Nightingales Residential Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to Person Centred Care.

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 did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Aspects of people’s care was not person centred. There was no evidence people or their relatives were involved in reviewing care plans. There were care plans displayed on a person’s bedroom wall. There was no evidence that the person had agreed to have these displayed in their personal space. It also meant the person’s care needs were on display for anyone who entered their room. Following the inspection the registered manager told us changes were being made and the care plans would no longer be displayed on the wall. The information in some people’s care plans did not demonstrate respect. Some information was written in a way that read negatively about the person and did not include details of how to positively support the person. The communication plan for one person who could not communicate verbally stated if the person needed to make a decision staff were to give them all the information they required to communicate but there was no information about how the person would be able to communicate. Positive Behaviour Support plans informed staff to provide reassurance. However, there were no details of what this support should be or how it should be provided.

Improvements were needed to ensure everyone had the opportunity to engage in activities that were meaningful to each person and reflected their own hobbies and interests. Whilst activities were provided each day, these were group activities. They had not been developed to reflect people’s individual interests. Not everyone was able to participate in the group activities and others chose not to. One relative told us, “There is a lack of differentiated stimulation.” Another relative told us their loved one would like activities that involved more movement or exercise. There was a lack of opportunity throughout the day.

Activities co-ordinators were working to develop a suitable activity program. They were talking with individual and small groups of people to develop a plan and they had started to provide individual and small groups of activities. However, for a lot of the day people were sitting round in the lounge, with television on but were not engaged with this and were unstimulated. Staff did come and chat with people but did not actively provide opportunities for people to engage in activity.

Individual life histories were being developed, those that had been completed were detailed. Staff told us they enjoyed learning about people’s history. One staff member said this helped them to engage with people as they understood their interests. Staff knew people well and worked to ensure people received the care and support they required and chose.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People’s relatives told us their loved ones were referred to relevant health and social care professional when required. One relative told us how the staff supported their loved one and engaged with health professionals to ensure they received the appropriate care and treatment.

The registered manager told us how they referred people for health and social care support. There were weekly GP visits to discuss people’s health needs. When needed staff could contact the GP surgery at any time if they have any concerns or questions. One staff member said, “If we needed to we would call the doctor, we wouldn’t wait until their weekly visit.”. If other health professionals were required any referral was made through the GP, for example to the district nurse or speech and language therapist. Once the referral had been accepted staff were able to liaise directly with the professional. Staff told us there was a good relationship with professionals and this was demonstrated when professionals visited the home. Healthcare professionals told us that referrals made to them were appropriate. Staff worked with healthcare professionals to ensure care and treatment prescribed was provided appropriately.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also states that people should get the support they need in relation to communication.

Although people had communication care plans these did not always include the relevant information. People’s relatives told us they were kept up to date with changes in their loved one’s health and well-being, for example, if they were unwell or had a fall. We observed staff communicating with people in a way that supported their understanding. This included using short clear sentences and maintaining eye contact.

The registered manager told us that information could be provided in large print if this was required. We also recommended that the provider identify if pictorial information, such as menus, would be beneficial to people.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. However, improvements were needed to ensure people were involved in decisions about their care.

Improvements were needed to ensure people and where appropriate, their relatives, were involved in planning and reviewing their care needs.

A recent survey had been sent out to relatives, the survey results had not yet been analysed. Feedback seen was positive. There were resident meetings and the activity staff had commenced individual or small group meetings to gain people’s feedback.

There was a complaints policy and this was followed. Complaints received had been managed appropriately. Relatives told us if they had any concerns they would discuss these with the registered manager. One relative spoke to us about the response they received, they said, “This was dealt with to my full satisfaction by the manager and staff and a full apology offered and gladly received.” The registered manager and staff told us they engaged with people and their relatives to gain their feedback throughout the day.

The provider made sure that people could access the care, support and treatment they needed when they needed it. However, improvements were needed to ensure the environment reflects the needs of people living with dementia.

Systems were in place to help ensure people received the care and support they needed relevant to their health or disability. Staff told us they worked with external professionals to ensure people received the relevant health and social care support they required. This included home visits and attending hospital appointments.

Some improvements were needed to the environment to ensure the home reflected the needs of people living with dementia. There was a lack of signage and objects of reference around the home to help people who were living with dementia to orientate themselves, for example, to bathrooms and toilets. There was no signage to help people find their way around the home, for example to their bedrooms, the lounge or dining room. Although staff were available to support people appropriate signage may help people to retain and improve their independence.

The home had been extended and refurbished since the last inspection. The home was accessible for people with mobility needs. Corridors were wide enough to accommodate people in wheelchairs and there were ramps to aid access to the building. People had access to a lift to ensure they could move safely between floors. There was level access to a secure outside patio area and people were seen going outside independently. Relatives spoke highly of the environment. One relative said, “The environment is up-beat, welcoming and cosy every time I go there. A lot of trouble has been taken with décor, and there always seems to be stuff going on, and different decorations up, which all adds to the very positive atmosphere.

Staff and leaders listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff demonstrated they were aware of the importance of ensuring people were not subject to inequality or discrimination due to their age or health needs. They supported people to receive the appropriate care and treatment by building effective relationships with health and social care professionals.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

There were systems in place to ensure staff had information about how people would like to be supported at the end of their lives. Some people had ReSPECT forms in place (Recommended Summary Plan for Emergency Care and Treatment). These included whether or not the person wished to be resuscitated in the event of a cardiac arrest.

Some people’s care plans included additional information about their end of life wishes. The registered manager told us people and their families were asked about their wishes but this was not something all families wished to discuss and this was respected.