We carried out a review of the data available to us about Nightingale on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Nightingale, you can give feedback on this service.
Nightingale is a care home that provides personal care for up to 12 younger adults with learning disabilities. At the time of the inspection, there were nine people living at the service.
People’s experience of using this service:
People who used words to communicate told us they felt safe, they were relaxed and familiar with the staff and each other. People were supported by staff who had received appropriate training to carry out their roles. The staff were confident in their support and training to provide safe care.
External and internal communication was not always effective in quickly reducing risks to people.
The registered manager and staff shared a clear vision about the quality of care and service they aimed to provide. They worked in partnership to make continuous improvements and develop best practice.
More information is in detailed findings below.
Rating at last inspection:
The last inspection was focused. The overall rating was Good (report published in November 2017).
Why we inspected:
We received allegations in relation to whether people were protected from abuse by robust safeguarding systems and structures. We reviewed this information and planned to carry out an inspection focusing on the questions, is the service safe? and is the service well led? The service remained rated Good overall.
Follow up:
We will monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.
Nightingale is a care home for adults living with conditions on the autistic spectrum and who have complex needs associated with this, including learning disabilities, communication difficulties and behaviours that challenge. Nursing care is not provided. The service is registered to accommodate up to 12 people, but managers have decided to limit this to 10 people. At the time of the inspection there were nine young adults living there.
Accommodation is provided in individual bedrooms on the ground, first and second floors in the two wings of the building. Each room has an ensuite shower room. Communal areas include two lounges, two kitchen dining rooms, a sensory room and an activities room. The upstairs floors are accessed by stairs only; there are no lifts. There is a secure garden at the back of the building with a lawn, plants, garden furniture and shelters. There is onsite parking for the service’s own vehicles and it is possible to park on the street near the house.
The service has a registered manager, as required by its conditions of registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People were treated as individuals, receiving person-centred care and support from staff who knew them and had a good understanding of them as people. There was an emphasis on meaningful activity and creative ways were found to support people to live as full a life as possible. The whole staff team, managers, support workers and ancillary staff, were trained and supported to do so. People were encouraged to access services and events in the wider community.
People told us they liked the food and were able to make choices about what they had to eat. Cultural and dietary needs were known and catered for. People’s weights were monitored on a regular basis and unplanned weight changes were referred to the GP with a view to a dietician referral.
Health Action Plans were in place and people had the support they needed to maintain their health. People’s care records showed relevant health and social care professionals were involved with their care.
People’s consent was obtained to their care, where they were able to give this. If they lacked the mental capacity to consent to particular aspects of their care, staff worked according to the principles of the Mental Capacity Act 2005. Where necessary there were Deprivation of Liberty Safeguards (DoLS) authorisations in place or these had been applied for.
People were protected against abuse. Staff treated people with dignity and respect. They had the knowledge and confidence to identify safeguarding concerns and knew how to act on these to keep people safe. When staff had raised concerns about poor practice by colleagues, the registered manager had taken the necessary action.
People were protected against avoidable harm. Risks to people’s personal safety had been assessed and plans were in place to manage these risks in the least restrictive way possible. People had positive behaviour support plans that identified what they might be communicating through behaviours that challenged, set out strategies for avoiding such behaviours in the first place and explained how people should be supported when the behaviours arose. People involved in accidents and incidents were supported to stay safe and action was taken to prevent further injury or harm. The premises were well maintained, with the appropriate certification for fire, gas and electricity in place.
There were safe medication administration systems in place and people received their medicines when required.
People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. Safe recruitment practices were followed before new staff were employed to ensure staff were suitable to work in a care setting. Staff were supported and developed to perform their roles through regular training, supervision and appraisal.
People and staff had confidence in the management of the service. The service had a positive, open, person-centred culture, with a motivated and confident staff team. People were involved in decisions about how the service was run. For example, they participated in staff recruitment. House meetings took place most months. There were regular staff meetings. The registered manager valued staff feedback and acted on their suggestions.
Quality assurance and governance systems were in place to monitor the quality of service being delivered and the running of the home. There was regular oversight from the provider’s management team, at local, regional and national level. A programme of audits fed into the provider’s ongoing improvement action plan. Action was taken where any shortfalls were identified.