CQC report explained · a nursing home
What the CQC found at Nightingale Group ltd. Trentham Care Centre
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unsafe medicines storage and administration, including risks with PEG medicines, covert medicines, medicine records and fridge temperatures. They found enough staff, appropriate risk assessments, safer recruitment, safeguarding arrangements and effective infection control.
- Effective?
- Good
- This key question was not inspected during this focused inspection. Its rating was carried over from the previous inspection.
- Caring?
- Requires improvement
- People's experiences varied. Some staff were kind and engaging, but inspectors saw people not always receiving personal, respectful or meaningful support, and some staff entered bedrooms without knocking.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its rating was carried over from the previous inspection.
- Well-led?
- Requires improvement
- Management had made significant progress, but quality checks did not reliably identify unsafe medicines practice, inaccurate activity records or a lack of personal contact. The provider remained in breach of good governance requirements.
What inspectors found, March 2023
Rated Requires Improvement; inspectors found unsafe medicines practices, inconsistent respect and weak quality checks, although the home had improved from Inadequate.
This was an unannounced focused inspection on 7 and 8 December 2022. Inspectors reviewed safe, caring and well-led care. They spoke with people, relatives, staff and a healthcare professional, observed care, and checked care plans, medicines records and quality checks.
The home had enough staff, followed safer recruitment checks, assessed care risks and managed infection control well. People were protected from abuse, and staff supported people to make choices and acted within the Mental Capacity Act.
However, medicines were not always stored or given safely. People did not always receive respectful or engaging support. The provider's checks did not reliably find these problems. The home remained in breach of regulations about medicines, dignity and governance.
The overall rating improved from Inadequate to Requires Improvement. The home had been in Special Measures since June 2022, but it was no longer in Special Measures after this inspection. CQC will ask for an action plan and continue to monitor progress.
Staffing
Inspectors found enough suitably qualified and experienced staff to meet people's needs promptly. Recruitment checks were also in place.
“People were supported by enough suitably qualified and experienced staff to meet their needs in a timely way.” from the report
Safeguarding
Staff had been trained to recognise abuse and knew how to report concerns. The provider had systems for sharing concerns with the appropriate agency.
“People were protected from the risk of abuse and ill treatment as staff members had received training on how to recognise and respond to concerns.” from the report
Infection control
Inspectors were assured that the home had suitable infection prevention arrangements, including staff training, personal protective equipment and outbreak planning.
“We were assured the provider was responding effectively to risks and signs of infection.” from the report
Improvement since the last inspection
The home improved from Inadequate and left Special Measures. Inspectors also found progress in staffing, recruitment, risk assessments, safeguarding and mental capacity practice.
“However, significant improvements had been made in terms of staffing, recruitment, risk assessments, safeguarding, notifications of incidents and the effective application of the mental capacity act.” from the report
Medicines
seriousMedicines were not always stored or administered safely. Inspectors found an unlocked medicine trolley, unsafe storage, poor PEG administration and gaps in staff knowledge and records.
“The provider had failed to ensure the proper and safe management of medicines. This placed people at risk of harm.” from the report
Dignity and respect
seriousPeople did not always receive respectful or engaging support. Inspectors saw staff enter bedrooms without knocking, and one-to-one activities were not always provided or recorded accurately.
“People's individual dignity was not consistently respected by all those supporting them or those directing care and support.” from the report
Quality checks
seriousThe provider's monitoring systems did not reliably find or correct unsafe medicines practice, inaccurate activity records or poor-quality interactions between staff and people.
“The provider had not embedded their governance systems, including assurance and auditing systems or processes.” from the report
No registered manager
needs fixingThere was no registered manager in post during the inspection. A manager had applied to register.
“At the time of our inspection there was not a registered manager in post.” from the report
- 01What changes have been made to medicine storage, including the unlocked trolley, medicine fridge temperatures and the medicine cupboard?
- 02How do you now check that PEG, covert and 'when required' medicines are administered safely and recorded correctly?
- 03How do you make sure staff knock before entering bedrooms and consistently protect people's privacy and dignity?
- 04How do you check that planned one-to-one activities take place and are recorded accurately?
- 05Who is currently responsible for the home while the manager's registration application is being considered?
