Nightingale Care and Nursing Home

Nightingale Care and Nursing Home is a residential care home providing personal and nursing care to up to 59 people. The service provides support to younger adults, and older people including those with dementia. At the time of our inspection there were 34 people using the service. The service supports people over 2 floors, with communal lounges and dining areas on each floor.

People’s experience of the service and what we found:

Risks to people were not always robustly assessed, which meant staff did not have the necessary guidance to support people’s known health risks safely. Medicines were not safely managed and poor record keeping in relation to medicines meant it was not always clear whether people had received their prescribed medicines. Protocols to support staff in administering ‘as required’ medicines did not provide person centred guidance to administer these appropriately.

Oversight within the service was not effective. Checks and audits did not identify areas for improvement consistently, and action to drive improvement was not always taken. The culture within the service did not always help to promote good outcomes for people. Whilst there were opportunities for people and relatives to feedback and be involved in the service, further improvements were needed to ensure effective communication with people and their relatives.

There were not enough staff effectively deployed to meet people’s needs promptly and safely as well as to provide adequate supervision in communal areas. Staff were not suitably trained in their roles, specialist training in relation to specific healthcare needs was not completed by all staff despite supporting people with those needs. Prompt referrals to healthcare professionals were not always made where required.

People’s dignity was not always maintained. Specialist aids and equipment used for accessibility were not always available for people which impacted on their independence.

People did not receive care that was personalised. Plans for end-of-life care were not always in place, or lacked detail to ensure people’s wishes were known. People had little stimulation, and staff did not always support people to maintain relationships with those important to them.

People were protected from the risk of abuse. The service was clean, and staff followed best infection prevention and control practice. People enjoyed the food at the service and meals provided met their dietary requirements. Overall, people fed back they had developed positive relationships with some staff. There was some consideration of people’s equality and diversity needs when supporting them.

People were generally 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 supported this practice.

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 the service under the previous provider was Good, published on 28 June 2016.

Why we inspected

The inspection was prompted in part due to not having been inspected under the new provider and due to concerns received about safeguarding, accidents and incidents and medicines. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches of regulations in relation to personalised care, dignity and respect, safe care and treatment, staffing and training and governance at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.