Nightingale Court

Nightingale Court is a residential care home providing personal care to up to 43 people. The service provides support to older people who may have dementia. At the time of our inspection there were 32 people using the service. Nightingale Court can accommodate 43 people in one adapted building across three floors.

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

Risks associated with people’s care were monitored and managed in a way which kept them safe. There were enough staff to keep people safe and meet their needs. There were busier times for staff, when there were instances of short notice unplanned staff absences, however, staff did not feel people were unsafe when this happened.

Communication within the staff group required more openness and transparency, so that concerns could be shared, listened to, and acted upon in a way which drives improvement to the service provision.

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 this service was requires improvement (published 22 March 2023).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about people’s safety and staffing levels. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nightingale Court is a residential care home providing personal care to up to 43 people. The service provides support to older people who may have dementia. At the time of our inspection there were 30 people using the service. Nightingale Court accommodates 43 people in one adapted building across three floors.

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

Recruitment of new staff was not consistently robust. The provider took action to address these shortfalls and put systems in place to strengthen the recruitment process.

People told us they felt safe and were supported by staff. Staff recognised different types of abuse and how to report it. The provider understood their safeguarding responsibilities and how to protect people from abuse and had mitigated risk of harm and reported incidents to the local authority. However, notifications to the CQC had not been sent at the time as there were gaps in the managers knowledge of when these should be sent. These notifications were completed retrospectively.

Potential risks to people's health and wellbeing had been identified and were managed safely. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risk associated with people’s care. There were sufficient numbers of staff on duty to keep people safe and meet their needs. People's medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.

People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. Staff had the training and support to be able to care for people in line with best practice. 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 did support this practice.

The manager was visible within the home and listened to people and staff's views about the way the service was run. The provider had put checks into place to monitor the quality of the service provision.

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 requires improvement (published 30 July 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of these regulations, however at this inspection we found the provider was in breach of Regulation 19, fit and proper person’s employed.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in July 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. This is based on the findings at this 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 Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to recruitment of new staff at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Nightingale Court is a residential care home providing personal care to up to 63 people. At the time of our inspection there were 31 people using the service.

Nightingale Court accommodates 43 people in one adapted building across three floors.

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

Aspects of the home’s environment posed a potential risk of harm to people. Environmental shortfalls had not been identified by the provider in order to mitigate potential risk of harm. Staff were not fully competent of what procedures they would follow in the event of a fire and how to safely evacuate people. The manager put immediate steps in place to ensure staff’s knowledge in this area improved.

People's medicines were mostly managed in a safe way; however, improvements were needed to ensure medication that was given in disguise in food or fluid was administered in a safe way. Medication was stored and disposed of in a safe way.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider systems were not consistently applied or robust to identify shortfalls in a timely way. We found areas that required improvement. In addition to this, the providers systems had not identified that notifiable events must be reported to the CQC had not been consistently submitted in 2021.

People told us they felt safe and supported by the staff who worked in the home. Relatives felt their family member was safe and cared for in the right way. Staff recognised different types of abuse and how to report it. The manager understood their safeguarding responsibilities and how to protect people from abuse.

Potential risks to people's individual health and wellbeing had been identified and were managed safely. People, and where appropriate, their relatives, had been involved with decisions in how to reduce risks associated with people’s care.

There were sufficient staff on duty to keep people safe and meet their needs.

Safe practice was carried out to reduce the risk of infection.

People's care needs had been assessed and reviews took place with the person and, where appropriate, their relative. Staff had the training and support to be able to care for people in line with best practice. People were supported to have a healthy balanced diet and were given food they enjoyed. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice.

People told us staff were kind and treated them well. Relatives felt the staff cared for their family member in a caring and supportive way. Staff treated people as individuals and respected the choices they made. Staff treated people with care and respect and maintained their dignity.

People's care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported to maintain their hobbies and interests. The manager told us their plans to improve activities for people who lived with dementia. People had access to information about how to raise a complaint. People's end of life care needs were met in line with their preferences in a respectful and dignified way.

The provider had supported the new manager by employing a previous registered manager of the home, to provide checks and support to the new manager. All people, relatives and staff felt the service was well run. The manager was visible within the home and listened to people's and staff's views about the way the service was run. The manager had put checks into place to monitor the quality of the service provision.

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 good (published 17 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and care and treatment of people who lived in the home. 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 and Well-Led sections of this full report.

Following our findings on inspection, the manager took prompt action to rectify shortfalls and put plans in place to improve the service.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

All staff and visitors took their own temperature on arrival and were provided with Personal Protective Equipment to wear. There was a visiting pod in place which was only accessible through the garden and could only be used through an appointment system.

