About the service: Nightingale House is registered to provide accommodation to 43 older people who may have dementia and requiring nursing or personal care. At the time of our visit, there were 36 people using the service.
People’s experience of using this service and what we found
People’s medicines were not always managed safely because we found shortfalls around the provider’s arrangements to make sure people received their medicines as prescribed. Risks associated with people’s care and support were not always reviewed. Accidents and incidents were recorded but not monitored to identify how the risks of reoccurrence could be minimised in future.
There was a risk of the water could become contaminated as the shower heads in two shower rooms could drop below the water level when the showers were in use. People were protected by safe recruitment procedures and there were enough staff to meet their needs. They were protected from the risks associated with the spread of infection. However, some of the flooring needed cleaning or replacing.
The needs of people were not always fully assessed before they used the service. Staff received training, supervision and support to give them the necessary skills and knowledge to help them care and support people effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice. People maintained good physical and mental health because the management team worked closely with other health and social care professionals.
Care and support were delivered in such a way as to maintain people’s privacy and dignity. People received care and support in accordance with their interests and diverse needs. They were encouraged to maintain their independence as much as possible.
People’s confidential information was not always kept securely and not all information was kept up to date in people’s care records. Some people’s care records had not been reviewed since January 2022 and there were some inconsistencies between paper care plans and the electronic system. People’s communication needs were recorded.
The provider took account of complaints and comments to improve the service. Informal concerns raised by people were addressed through discussion with staff on a day to day basis. People were supported to access activities which were tailored to their individual needs.
There were quality assurance and governance systems in place to drive continuous improvement. However, the systems were not always working effectively because the provider had not identified and improved some of the issues we found during the inspection. The provider failed to keep us informed about matters that affected the service. For example, they had not reported certain incidents/accidents to the Care Quality Commission (CQC).
Staff were aware of who they were accountable to and understood their roles and responsibilities in ensuring people’s needs were met. There was an open and inclusive culture in the service, with staff, people, relatives and other external professionals encouraged to help improve the service. The registered manager had good links with a number of health and social care professionals and this helped to ensure people's needs were met.
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 Good (published 02 September 2020).
Why we inspected
We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.
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.
Enforcement
We have identified breaches in relations to safe care and treatment and good governance.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.