Nightingales Residential 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 service 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 service was in breach of legal regulation in relation 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. However, improvements were needed to ensure this was based on understanding challenges and the needs of people and their communities.

There was a positive culture at the home. This positive culture related to people, relatives, and staff. All staff were committed to developing the home for people, to improve their quality of life and their outcomes. However, improvements were needed to ensure the developments required reflected the wishes and needs of people, for example to ensure people received support that reflected their individual choices and needs.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation.

Feedback from people’s relatives was positive about the registered manager and staff. One relative said, “Nightingales is a godsend as far as I am concerned and I am very grateful to [registered manager] and their team for looking after my mother through this horrible disease.” Another told us, “I would like to say a special thank you to [the manager] who has delivered on all of her promises to ensure that Nightingales offers the greatest of care, as well a lovely atmosphere for mum to live in.”

Staff spoke positively about the support they received. One staff member said, “I feel comfortable approaching the manager with concerns. They maintain an open-door policy and responds professionally and appropriately.”

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

Staff understood whistle-blowing policy and told us how they would report any concerns internally. However, improvements were needed to ensure they understood how to raise concerns external to the service. They told us they could always contact and speak with the registered manager even when they were not at work. Staff told us they were confident any issues raised would be addressed.

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.

Staff received training in equality and diversity. Staff were encouraged to share concerns and ideas. This was achieved through supervisions, appraisals and team meetings. The registered manager told us, and records showed, how staff’s individual needs and culture were respected. Staff told us they felt valued and everyone worked well together. One staff member told us,” We have anti-discrimination policies and leaflets around the building walls which is quite good, I think. Making a complaint is very straightforward here and the manager is always open to listen to us.”

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes. Improvements were needed to ensure records were fully completed and care plans and daily notes fully reflected the support people needed and received.

The provider did not have effective systems in place to monitor the quality of service and the running of the home. Care plans and risk assessments did not always include relevant, up to date guidance. Care plans were reviewed but these were not always updated to include current and relevant information. Some assessments had been reviewed others had not however these did not always include the same information as care plans. Daily notes were brief and did not give a full picture of what people had done each day. Daily notes did not always identify what actions were taken when concerns were identified. For example, one entry stated person had declined their meal but there was no information about what steps staff had taken to monitor the person’s welfare or offer the person alternative meals. These shortfalls had not been identified in care plan reviews.

The provider did not have a robust governance system in place. Some care staff had been allocated audits and checks which they completed. Following an audit there was no action plan to identify work required and when this has been completed. For example, the Health and Safety checklist identified that staff did not know what to do if there was a gas leak but there was no evidence of actions taken. Whilst staff were committed to improving and developing the service it was not clear if staff were aware of the value of audits. Audits need to be seen as worthwhile and demonstrate how they are being used to improve the service.

There were no audits to identify and address the shortfalls we found in relation to most issues we found. The registered manager told us the shortfalls in relation to employment histories had been identified but this had not been fully addressed.

Following the inspection the registered manager told us about changes they were implementing to make the improvements that were required. Whilst these had started, time was needed to ensure they were fully embedded into everyday practice.

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 registered manager had developed positive working relationships with services who supported people living at the home. This included the GP and district nursing teams. Staff told us how they would contact relevant external professionals to help them meet people’s needs. Feedback from external professionals was positive about working relationships.

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

The systems in place were not effective and had not identified all concerns to drive improvements, which meant learning opportunities were missed. The registered manager told us there had been a recent ‘mock’ inspection by an external consultant. They had identified many of the concerns we found. Whilst some work had started for example, in relation to employment histories and meaningful activities there was further work that had not been commenced.

The registered manager and most staff were enthusiastic about implementing the required changes. One external professional told us about work they were undertaking with staff and said, “Staff are very interested.” The registered manager was undertaking further studies and was using their knowledge to inform and develop staff for the benefit of both people and staff. The registered manager and staff were working with the local authority Market Support Team to make improvements to the service.