

People did not receive their medicines safely. Not all staff members followed best practice when administering medicines and not all medicine errors were reported in line with the providers procedures.

There were inconsistencies with the way people were treated by staff. Not everyone received empowering and valuing interactions from the staff supporting them, whilst others reported being supported by caring and kind staff.

The provider did not have effective quality monitoring processes or checks in place to ensure safe care, or to identify or meet inconsistencies in people’s experiences.

The provider had assessed the risks associated with people’s care and support. Staff members were knowledgeable about these risks. People were supported by enough staff to promptly respond to them when needed. The provider followed safe recruitment practices. The provider had effective infection prevention and control practices in place.

People were protected from the risks of ill-treatment and abuse as staff had been trained to recognise potential signs of abuse and understood what to do if they suspected harm or wrongdoing.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests; the application of the policies and systems supported good practice.

The provider, and management team, had good links with the local communities within which people lived.

The last rated inspection rating was on display at the location and on the providers website.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 23 June 2022). At that inspection there were breaches of regulation regarding safe care, safeguarding, dignity, staffing and governance processes. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Although improvements were made at this inspection, we found the provider remained in breach of regulations regarding safe care and overall governance. Improvements have been required for 3 consecutive inspections.

This service has been in Special Measures since 23 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led.

We looked at infection prevention and control measures (IPC) under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nightingale Group ltd. Trentham Care Centre on our website at www.cqc.org.uk

Enforcement

We have identified continued breaches in relation to the safe administration of medicines, dignity and overall governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nightingale Group ltd. Trentham Care Centre is a care home providing personal and nursing care to 111 people at the time of the inspection, some of whom were living with dementia. The service can support up to 155 people. People who used the service were both younger and older adults who had mental health needs such as dementia, and physical disabilities. Nightingale Group ltd, Trentham Care Centre accommodates people across five different units, each of which had their own purpose built facilities.

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

People did not consistently receive their medicines safely or as prescribed.

People were not safe as the provider failed to identify risks or put effective measures in place to mitigate potential harm.

People were not protected from the risks of abuse or neglect as the provider failed to consistently follow reporting procedures when concerns were raised with them.

Although there were enough staff to support people the provider could not effectively demonstrate staff had the right skills and training to safely meet people’s needs.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible or in their best interests; the application of policies and systems in the service did not always support best practice.

The provider did not consistently learn from incidents, accidents, or near misses as their processes were inconsistent and did not robustly identify and promote good practice.

People were not always treated with kindness or compassion, nor was their dignity respected by those supporting them.

People did not have their privacy respected or promoted by staff.

People were not always offered choice, nor their preferences known or respected by those who supported them.

The provider’s quality checks were ineffective in identifying or driving good care. Managers and staff were not clear about their roles, their understanding of quality performance, risks or regulatory requirements.

The provider had failed to make notifications to the CQC as required by law.

Although we were assured in other areas regarding the providers infection prevention and control practice, staff members incorrectly wore their face masks at multiple times throughout our inspection.

The last rated inspection rating was on display at the location and on the providers website.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 December 2021). At that inspection there were breaches of regulation regarding safe care and governance processes. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection. Additionally, we had received concerns about the care provided. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led.

We looked at infection prevention and control measures (IPC) under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nightingale Group ltd. Trentham Care Centre on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to keeping people safe, safeguarding from abuse, providing dignified care, staffing, overall governance and notifying us about significant events.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Nightingale Group Ltd, Trentham Care Centre is a care home that was providing personal and nursing care to 115 people at the time of the inspection. The service can support up to 155 people. People who used the service were both younger and older adults who had mental health needs such as dementia, and physical disabilities. Nightingale Group Ltd, Trentham Care Centre accommodates people across five different units, each of which had their own adapted facilities.

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

People’s risks were not always managed and monitored in a safe way. Medicines were not always managed safely.

Care plan documentation was not always completed to reflect people’s care needs.

