About the service:

Nightingale House is registered to provide accommodation to 43 older people who may have dementia and/or 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:

¿People who used the service were protected from the risk of abuse because the provider had taken steps to identify the possibility of abuse and prevent abuse from happening.

¿Risks to people had been assessed and identified as part of the care planning process. Medicines were managed safely and stored securely at the service.

¿People were supported to access routine medical support from healthcare professionals such as general practitioners and dentists, to ensure their health and wellbeing was maintained. Staff supported people to eat and drink sufficient quantities.

¿There was an on-going training programme in place for staff to ensure they were kept up to date and aware of current good practice. Staff recruitment process was robust. Staffing levels were organised so that people received appropriate support to meet their needs.

¿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 supported this practice.

¿Staff were kind and compassionate and respected people’s privacy and dignity. They knew people’s preferences, abilities and skills. People were fully supported to take part in their various activities.

¿ People’s needs were assessed, and care and support were planned and delivered in line with their individual care plan. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

¿The quality of the service was monitored regularly through audit checks and receiving people’s feedback. There was system in place to handle and respond to complaints.

Rating at last inspection:

Good (report published 10 September 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on CQC website at www.cqc.org.uk.

This was an unannounced inspection carried out on 20 July 2016 and was carried out by one inspector.

Nightingale House is registered to provide accommodation for up to 42 people requiring nursing or personal care. This was due to some rooms that were registered for double occupancy. However, the provider has converted all rooms to single use only. Therefore at the time of inspection, 37 people were accommodated and the home was at full occupancy. There was lift access to the first floor making it accessible to people.

At the time of the inspection there wasn’t a registered manager at the service. An interim manager has been in charge of the home since the previous manager left. They have made an application to the Care Quality Commission to become the registered manager. 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 understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare. Medicines were managed and handled safely for people.

Arrangements were in place to keep people safe in the event of an emergency.

There were sufficient staff to meet people’s needs. Staff were attentive, respectful, patient and interacted well with people. People told us that they were happy and felt well cared for. Risk assessments were in place about how to support people in a safe manner.

Staff undertook training and received supervision to support them to carry out their roles effectively. The interim manager and the staff team followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff training records showed they had attended training in MCA and DoLS.

People were supported to maintain good health and had access to health care services when it was needed. People received a nutritionally balanced diet to maintain their health and wellbeing.

People’s needs were assessed before they moved in to the home. Care plans were person centred and were regularly reviewed. Care plans were updated when people’s needs changed.

The service had a clear management structure in place. People and staff told us they found the interim manager approachable and that they listened to them.

The provider sought feedback about the care provided and monitored the service to ensure that care and treatment was provided in a safe and effective way to meet people’s needs.

Any complaints were documented along with the actions taken. There was an effective system in place to monitor the quality of service provided.

We inspected Nightingale House on 22 March 2016 after we carried out an unannounced comprehensive inspection of this service on 24 June 2015. We found some breaches of legal requirements and after the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to supporting staff by means of regular training, supervision and appraisals and ensuring that medicines were managed properly and maintaining accurate records of medicines.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We also received concerns in relation to the safety and management of the service. This focused inspection looked into those additional concerns. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Nightingale House on our website at www.cqc.org.uk

At this inspection we found that improvements to record keeping, staff supervision and appraisals had been completed and the service now met legal requirements. We found that medicine guidelines were followed and people received their medicines on time.

The service is registered to provide care for 43 older people some of whom had dementia care needs. On the day of our visit there were 38 people using the service. The service did not have a registered manager in place at the time of our inspection because the previous registered manager had left the service and was deregistered. The current manager was still in the process of completing registration with the Care Quality Commission.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s records were kept up to date and reflected their current health needs including any advice given by other healthcare professionals. Medicines were managed safely and accurately. People were supported by staff who had attended relevant training and received regular supervision and annual appraisals. This enabled staff to keep up to date with practice and deliver evidence based care. We did not find any concerns with the new leadership of the service. People and staff told us that the manager was visible and approachable.

We carried out this inspection after receiving concerns about staffing levels and the administration of medications. We were told that night staff were expected to get people up at 5am even if they were still sleeping, to ease the burden on the day shift. We were further told that staff working at night were not able to administer medications and that if people needed medication on an 'as required' (PRN) basis they had to wait until the day shift staff arrived.

People told us they were able to get up when they wanted. One person said "I get up when I want to and come down." We found that people were able to choose when to get up in the morning. However, we found that there were not always suitably qualified and skilled people working at the service. In particular we fund that at night there were not always staff on duty that were able to administer medication.

People we spoke with told us that they were treated with dignity and respect, and that they were able to make choices over their daily lives. A relative told us the staff were "definitely polite" to her grand mother. We observed that staff interacted with people in a friendly and respectful manner. People told us the service was able to meet their needs. One person said "anything I want them to do, they do it." We saw that care plans and risk assessments were in place setting out how to meet people's needs. Records showed that people had access to health care professionals, and we noted that a community nurse and a dentist visited the service on the day of our inspection.

People told us that they liked the food, and they were provided with sufficient amounts to eat and drink. Comments included "food is very good, plenty of it" and "I am 100% happy with the food." We found that where people were at risk of malnutrition the service had involved professionals including GP's and dieticians. We found that medications were stored and administered safely.

People we spoke with told us they thought there were enough staff to meet their needs. One person told us "it's pretty quick really" when asked how long they had to wait for staff if they needed any assistance. A relative told us they felt sometimes more staff would be helpful, although we observed that staff were able to carry out their duties in a prompt manner.

People we spoke with who use the service gave positive feedback. Comments included, “It is very friendly.” “Oh yeah, definitely I am treated well.” and “I am quite happy here.”

We carried out an inspection of Nightingale House on 26 and 27 January 2015. This was an unannounced inspection . At the last inspection in July 2013 the service was found to be meeting the regulations we looked at.

Nightingale House is a residential home that provides care for up to 43 older people some of whom may be living with dementia . At the time of the inspection there were 34 people living at Nightingale House.

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.

Information relating to medicines was not always recorded correctly. Information regarding people’s allergies were not recorded consistently and people’s full names were not always recorded on medicine administration sheets. This meant that people were at risk of receiving incorrect medicines or medicines that they were allergic to.

Staff did not receive regular supervision and appraisals. This meant that staff’s work was not always assessed and documented in line with their company policy.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People told us that they felt safe at Nightingale House and that staff treated them with dignity and respect at all times.

Staff received all mandatory training for example, safeguarding, infection control, basic life support, prevention and management of falls, fire safety, person centred care, Mental Capacity Act and DoLs and dementia care.

Staff treated people with dignity and respect at all times, staff were knowledgeable of the people they supported and were able to meet their needs.

The service had an open and positive culture and continually questioned the service delivery. The registered manager was keen to maintain partnership working with other health care professionals.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 now known as 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 this report.