Nightingales Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. However, we found the service was in breach of legal regulation in relation to Consent.

This service scored 62 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We identified shortfalls in relation to, the assessment of people’s risks assessments, care plans and medicines management. People’s needs were assessed and recorded however, where needs had been identified, the care records did not contain sufficient or current information. Care plan reviews were completed but these did not identify the shortfalls we found. There was no evidence people or their relatives were given the opportunity to be involved in the reviews of their care. This is an area that needs to be improved.

People’s care and treatment was provided in line with current evidence-based good practice and standards. However, care plans and risk assessments did not always include details of the most current support required.

Records showed the use of nationally recognised tools for example the Waterlow score for assessing people’s risk of pressure damage and the Malnutrition Universal Screening Tool (MUST) for monitoring people’s weight. Staff received regular training and updates to help ensure they understood the current standards of care to support people effectively. People’s care and support needs were regularly reviewed. Staff understood the care and support people required and told us how they provided this. However, care plans and risk assessments did not always include details of the most current support required. This is an area that needs to be improved.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People’s relatives told us staff worked together with other teams to ensure their loved ones received the appropriate care and support. Staff told us about referrals and ongoing discussions took place regarding people’s health and social care needs.

Staff told us they worked together as a team to ensure people received the care and support they needed. They said they updated each other about changes to people’s needs in daily notes, the handover book and general communication. Staff also worked across roles when required to ensure the service ran smoothly. We saw evidence of this during our visits.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff had a good understanding of people’s health needs and when to contact the relevant health professionals. They told us people attended regular health appointments for example, optician and chiropodist. There were weekly meetings with the local GP and community nursing team. This helped ensure people’s health needs continued to be monitored on an ongoing basis. Staff told us if they were concerned about people’s health they would contact the relevant health professional. One staff member said, “We wouldn’t wait for the weekly meeting we would contact them when we needed them.” Where people had concerns about their own health staff supported them to discuss this with the GP at their weekly meeting.

One healthcare professional told us they had worked with the service for a while and they had identified improvements had been made in ensuring people’s health needs were met in a timely way. They told us, “This is very positive.” Another health care professional told us staff followed guidance given to support people.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People’s relatives told us about improvements made in their loved ones since they moved into the home. One relative told us, “[Name’s] mood is immeasurably better since moving to Nightingales. She has gone from being [unhappy] to smiling and joking. She is probably as happy as it is possible to be when you have Alzheimer’s, something I wasn’t expecting her to ever be again.” Another relative said, “Mum has improved greatly in the two years she has been living at Nightingales despite all her health issues.”

We saw examples of staff working with healthcare professionals to provide the appropriate shared care to people. External professionals told us staff worked with them to improve people’s skin integrity.

The registered manager and staff had worked with local healthcare professionals to introduce a portable vital signs monitoring system. This included the appropriate equipment for staff to record people’s vital signs, such a blood pressure and temperature and submit these readings to the most relevant healthcare professional. This helped to quickly identify when people may be becoming unwell and seek prompt medical assistance. This early identification of changes in health meant treatment was sought and received earlier and could help prevent unnecessary hospital admissions.

The provider did not always tell people about their rights around consent. People and their representatives were not involved in making best interest decisions.

A number of Mental Capacity Assessments (MCA’s) had been completed for each person. However, these did not always demonstrate what they were assessing or why. For example, there were MCA’s for breathing, this included for people who did not have any breathing concerns and did not need any support for example inhalers or oxygen. Where people had been deemed to lack capacity there was no information about how this was displayed. Where best interest decisions had been made there was no evidence of the person or their representative being involved in making the decision. Records showed the decisions were made by staff, with no information about why the particular decision had been made.

One person had been deemed to have capacity to make their own decisions. However, they had a number of MCA’s completed, each stated the person had capacity. There was no rationale for why these had been completed.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The service was not working within the principles of the MCA, however, appropriate legal authorisations were in place when needed to deprive a person of their liberty.

Staff received mental capacity training. One staff member told us, “I understand mental capacity as a person’s ability to make decisions for themselves. We always assume capacity unless proven otherwise. I support residents in making daily choices, what they eat, wear, or how they spend their time, by offering options and respecting their preferences.” Throughout our visits we observed staff offering people choices and supporting them to make their own decisions.