The governance systems in place were not consistent across the service, and were not always effective in identifying areas for improvement and therefore lessons were not always learned when things went wrong. Staff ratios were calculated using a dependency tool, but we received mixed responses about there being enough staff to support people.

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; however, the policies and systems in the service did not support this practice.

Staff were trained to recognise and respond to concerns of abuse. There were adequate infection prevention and control measures in place.

People and relatives said they had received feedback from the service and felt engaged.

Rating at last inspection

The last rating for this service was good (published 2 May 2019).

Why we inspected

We received concerns in relation to staffing numbers across the service and general concerns about people’s nursing and mental health care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nightingale Group Ltd, Trentham Care on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) at this inspection.

We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Nightingale Group Ltd, Trentham Care Centre is a residential care home that was providing personal and nursing care to 148 people at the time of the inspection. People who used the service had physical disabilities, sensory needs and mental health needs; such as dementia.

People’s experience of using this service:

Improvements were needed to ensure there were systems in place to monitor all areas of people’s care needs and to ensure the improvements were consistently implemented across the service. Records were in the process of being updated to ensure they reflected people’s up to date needs and preferences in the way they wished their care to be provided.

People were supported by safely recruited staff who had the skills and knowledge to provide safe and effective support. People were supported by staff that understood their responsibilities to safeguard people from the risk of harm. There were systems in place to ensure lessons were learnt when things went wrong.

People were supported by caring and compassionate staff that supported people with patience. People’s choices were respected in line with their individual communication needs to promote informed decision making. People’s right to privacy was up held and their independence was promoted.

People had the opportunity to be involved in interests and hobbies and for social interaction. Complaints were listened to and improvements were made as a result of feedback. People’s end of life wishes were gained, which ensured their preferences were taken into account at this time of their lives.

There was an open culture within the service where feedback was gained from people, relatives and staff, which was used to make improvements to people’s care. The provider had recognised that improvements were needed at the service and had started to implement changes to the way the service was managed. The provider had a clear vision for the future of the service.

Rating at last inspection:

Requires Improvement (report published 26 April 2018).

Why we inspected:

This inspection was carried out to check the provider had made improvements to the service since the last inspection. We found improvements had been made and the overall rating had improved to good.

Follow up:

We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Nightingale Group ltd. Trentham Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Nightingale Group ltd. Trentham Care Centre accommodates 155 people in three adapted buildings, with five units within these buildings. At the time of our inspection there were 136 people living at the home.

There was a registered manager in post at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Peoples risk assessments were not consistently followed by staff. Guidance for administering some medicines lacked detail for staff to follow. Checks required on controlled drugs were not always carried out. People did not consistently receive personalised care and were not consistently able to access social stimulation. The governance arrangements were not consistently being followed by staff.

People were supported by staff that could recognise abuse and understood how to safeguard them. People were supported by sufficient suitably recruited staff. People received their prescribed medicines. People were protected from the risk of infection. Incidents were reviewed to ensure learning when things went wrong.

People’s individual needs were assessed and care plans were in place to meet their needs. Staff were trained and demonstrated a knowledge of how to support people and provided consistent care. People were supported to have enough to eat and drink and could make choices about their meals. People had equipment and adaptations to enable staff to support them effectively. People were supported to access health professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

People received support from caring staff that knew them well. People were able to make informed choices and had their individual communication needs met. People were supported in a way that maintained their dignity and staff were respectful and ensured they had their privacy protected.

People’s preferences were understood by staff when they provided support. People were supported to maintain their religious beliefs. People understood how to complain and the registered manager ensured all complaints were responded to. People were supported with dignity at the end of their lives.

The registered manager was accessible and people and their relatives were able to share their views about the service. There were quality audits in place which enabled the registered manager to check people had received the care and support they needed. Lessons were learned when things went wrong and people and their relatives felt involved in the service.

The service is registered to provide accommodation and personal care for up to 143 people. People who use the service have complex physical health and/or mental health needs, such as dementia, acquired brain injury and behaviours that challenge. At the time of our inspection 125 people were using the service.

