Nightingale Nursing and Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The interim management team and provider’s senior leadership team reviewed accidents and incidents and took action to prevent the risk of re-occurrence. Learning from incidents, audits and concerns were shared in team meetings and at daily handover to ensure risks were reduced. For example, a concern was raised regarding admission documentation and how different departments gained information about new people at the service. As a result of this concern, a new process was implemented and shared with staff at a team meeting to ensure people received safe care upon admission. This reduced the risk of people receiving inconsistent care when first arriving at Nightingale.

The provider worked with people and healthcare partners to establish and maintain safe systems of care; however care plans were inconsistent, some provided detailed guidance for staff whereas others required further development. For example, care plans relating to diabetes needed clearer information for staff to follow in the event of a person becoming unwell. We also found care plans relating to self-neglect lacked sufficient detail to provide staff with a clear and consistent strategy. Guidance did not fully outline the specific interventions required to support the person safely. This meant there was a risk the person might not receive care and support appropriate to their needs. We fed this back to the provider who acted immediately to reduce any ongoing risk. We found other care plans to be detailed with clear guidance. For example, a care plan relating to pressure area care was detailed and staff followed the guidance in place. This protected the person from the risk of skin damage. Staff communicated well with other professionals to ensure there was a continuity of care. Records evidenced input from health care professionals. A staff member explained they contacted other professionals such as dieticians and wound care nurses when needed. Eight people and/or their relatives were able to share their views about seeking healthcare support, 7 of which stated they were happy with the timeliness whereas one person felt they could seek advice sooner. We reviewed records and found no delays in seeking healthcare support. This meant the service sought out advice and support to protect people from the risk of harm.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Staff completed training in safeguarding which meant they knew how to recognise and report safeguarding concerns in a timely manner. People told us they felt safe living at Nightingale. A person we spoke with said, “I feel safe, I would speak to the nurse if I was unhappy about anything.” Relatives raised some concerns about historical safety concerns, we raised this with the provider. The provider had addressed these concerns prior to our assessment, new processes, new training, induction and enhanced scrutiny of audits had been implemented as a result. The provider acknowledged the concerns shared by relatives and was working hard to improve the safety and quality of care at Nightingale. The management team were aware of the responsibility to report safeguarding concerns to the local authority and CQC, we found concerns were reported without delay. Systems and processes in place meant safeguarding incidents were reviewed and any learning opportunities shared. This reduced the risk of repeated incidents.

The provider had an inconsistent approach to the management of risk. We found inconsistencies in the way risks were assessed and managed. We found some risk assessments in place were difficult to follow which increased the risk of people receiving unsafe care and support. For example, a person who was at risk of falls had an inaccurate risk assessment in place. We found risk reduction measures such as falls prevention equipment had been implemented to keep people safe from harm. People and their relatives told us they were not always involved in reviewing their care needs. For example, a relative we spoke with said, “My [relative] has a care plan, which they were involved with, we have just updated it.” However, another relative told us, “I have not seen it since it was set up. It hasn’t been discussed with me either.” The management team told us they were aware there had been inconsistencies and had commenced work to review all risk assessments, to ensure staff had accurate guidance, to support people safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider had robust systems in place to ensure the environment was safe and well maintained. A designated member of staff ensured weekly and monthly checks were completed to minimise environmental risks. For example, the monitoring of water temperatures to ensure they did not pose a scalding risk to people was consistently completed. Additional safety checks such as annual checks of electrical equipment were completed by a trained professional. The home was safe in the event of a fire, all people had personal emergency evacuation plans in place in the event of an emergency.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together to provide safe care that met people’s individual needs. We received mixed feedback about the number of staff on duty, some people said they felt there were enough whereas others said they felt there could be more. For example, a person said, “The staffing has got better recently.” Although another person we spoke with said, “I find it hard to find staff.” Staff told us staffing levels had recently increased following a review of people’s needs. We reviewed the providers staffing schedules and dependency tool which demonstrated there were enough staff on duty to meet people’s needs. We also found the provider analysed call bell waiting times weekly to further assure themselves staffing numbers were correct. There had been a significant reduction in call bell waiting times following the review of staffing levels.

Recruitment processes were followed to ensure only suitable staff were appointed. Checks including, interviews, references and Disclosure and Barring Service (DBS) checks were conducted before staff started working at the service. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. We observed the home to be clean and well maintained on the day of our inspection. A relative we spoke with said, “I have no complaints, the home is clean.” Staff completed training in infection prevention and control and had access to personal protective equipment, such as gloves and aprons. This meant staff supported people with their personal and/or nursing care needs safely.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Staff received training in medicines and had their competency assessed. Where medicines errors occurred, action was taken to address the errors, share learning and make improvements to ensure people received their medicines safely. For example, a relative told us of a delay in their relative receiving their medicines, we found action had been taken to ensure this incident was not repeated and learning was shared with the staff team. Each person had a medicine care plan in place detailing how they liked to take their medicines. Staff recognised any adverse reactions to medicines and sought medical attention without delay.