Archived: Nightingale House

Updated 25 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We inspected Nightingale House on 15 October 2018 and the visit was unannounced. The first day of the inspection was carried out by one Inspector and a Specialist Advisor (the Specialist Advisor had experience working and caring for people with complex health needs and learning disabilities). We returned to complete our inspection on 16 October 2018 which was announced, with one inspector.

We checked the information we held about the service and the provider. This included notifications the provider had sent to us about significant events at the service and information we had received from the public. The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also received feedback from the local authority who commission services from the provider. We used all of this information to plan our inspection.

During the inspection visit we spent time observing care and support in the communal areas. We observed how staff interacted with people who used the service. We spoke with two care staff, team leader, deputy manager, registered manager and the regional operations manager.

Following the inspection visit we spoke with two people's relatives via telephone. We contacted two health and social care professionals by e-mail requesting feedback about the service. We did this to gain people's views about the care and to check that standards of care were being met.

We looked at the care records for three people. We checked that the care they received matched the information in their records. We also looked at records relating to the management of the service, including quality checks and staff files.

Updated 25 December 2018

This inspection took place on 15 October 2018 and was unannounced. We returned on 16 October 2018 announced.

The overall rating for the service awarded at the previous inspection which took place on 12 September 2017 was ‘Requires Improvement’. The provider was not meeting one of the regulations that we checked and was in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to take action to make improvements to promote people's safety and to improve systems and processes to monitor the quality of the service. The provider submitted an action plan outlining their plan for improvements.

At this inspection we found further improvements were still required. This is the second consecutive time the service has been rated ‘Requires Improvement’. Providers should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding’. Good care is the minimum that people receiving services should expect and deserve to receive.

Nightingale House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Nightingale House accommodates up to 12. The service specialises in caring for children and young adults with complex health needs and acquired brain injury, including learning disabilities or autistic spectrum disorder and sensory impairment. Nightingale House provides eight long term beds and 4 short term beds. At the time of our visit three people were living at Nightingale House. In addition to this one person was at the service for respite. People using the service at the time of the inspection were 19 years of age and above.

A registered manager was in post. 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.

We found that safeguarding concerns were not always being reported to the local authority safeguarding team. This did not ensure people were protected from the risk of abuse and avoidable harm. Staff did not always seek medical support where there had been an incident involving a person using the service.

The providers quality monitoring systems required further improvements as they had not identified issues that were found at this inspection. Personal information was not stored securely. Risk assessments were not always updated following incidents.

People were supported in a safe way to take their prescribed medicine. At the time of the inspection visit there were sufficient staff on shift. However staffing levels needed to be kept under review as the number of people using the service increased including both long term and short stays.

Relatives felt their family members were safe with the support provided by staff.

Recruitment procedures ensured prospective staff were suitable to support people who were using the service.

Staff had received training in infection control and were provided with personal protective equipment to use when carrying out care and support tasks.

People’s representatives were involved in their care to enable them to make decisions about how they wanted to receive support in their preferred way.

People were supported to receive a balanced diet that met their preferences and assessed needs. People accessed healthcare services received coordinated support to ensure their preferences needs were met.

Relatives told us that staff treated their family members in a caring way and respected their privacy and supported them to maintain their dignity. The delivery of care was tailored to meet people's individual needs and preferences.

People were supported to maintain their interests and be part of their local community.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. Relatives knew how to make a complaint and felt that following the changes in management appropriate action would be taken to address their concerns.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. Relatives knew how to make a complaint and felt that following the changes in management appropriate action would be taken to address their concerns.

We found a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.