The service had a registered manager. 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.

Risks of harm to some people were not being minimised as safe infection control procedures were not being followed in relation to their specific conditions and some staff did not know how to keep these people safe. Medicines were not managed safely and put people at risk of not having their prescribed medicines at the times they required them.

The principles of the MCA 2005 were not being consistently followed as some people were not consenting to or being supported to consent to their care. People did not always have their choices and individual preferences met and there were limited opportunities for people to participate in hobbies and interests of their choice.

Systems the provider had in place to monitor and improve the service had not been fully effective in ensuring improvements in people's quality of care were made.

There were sufficient suitably trained staff to meet the needs of most people who used the service in a timely manner, however some specialist training was required to meet all people's needs safely. New staff were employed following safe recruitment procedures and agency staff were checked for their suitability to work with people who used the service.

People were safeguarded from the risk of harm and abuse as staff and the management knew what to do if they suspected someone had been abused. The local safeguarding procedures were being followed.

Staff who cared for people felt supported and received regular supervision and on going training. People felt the staff were competent and effective in their roles.

People received health-care support from other professionals when their needs changed or they became unwell. People were supported to maintain a healthy diet and support was sought if people experienced difficulty in eating and drinking.

People told us and we saw that staff treated them with dignity and respect. People's right to privacy was upheld and they were encouraged to have a say in how the service was run. People and their relatives were involved in their care planning and kept informed of any changes.

The provider had a complaints procedure and people and their relatives felt their complaints were taken seriously and acted upon. Changes to the management structure had created opportunities for staff to develop and had played a part in the improvements made since our last inspection.

The service is registered to provide accommodation and personal care for up to 143 people. People who use the service have complex physical health and/or mental health needs, such as dementia, acquired brain injury and behaviours that challenge. At the time of our inspection 122 people were using the service.

The service had a registered manager. 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.

At this inspection, we identified a number of Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely and people were not always protected from the risk of abuse. This meant people’s safety, health and wellbeing was not consistently promoted.

There were not enough suitably skilled staff available to meet people’s individual care needs and preferences in a timely manner and people did not always receive the right care at the right time. Gaps in staff training meant people could not always be assured that they consistently received their care in a safe and effective manner.

Effective systems were not in place to consistently assess, monitor and improve the quality of care. This meant that improvements to the quality of care were not always made in a prompt manner and any improvements to the quality of care were not always sustained.

The legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were not consistently met. This meant people could not be assured that decisions were made in their best interests when they were unable to do this for themselves.

People were not always treated with dignity and their privacy was not always promoted.

Safe recruitment systems were in place to ensure people employed by the provider were of suitable character. However, improvements were needed to ensure temporary agency staff employed by external providers were also of good character.

People were supported to access suitable amounts of food and drink of their choice and their health and wellbeing needs were monitored. Advice from health and social care professionals was sought and followed when required.

When people were able to make choices about their care, the choices they made were respected by the staff.

People and their relatives were involved in the planning of their care and their feedback about the quality of care was sought and acted upon to make improvements.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manger informed us of notifiable safety incidents in accordance with the requirements of their registration.

We visited all five of the units at Guardian Care Centre, undertook observations of care and staff engagement and spoke with nine relatives, fifteen staff and eight service users. We looked at records of care and assessments, care monitoring information, staff meeting minutes, rosters and supervision and training records, We also requested information from the provider following the inspection to help us form a judgement of compliance.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

At the time of the inspection the service was subject to investigations under safeguarding procedures agreed in Stoke-on-Trent. This meant there had been concerns about the care and support people had received. Local health and social care professionals, and the police were involved in those enquiries, some of which had been concluded. During the investigations admissions to the service were suspended.

Some staff and relatives told us they felt that changes to staffing levels meant there were insufficient staff to provide people with the support they needed, potentially placing them at risk of harm.

We found that some people were not receiving the care and treatment they were assessed as requiring, which meant their health and welfare needs were not being met.

