This was an unannounced comprehensive inspection carried out on 29 and 31 May 2018.

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

The home can accommodate up to 215 older Jewish people across six self-contained units, each with separate adapted facilities. Three of the units known as Ronson, Sampson and Wohl specialised in providing nursing care to people, while the units known as Sherman, Wine and Osha were residential and provided people with personal care. At the time of our inspection 180 older people resided at the care home, the majority of whom were living with dementia.

At our last inspection of the service in February 2016 we rated them ‘Good’ overall and for four five key questions, ‘Is the service safe, effective, caring and well-led?’ and ‘Outstanding’ for the key question, ‘Is the service responsive?’

At this inspection we have increased their overall rating from ‘Good’ to ‘Outstanding’ and for the two key questions, ‘Is the service caring and well-led?’ The service remains ‘Outstanding’ for the key question, ‘Is the service responsive?’ and ‘Good’ for the two key questions, Is the service safe and effective?’ This was because we found the provider continued to drive improvement, particularly in relation to the service being caring and well-led.

The service continued to have a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We received extremely positive feedback about the standard of care provided at the home from people living there and their visiting relatives and professional health and social care representatives. We observed staff continued to be compassionate and kind throughout our two-day inspection.

People nearing the end of their life received compassionate and supportive care at Nightingale House. The service retains their Gold Standards Framework (GSF) award with ‘Beacon’ status. The Gold Standards Framework is a professional accreditation awarded to care homes in recognition of their high-quality end of life care practices. Beacon status is awarded to those services who have maintained best end of life care practices. The provider worked closely with all the relevant community health and palliative care professionals and respected the wishes of people nearing the end of their life. Staff received end of life care and bereavement training, which included a specific module on understanding death and dying from the perspective of the Jewish faith.

The service had built up strong links with the wider community. Since the last inspection, the service had embarked upon an innovative inter-generational project which had led to the opening of an on-site nursery to bring children and people living in the home together on a daily basis to participate in shared social activities. The service also had good links with other local community groups and institutions. For example, entertainers, drama groups, musicians and a mother and toddler group regularly visited the home to perform or just interact with people living at the home. The service also employed a community outreach worker who kept people updated about what was happening in the local Jewish community.

Activities provision within Nightingale House remained person-centred and innovative, which enabled people to live active and fulfilling lives. The service had its own concert room, well-equipped activity centre with pottery kiln, cooking facilities and internet-café, a library, cafe, well-kept garden

We conducted an inspection of Nightingale House on 22, 23 and 24 February 2016. The first day of the inspection was unannounced. We told the provider we would be returning for the second and third days. At our last inspection on 11 December 2013 we found that the provider was meeting all of the regulations we checked.

Nightingale House is a care home with nursing for up to 215 older Jewish people. There are five units at the home, each overseen by individual unit managers who are accountable to the Director of Care who is the registered manager of the home. Sampson and Ronson units provide care to people with advanced nursing needs. Sherman and Wine units provide residential care for people with dementia. Wohl unit provides residential care for people with advanced dementia needs.

There was a registered manager at the service. 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.

Staff had completed medicines administration training within the last year and were clear about their responsibilities. Pain assessments were carried out appropriately and these were monitored by the GP.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or where the person’s care needs had changed.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act (MCA) 2005.

Staff demonstrated an outstanding understanding of people’s life histories and current circumstances and supported people in an exceptionally caring way. Staff took time to get to know people to deliver empathic care that produced positive results for their well-being. One person had a newspaper activity group created specifically for them that other people also enjoyed as it allowed them to continue a pastime they had always taken part in. The service employed a ‘Person Centred Care Facilitator’ who helped care workers to provide a specifically tailored approach to people’s individual needs. There were numerous examples of this being delivered in practice.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs. These were clear and easy to follow.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met. The service employed a religious adviser who provided formal and informal guidance and friendship.

People were supported to maintain a balanced, nutritious diet. Staff and volunteers had participated in training called ‘Meals Matters’ which allowed them to understand the dining experiences of people with dementia and how they could improve this. People were supported effectively with their health needs and were supported to access a range of healthcare professionals. The service had access to many in-house services including occupational therapists, physiotherapists, dentists, GP’s and an in-house pharmacy.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Complaints were taken very seriously and there was evidence of considerable planning to implement learning fro

Most of the people we spoke with said they liked living in the home and felt safe there, although there was the “odd hiccup”. People were generally positive about the staff and found them kind and caring. They said that there were always staff available, and they felt able to approach them if they had any concerns.

However, some people and their relatives felt that some of the staff lacked initiative, and could do more to remind people when activities are available. In the Gerald Lipton Centre several people said they were dissatisfied with the lack of activities. One person said “the main issue is the boredom”, and another person said that if they didn’t want to participate in the planned activity there was nothing else to do.

We spoke with nineteen people using the service, four relatives or friends and eleven staff members during this unannounced visit to Nightingale House.

The majority of comments from people using the service were positive about the care and support provided to them with individuals confirming that they were treated with dignity and respect by care staff. Comments included "they are all nice people", "respectful? remarkably so, very patient" and "they all treat me nicely". One person told us "you feel as though you're safe, you're looked after" and "staff are helpful, it may take time but it gets done".

We saw some very good practice in the way some staff interacted with people using the service however this was not uniform across the home. Now that the project with the University of Bradford was drawing to a close, the commitment to on-going staff development will need to be supported in order to fully embed person centred care across the home.

The planned move of Kingsley unit (previously called Main Building) to a newly renovated floor in a different part of the home will be a positive one for people using the service, their relatives or friends and staff. The current environment of Kingsley unit compared very poorly with the high standard of Wohl Wing which was purpose built for people living with dementia.