This was a focused inspection of Safe, Caring and Well-led, including infection prevention and control under Safe; Effective and Responsive were not inspected and their previous ratings were carried over. This explanation was written from the published report of 8 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2022
Rated Inadequate and placed in special measures; inspectors found serious risks involving medicines, safety, dignity and management.
This was an unannounced focused inspection on 9 and 18 May 2022. Inspectors spoke with people, relatives, staff and a health professional. They observed care and checked care plans, medicines records, staff recruitment and training records, audits, and incident reports.
The home was rated Inadequate for Safe, Caring and Well-led. Inspectors found unsafe medicines practice, poor risk management, failures to report possible abuse, gaps in staff training and checks, and care that did not always protect people's dignity or privacy.
The overall rating fell from Requires Improvement at the previous inspection. The inspection was a follow-up to earlier concerns, but the home remained in breach of regulations and had not made enough improvement.
The home was placed in special measures. The CQC said it would keep the home under review and normally re-inspect within six months, with possible action to prevent the provider from operating if improvement was not enough.
Infection control arrangements
Inspectors were assured in several infection prevention areas, including visiting, testing, admissions and outbreak management.
“We were assured the provider was making sure infection outbreaks could be effectively prevented or managed.” from the report
Mental Capacity Act arrangements
Inspectors found that required legal authorisations were in place where people were deprived of their liberty. Conditions linked to those authorisations were being met.
“We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.” from the report
Links with health professionals
The management team had links with health and social care professionals, and advice was recorded in people's care plans. However, staff did not always know this information.
“The management team had established links with other health care professionals.” from the report
Medicines were not reliably safe
seriousRecords did not show that some medicines had been given as prescribed. Inspectors also found problems with medicines given through feeding tubes, disguised medicines, pain patches and storage temperatures.
“These discrepancies showed the provider was unable to demonstrate people had received some of their medicines as prescribed.” from the report
Risks were not managed
seriousRisk assessments and monitoring were incomplete. Inspectors found gaps in repositioning, food and fluid monitoring, and communication of important health risks to staff.
“Systems had not been established to assess, monitor and mitigate risks to the health, safety and welfare of people using the service.” from the report
Safeguarding procedures failed
seriousThe home did not consistently recognise or report incidents that could involve abuse. Inspectors also could not confirm that staff had received safeguarding training.
“Systems were not robust enough to safeguard people from abuse and improper treatment.” from the report
Staffing and training checks were incomplete
seriousThere were many agency staff, but the home could not provide all their profiles or show that staff had the right training and skills. Some agency inductions were not completed.
“The provider failed to deploy enough suitably qualified, competent and experienced staff to enable them to effectively and safely meet people's needs.” from the report
Dignity and choice were not protected
seriousInspectors saw people supported in ways that were undignified or disrespectful. People were not always offered choices about food, staff gender or other aspects of their care.
“People's individual dignity was not respected by those supporting them or those directing care and support.” from the report
Management checks did not drive improvement
seriousThe home's audits and improvement systems did not identify or correct repeated problems. Managers were not clear about risks, staff competence or their own procedures.
“The provider did not have effective governance, including assurance and auditing systems or processes in place.” from the report
- 01What immediate changes have been made to ensure every medicine is given as prescribed and recorded correctly?
- 02How are you checking that agency staff have completed induction and understand each person's risks and care needs?
- 03How are safeguarding concerns now recognised, reported to the local authority and notified to the CQC?
- 04What changes have been made to protect people's dignity, privacy and choices during personal care and meals?
- 05How often are care records, repositioning, food and fluid monitoring, and quality audits now checked by managers?
This was a focused inspection of Safe, Caring and Well-led; Effective and Responsive were not inspected and their ratings carried over from the previous inspection. This explanation was written from the published report of 23 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Nightingale Group ltd. Trentham Care Centre
9 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- March 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Nightingale Group ltd. Trentham Care Centre →
- June 2022Inadequatedown from Requires improvementSafe: InadequateCaring: InadequateWell-led: Inadequate
Read what inspectors found at Nightingale Group ltd. Trentham Care Centre →
- December 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- May 2019Goodup from Requires improvementSafe: GoodCaring: GoodWell-led: Requires improvement
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2016Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- April 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- July 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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