Is the service effective?

People provided mixed views of the care and service they received, some told us that they were happy with their care but said that they sometimes had to wait for support. People were usually provided with choices about their daily lives. People could choose where to spend their time but told us there was very little for them to do to occupy their time. We found that some people hadn't received their care as planned and some elements of care were not provided because staffing levels limited staff ability to accompany people on activities of their choice.

People were assessed when they moved to the home and plans of care were in place. People's nutritional needs were assessed and regularly evaluated. There were gaps in some of the daily records.

Is the service caring?

People provided us with a range of views about the service; they told us staff were kind and caring. Comments included: "Staff are excellent" and "They know me and what I need". They said they got on well with the staff although they were very busy. One person said: "The staff are kind but very busy". Another person said: "The staff are wonderful".

Relatives said: "I've no concerns about the care my relative receives". "The care is okay but it is not always provided as it should be". "They are paid to provide specialised care but I think it's nothing special".

We observed that when staff spent time with people they treated them in a respectful manner. We saw there was a relaxed atmosphere in the home and people appeared comfortable with the staff.

Is the service responsive?

The home did not provide enough stimulating and interesting things for people to do. We have asked the provider to tell us how they are going to improve this aspect of people's care.

People and relatives told us they had voiced concerns about staffing levels and the standards of care at the service, but felt their concerns were not being listened to. The registered manager told us that relatives meetings had been introduced to ensure that they were able to discuss any concerns and any actions to improve the service.

Is the home well led?

The provider has recently made changes to the management arrangements at the home. This meant the registered manager is now supported by a management team to ensure the service is developed and improved. Additional clinical lead posts had been created to support the manager and to increase the oversight and monitoring of the service.

Improvements to the frequency of staff supervision and staff meetings since the last inspection were evident. Some staff told us they valued the opportunity to discuss their working practice and felt they were listened to. Some staff told us they were not confident that any concerns they may have would be resolved.

During this inspection we found that improvements had been made to how the service managed the records they kept on behalf of people who used the service. We found that medication management arrangements had also improved. We found that a programme for staff supervision was being introduced but some staff still told us they hadn't received any type of formal supervision and did not feel fully supported to undertake their role.

Since the last inspection a number of concerns have been raised about the service and referrals have been made under safeguarding procedures for investigation. The concerns included allegations of abuse, neglect and poor standards of care. The local authority has initiated a Large Scale Investigation which included all other agencies involved with the service. This has involved a review of some people's needs and a suspension on placements at the service.

Throughout the inspection we observed how people and staff interacted and observed how people's care was being delivered. Staff were observed to be kind, caring and usually attentive. People we spoke with told us, "The care here is excellent" and "I don't think we could get better care anywhere".

We saw that staffing levels were sufficient to meet people's needs, but noted that staff did not always receive supervision or opportunities to meet as a team.

Medication was stored appropriately but some record management and administration issues were noted.

Staffing levels were sufficient to meet peoples care needs, and staff told us they had received an induction and had access to training, but some staff hadn't received training relevant to the care needs of the people they supported. Or received regular supervision of their practice.

Records were detailed and reflected people's needs, but some daily records and records of reviews or evaluations of people's care needs were not always maintained or up to date.

At the time of the inspection Guardian Care Centre was providing accommodation and support for up to 143 people. Some people using the service had dementia related conditions and we used our SOFI tool to help us see what people's experiences were like. The SOFI tool allowed us to spend time watching what was going on in a service and helped us to record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff.

We saw that people were included in making decisions and their consent to care and treatment was sought and recorded. Where people's capacity to consent was limited best interest decisions had been made on their behalf.

We saw the care records included all information about how people needed to be supported and how risks had been assessed.

Staff understood their responsibilities to recognise and protect people from the risk of potential abuse.

Essential training was provided and staff confirmed that they felt supported by the management of the home.

We saw that the service was monitored and audited to ensure that quality standards were maintained.