Use was made of the three communal areas to assist people in maintaining a social distance from each other. Staff were kept informed of any changes in people’s needs through handover meetings which took place in large communal areas.

The activities co-ordinator lead small groups of people in activities in another part of the home and people were encouraged to sanitise their hands between each activity.

Staff wore large name badges which included a photo of themselves and their name in large print. This helped people recognise who was supporting them and provide reassurance.

The registered manager carried out window visits as part of their pre-assessment to introduce themselves and answer any queries people had.

A designated room was used by a trained member of staff to efficiently and safely test staff for COVID-19.

At the last inspection the service was rated Good. At this inspection we found the service remained Good with a rating of Outstanding in Responsive. At this inspection we found improvements in the commitment and individualised approach to responding to people’s ambitions showed by the registered manager and staff, provided clear therapeutic benefits for people living with dementia which was outstanding.

The management staff team were highly committed to ensuring people’s lifestyle choices were responded to with careful planning so people could succeed in their different ambitions. People were encouraged to maintain or develop interests which held important meaning in their lives so people were not disadvantaged because of their mental health needs.

People’s end of life care needs were met by staff who were committed in working alongside healthcare professionals. This assisted people to access therapeutic interventions to support people with their experiences. People also had opportunities to make their end of life care wishes known so there was no risk of these not being followed at this important time of their lives.

People maintained positive links with their community which enhanced their lives. People were encouraged to retain relationships important to them and develop friendships. People's religious and spiritual needs were recognised and embraced which supported people to continue to practice their religions and meet their spiritual needs in ways they wished to do so.

People who lived at the home and their relatives worked in partnership with staff to plan their care. Care records were personalised and contained detailed information about what was important to people. There was a consistent staff team who knew and respected people as individuals and provided extremely responsive care which put people at the heart of all the care offered.

People who lived at the home and their relatives were encouraged and felt confident to voice their views and opinions. The registered manager listened to what people had to say and took action to resolve any issues. There were systems in place for handling and resolving complaints which focused upon opportunities for learning lessons.

Staff cared for people with kindness, patience and understanding. Staff had time to meet people's needs and to spend time in conversations with people individually, without rushing. People were provided with care which was respectful, dignified and took into account people’s right to privacy and confidentiality.

Staff listened to people and had a detailed understanding of their needs and preferences. This supported staff to assist people in having positive dining experiences at the home and staff were aware of people's dietary requirements.

People were supported to make safe choices in relation to taking risks in their day to day lives which helped people to maintain their own levels of independence. This was because staff made sure people had the equipment and aids they required to meet their needs. Staff had been trained and understood how to support people in a way which protected them from harm and abuse. There were arrangements in place to make sure staff were trained and competent in medicine administration which reduced risks to people’s safety and welfare.

Staff received regular training which provided them with the knowledge and skills to meet people's needs in an effective, responsive and personalised way. The management team supported staff to gain additional knowledge within their various champion roles to promote a greater awareness and understanding of the diverse needs of people who they provided care and support to.

The management team and staff shared common values about the aims and objectives of the service people were provided. These were based around people being supported to live the best lives as possible. Regular quality audits and checks were completed so improvements were continually recognised and there was effective follow up action which made sure people received a high quality service.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person's needs and how to give care and support to meet those needs. People told us: 'Yes, I'm OK here' and: 'I like it here, it's nice'.

The home had a complaints policy in place and demonstrated that they listened to and responded to peoples' comments about the home.

During this inspection we reviewed the improvements had been taken to address the shortfalls. We found that a range of actions had been made and that the registered provider was meeting the standards.

The registered manager showed us the various improvements that had been introduced to ensure that people received appropriate care and support. We found that extra measures had been put in place for assessing the quality of the services that people could expect to receive.

Most people were unable to express their views verbally, so we spent time observing how staff supported them. We saw that staff were checking that people were appropriately dressed and walking safely to reduce the risk of them falling. Staff were observed giving people support and advice about how they needed to walk to protect them from having accidents.

The two care files that we looked at confirmed that they had been updated to match the care that people were receiving.

We talked with two senior care workers who described the improvements that had been made. One senior care worker said, 'They have made a big difference.'

We saw that people were treated with respect and staff maintained their privacy and dignity. A person told us, "I like it here." We looked at the care records of five people who used the service. We spoke with a relative who said, "They look after X well." The accident records told us that there was a high incidence of people who had fallen, we brought this to the attention of the registered manager and requested a review of practices within the home.

We spoke with staff that had different roles. They told us they enjoyed their work and were well supported. They said they were provided with training opportunities to meet the specific needs of the people who used the service and to keep them safe.

We found that the registered manager had arrangements in place to monitor the quality of the services that people received but they had not taken appropriate action to reduce the risks of people falling.