Nightingale Nursing and Care Home

Nightingale Nursing Home is a nursing and residential care home providing personal and nursing care to people aged 65 and over. At the time of the inspection 28 people lived at the service. The service can support up to 49 people in one adapted building over two floors.

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

People’s needs were assessed, and any risks associated with their health conditions documented. Staff knew about risks associated with people’s health conditions and understood how to provide care which kept people safe. Risks associated with the service environment were assessed and mitigated. There were enough staff to keep people safe. People received their prescribed medicines safely. The service was clean and the approach to cleanliness and infection control had improved since we last inspected. People were protected from the risk of abuse. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.

Staff got the right training to meet people’s needs. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People were supported and encouraged to have a varied diet that gave them enough to eat and drink. People were supported by staff to access healthcare services when required. The provider ensured the environment was suitable for people's needs.

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 supported this practice.

People were supported to express their views about their care and daily lives and make their own decisions as far as possible. Relatives felt they were kept informed about their family member’s care. People’s confidential personal information was stored securely, and the staff team were clear about who should have access to this. We saw staff ensured people's privacy and dignity were respected.

People said that staff knew their likes and dislikes and respected their choices. Care plans were personalised and contained information about people's likes and dislikes. People's communication needs were clearly identified in their care plans; this helped staff understand how best to communicate with each person. The service had a policy and process for managing complaints, which was displayed clearly in the home. People and relatives were supported to discuss their end of life care, and staff knew how to support people and their relatives in the way they wanted.

The service was well-led. The provider and registered manager undertook regular audits of all aspects of the service to review the quality of care. These were effective in identifying areas where improvements were needed. Regular feedback was sought from people, relatives and staff about the quality of the service. Any issues raised were acted on promptly, and everyone was told what action was taken so they could see what had been improved. The registered manager and manager and provider’s nominated individual were open with the inspection team about where improvements had been made, and where there was still further work to do.

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 August 2021) and there were breaches of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 23 August 2021. 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 action we told the provider to take at the last 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.

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

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.

Nightingale Nursing Home is a nursing and residential care home providing personal and nursing care to people aged 65 and over. At the time of the inspection 28 people lived at the service. The service can support up to 49 people in one adapted building over two floors.

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

Risks to people in relation to their personal care and health needs were not managed safely. People were at risk of developing pressure ulcers or existing wounds deteriorating. People at risk of falls did not always have information about their falls accurately recorded. Medicines were not well managed. People at risk of dehydration or malnutrition did not always have this managed safely. There were times when there was not enough staff to meet people’s needs safely. Staff did not receive all the training necessary to keep people safe and provide care effectively.

Risks associated with the building environment were not well managed. For example, areas of the building were visibly damaged and therefore unable to effectively be cleaned to reduce the risk of infection. Equipment was not clean. The provider had not ensured the environment was suitable for people's needs.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

People were not always involved in planning or reviewing of their care, particularly where they were less able to communicate their needs. The provider had not taken steps to ensure that people were given information about their care and support in ways which were accessible for them. The provider did not ensure people’s confidential personal information was stored securely.

The provider had not ensured systems and processes to assess risk and monitor quality were sufficient and effective in driving improvements. The provider’s governance systems did not support staff to identify themes of concern and take appropriate action to maintain safe care in a consistent way. Audits of the quality of care were not effective at identifying issues. The provider did not consistently assess, monitor and mitigate the risks in relations to the health, safety and welfare of people.

People and their relatives generally felt the service was safe. It was difficult for some relatives to comment on aspects of the service’s safety, due to restricted visiting during the coronavirus pandemic. Staff we spoke with demonstrated good knowledge of people’s needs, but did not consistently get the support they needed to deliver care safely and effectively. Staff understood how to recognise and report concerns or abuse. Staff received training in safeguarding and felt confident to raise concerns. Relatives said all care staff were approachable, friendly and kind. We saw people using the service felt comfortable around staff, and interactions were unhurried, positive and friendly. The provider and staff team we spoke with were positive about being able to improve the service, and deliver high quality person centred care going forward.

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 the service under the previous provider was Requires Improvement, published on 12 February 2020. This service was rated requires improvement in December 2019 and March 2018. Prior to this, in August 2017, the service was rated Inadequate. In January 2017 and March 2016, the location was rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and poor quality of care. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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.

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 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 six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

Please see the action we have told the provider to take at the end of this report. We have served the provider with warning notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A Section 29 warning notice tells a provider or registered manager that they are not complying with a condition of registration, requirement in the Act or a regulation, or any other legal requirement that we think is relevant.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures

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.