Nightingales Residential Home

Nightingales Residential Home is a residential care home providing personal care to up to 23 people. The service provides support to older people, people with physical disabilities and sensory impairments. At the time of our inspection there were 15 people using the service.

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

People told us they felt safe and were supported by a group of consistent staff who knew them well. People were provided with care by appropriately recruited staff who had received training in how to support them safely and effectively. Staff were aware of the risks to people and were kept up to date with changes in people's care needs. Staff had received training in how to recognise signs of abuse and were aware of their responsibilities to report any concerns they may have. People received their medication as prescribed.

People were supported to maintain a health and balanced diet and they were encouraged to make choices about food they ate. Care and support were person-centred and people's bedrooms were personalised to their tastes. People were supported to have maximum choice and control of their lives and staff provided them with care in the least restrictive way possible; the policies and systems in the service promoted this practice. People were enabled to access a variety of healthcare services to assist them in maintaining good health, and the local GP conducted regular rounds. The service provider had a training programme to support staff to improve their skills and knowledge.

People were happy with the care they received. Staff were kind and compassionate and supported people to maintain their dignity and independence. We observed lovely interactions between staff and people.

People had electronic care plans in place that were up-to-date, detailed, and person-centred. This enabled staff to understand and meet their needs and expressed people’s wishes and preferences. Staff ensured they communicated and shared information with people in a way they could easily understand. There was a complaints process which people and relatives were aware of and they had information about the procedure to follow.

People living at the care home, their relatives and staff working there were all complimentary about the way the service was managed. The management team had auditing systems to maintain ongoing oversight of the service and make improvements where necessary.

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 7 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about lack of completed risk assessments and care plans, poor governance, unwitnessed falls and people being at risk of dehydration. A decision was made for us to inspect and examine those risks.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nightingales Residential Home 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. Nightingales Residential Home accommodates 23 people in one adapted building which is set over three floors. There were 18 people living at the home at the time of our inspection.

People’s experience of using this service

People told us they felt safe and well supported. Staff had a good understanding in how they protected people from harm and recognised different types of abuse and how to report it. Potential risks to people’s health and wellbeing had been identified. People, and where appropriate, their relatives, had been involved with decisions in how to reduce the risk of harm. Risk assessments for fire safety were now in place. There were sufficient staff on duty to keep people safe and meet their needs. People’s medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People’s care needs had been assessed and reviews took place with the person and where appropriate their relative. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. 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 did support this practice.

Staff treated people as individuals and respected the choices they made. Staff treated people with respect and maintained their dignity.

People’s care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported and encouraged to maintain their hobbies and interests. The provider recognised that more social activities were required at weekends and had recruited a new activities co-ordinator to fulfil this role. People had access to information about how to raise a complaint. People’s end of life care needs were met in line with their preferences and done so by staff in a respectful and dignified way.

All people, relatives and healthcare professionals we spoke with spoke highly of the provider and manager and felt they run a service that was welcoming and friendly. The manager was visible within the home and listened to people and staff’s views about the way the service was run. The provider had put checks into place to monitor the quality of the service provision. These checks were still being established and the provider was adapting these as the manager, new deputy manager and senior staff were stepping into their new responsibilities.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 04 January 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Fire safety procedures and checks were not effective and maintenance of fire doors did not keep people safe from the risks of fire.

People did not always receive effective and safe support with their medicines.

Care and support plans for people did not reflect their current needs and did not give sufficient instructions to the care team on how best to support them. Care and support assessment and planning did not follow best practice.

People did not have effective and personal end of life care plans.

People’s individual protected characteristics were not clearly identified. The instructions to staff on how to promote people’s identity was unclear.

People’s privacy was not always respected by those working at the home.

People’s individual communication needs had not been assessed in line with best practice.

The provider did not have effective systems in place to monitor the quality of the service they provided or to drive improvements where needed.

The provider and registered manager failed to submit notifications of important events to us in a timely manner.

People’s privacy was not always respected by those working at Nightingales Residential Home.

People felt that the activities that were available were limited and that at times they felt unstimulated.

Staff members had access to training and felt supported in their role. New staff members completed a structured introduction to their role.

People were referred to additional healthcare services when it was required.

People received help and support from a kind and compassionate staff team with whom they had positive relationships with.

The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

People were protected from the risks of abuse and ill-treatment as the staff team had been trained to recognise signs of abuse or risk and knew what to do to safely support people.

The provider followed effective infection prevention and control procedures.

The provider and management team had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection: Good (Last report published 02 March 2016).

About the service: Nightingales Residential Home is a residential care home that accommodates up to 23 older people some of whom were living with dementia. At the time of our inspection there were 20 people living at the home.

Why we inspected: This was a planned inspection based on the rating at the last inspection, ‘Good.’ At this inspection we found concerns with the service and the support provided. Therefore, we have rated the service requires improvement overall.

There was a registered manager in post and she was present during our 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they were happy with the services provided. They felt staff understood their needs and they felt safe. People were assured that there were sufficient numbers of staff that had acquired the skills they needed through training and experience to meet their needs. Recruitment procedures were robust and protected people from the poor practice of unsuitable staff compromising their safety.

Medicines were securely stored and medicines were competently administered to people by staff in a timely way. Community healthcare professionals were appropriately consulted, and their advice and prescribed treatments acted upon, to help sustain people’s health and wellbeing.

People said they enjoyed their food and had plenty to eat and drink. They enjoyed a varied and balanced diet to meet their nutritional needs. Meal portions suited people’s appetites and choices of food suited people’s individual preferences and tastes. People who needed support with eating or drinking received the help they required.

People were given choices about their care and support. This enabled people to be involved in the decisions about how they would like their care and support delivered. Staff understood their caring roles and responsibilities and were motivated to do a good job. Their manner was friendly and they encouraged people to retain as much independence as their abilities allowed. There were spontaneous as well as regularly organised social events to stimulate people’s interests.

We saw people were treated with dignity and respect. People told us that staff looked after them well and were kind. It was evident to us from what we saw that staff knew what mattered to people, were polite.

People knew how and who to complain to. They were assured that they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction.

People’s quality of care was effectively monitored by the audits regularly conducted by the management team and the provider which showed they were continually looking at how they could provide better care for people.