Nightingale Care and Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff and leaders did not take effective of prompt action to mitigate risks to people, leaving people at risk of harm. Staff did not always complete as and when required medication records and therefore could not evidence that people required the medication. Leaders had not ensured that people were supported in line with their individual care plans. We observed that some areas of the service were not clean. However, evidence highlighted that there were enough staff deployed and staff had received suitable training to support people safely. People were protected from the risk of abuse because staff and leaders understood their responsibilities in relation to safeguarding.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst leaders and had made some improvements following the last inspection to improve their learning culture these have yet to be embedded. Meetings had been conducted with people, relatives and staff and the provider was transparent about where further improvements were needed and how these were being addressed. The provider had policies and processes in place to monitor incidents and accidents, including how they will be open and transparent with people receiving care. A ‘you said, we did’ had been implemented at the service which took peoples feedback and communicated how this had been completed. The provider had introduced a ‘change process’ with dedicated topic leads to drive each area forward. This had not yet been fully embedded.

Leaders were working to develop a culture of learning when things went wrong. For example, following accidents and incidents they explained these were reviewed to see what could be done to mitigate risk, such as implementing specialist equipment. Leaders provided opportunities for staff to discuss and share learning through staff meetings a weekly clinical review. Staff confirmed these were regularly taking place. Staff confirmed that lessons were learned and shared through regular team meetings. On the whole, staff demonstrated a proactive attitude to learning from when things went wrong, reflecting on the previous inspection as an example.

The provider has held meetings with relatives. Relatives stated that the provider and leaders have been transparent and that they were eager to drive improvements at the service. Relatives told us that concerns raised previously have been resolved. A relative told us “There is a temporary manager there. In early December she held a meeting and shared with us the inspection and notices applied and the steps they would be applying to meet the CQC requirements. There have been some obvious changes. For example, they have put all the residents on one floor. I have to say all the staff I have met before and since the CQC report, are great. They are certainly faster to respond to things like my [family member] using the buzzer”.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us that they felt their family members were safe. Relatives felt mostly satisfied with how safeguarding was managed at the service. One relative told us "They are much better now since the involvement of the CQC last November.”

Staff received training in how to identify and respond to safeguarding concerns. Records are in place to monitor safeguarding concerns, and this identified where lessons can be learnt. Deprivation of Liberty Safeguards (DoLS) had been submitted to the Local Authority.

Safeguarding information was not observed around the home; however, this was available in the office. Leaders advised that they were aware of this, and this was going to be actioned.

Staff told us that they have received practical safeguarding, mental health and positive behavioural support training which they found useful. Staff stated that they felt this helped better their understanding of processes. Leaders understood their responsibilities in relation to safeguarding. Leaders explained they met regularly with safeguarding professionals to review ongoing safeguarding referrals. This was monitored on a spreadsheet. Leaders shared they gave relatives and people information about how to raise a safeguarding through their regular meetings and ensured information was available for staff such as local authority contact details.

Staff and leaders explained they were in the process of working with people and relatives to input into care plans and risk assessments. At the time of our inspection, written feedback had been collated from some people however this was yet to be inputted into their care plans and risk assessments. We were assured the provider was working to involve people in managing their risks.

We observed some instances where people’s risks were not always safely managed. For example, one person had experienced a fall the day before our on-site inspection, whilst plans were in place to implement measures to reduce further risks of falling and injury, these had not been immediate and therefore the person remained at risk. We observed some staff provide support to people’s risks safely. For example, when moving and handling staff explained the support they were providing. Staff supported people’s choices in relation to risk and helped them to manage this safely, for example for people who smoked. Another person with a sensory impairment was observed to be mobilising around the service with no shoes or socks on. Staff identified this and responded promptly. We observed some staff provide support to people’s risks safely. For example, when moving and handling staff explained the support they were providing. Staff supported people’s choices in relation to risk and helped them to manage this safely, for example for people who smoked.

We found evidence that leaders were working to involve people and their relatives in care planning. But the feedback from some relatives felt they had not always been involved in this process. One told us “No, don’t know about it”.

We looked at 6 people’s care records. Improvements had been made in the assessing of people’s risks and overall people’s care was provided in line with their care plans. However, we found some instances in which it was not clear if people had been supported safely. For example, one person’s fluids needed to be thickened to reduce their risk of choking, fluid records on occasions noted that these were not in line with the person’s SALT (Speech and Language Therapy) recommendations. We found one occasion where there was a significant gap in re-positioning charts for a person who had a sacral pressure sore. One person’s falls risk assessment had not been reviewed following falls. It is not clear if this is a recording error or a concern with care provision. We reviewed the wound care charts for the one person with a pressure area concern. These had improved since our last inspection and were now completed fully, with input from relevant professionals to allow for an effective review of the person’s wound.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

To ensure staff have more presence within the home, the provider had taken steps to better allocate staff. The service had tools in place to ensure adequate staffing levels. The home had proved success in reducing the call bell times and audits showed people were not waiting for long periods for assistance.

During the on-site visit, there appeared to be adequate staffing available to support individuals as required. Staff appeared busy however care did not appear to be rushed. We carried out a short observational inspection framework (SOFI) to understand people’s experiences. The SOFI showed us that staff took time to ensure their interactions with people were positive and met their emotional and diverse needs.

Since our last inspection, leaders shared they had reviewed the deployment of staff and all people had been moved upstairs to support with this as previously the layout of the home had not been considered. They told us people’s dependencies were regularly reviewed to ensure staffing levels met their needs. Staff felt overall staffing levels were improved as people had moved onto one floor. Staff had been allocated wings which provided more effective deployment. Staff confirmed they had received training, but additional training had been requested such as with the electronic care records system to help them carry out their roles more effectively.

Relatives told us that things have improved since people have been moved onto the upper floor. Some relatives however, felt that at times there does not appear to be enough staff to cover communal areas and for peoples wishes to be met. Most relatives felt that staff received appropriate training to do their jobs effectively. One relative told us "I have always believed that [staff are trained]. The carers for my [family member] have been absolutely outstanding".

The service has completed infection prevention control audits. This identified that improvement was required in this area, and this was yet to be actioned.

Some areas within the home were not observed to be clean. Several bedrooms which had a malodour. Within peoples’ bathrooms, there were soiled pads found and bins were overflowing. Protective equipment was also observed to be disposed of incorrectly.

Relatives told us that cleanliness at the home has improved and beds are changed more frequently. One relative however told us “The common room needs vacuuming. It is not dirty otherwise I would bring it up, just not thorough. Some weeks I see the same crumbs in the same place, and I know that was there from the last time”.

Leaders told us that Infection Prevention Control (IPC) has not been a priority at present due to other risk areas taking priority. We were assured that IPC will be addressed as the next priority.

Medicines were not always managed safely. People’s prescribed medicines were not always in stock. PRN protocols for as required medicines were not always in place or provide sufficient guidance to support staff administering these medicines. This placed people at risk of not receiving their medicines or receiving them unsafely.

A resident told us how they were supported by staff to administer one of their medicines. The staff had carried out a risk assessment to check the person was safe to administer this medicine and check what risks this medicine posed to other people using the service. Staff checked to see if the resident was taking their medicine correctly but were not keeping a written record of this.

Staff confirmed there had been a concerted effort to ensure improvement were made in how medicines were managed by the service. Staff confirmed regular audits were being carried out to ensure improvements were ongoing. Staff that administered medicines confirmed that they had undergone an assessment to check of their competency to administer medicines safely. Staff confirmed they were recording the administration of creams and ointment that were administered as part of people's personal care routines.