CQC report explained · a nursing home
What the CQC found at Nightingale House
Rated Outstanding: inspectors found the home performing exceptionally well.
- Safe?
- Good
- People felt safe, staff understood safeguarding, risks were assessed and medicines were managed safely. Inspectors noted that government visiting and self-isolation guidance was not always followed, although risk assessments and other measures were used.
- Effective?
- Good
- People had access to onsite doctors, nurses, therapists and other healthcare professionals. Staff were trained and worked together, and people received suitable support with food, drink, mobility and health needs.
- Caring?
- Outstanding
- People and relatives described the care as outstanding. Staff respected people's choices, privacy, dignity, culture and individuality, and supported people to maintain or regain independence.
- Responsive?
- Outstanding
- Care plans were detailed and regularly reviewed. People had meaningful activities, support with relationships and communication, culturally relevant care and exceptionally compassionate end of life support.
- Well-led?
- Outstanding
- Inspectors found exceptional leadership, an inclusive culture and strong quality checks. Staff felt supported and described the management team as visible, fair and focused on people's needs.
What inspectors found, January 2023
Rated Outstanding overall; inspectors found exceptionally caring, responsive and well-led care, with safe and effective care rated Good.
This was an unannounced inspection carried out on 28 and 29 September and 3 October 2022. Inspectors spoke with 25 people, 18 relatives and 22 staff. They reviewed care, medicine and recruitment records, and checked how the home was run.
People were described as safe and well supported. Staff were trained, medicines were managed safely, risks were reviewed and there were enough staff. Inspectors noted that government guidance on visiting and self-isolating was not always followed, but the home carried out risk assessments and used other safety measures.
The home provided highly personal care. People were involved in decisions, supported to stay independent and helped to follow their cultural, religious and social interests. Inspectors highlighted the intergenerational nursery, healthcare professionals based at the home, personalised activities and compassionate end of life care.
The overall rating was Outstanding. Caring, Responsive and Well-led were rated Outstanding. Safe and Effective were rated Good. All five ratings stayed the same as at the previous inspection published in August 2018.
Kind and respectful care
People and relatives consistently described staff as exceptionally kind, thoughtful and caring. Staff respected people's dignity, choices and individuality.
“People and their relatives described care as outstanding.” from the report
Personal choice and independence
People were involved in decisions about their care and daily lives. Staff supported people to develop skills and do more for themselves where possible.
“People were supported to express their individuality and their strengths.” from the report
Meaningful activities
The home offered a wide range of social, cultural and religious activities. The intergenerational programme gave people regular contact with nursery children through activities such as singing, gardening and cooking.
“People using the service and the nursery children took part in daily intergenerational activities such as singing, gardening and cooking.” from the report
Compassionate end of life care
People's wishes for their final days were recorded and followed. Families were kept informed and could receive practical and emotional support while spending time with their relative.
“People at the end of their lives received exceedingly compassionate care.” from the report
Strong leadership and oversight
Inspectors found visible leadership, a supportive culture and several layers of checks on care quality. Staff were enthusiastic and felt supported in their roles.
“The quality of care underwent robust multi-layered checks which enabled the provider to develop and sustain an outstanding service.” from the report
Visiting guidance was not always followed
minorThe provider did not always strictly follow government guidance about visiting and self-isolating after people went out. Inspectors said the home assessed the risks and used measures that were effective in protecting people.
“The provider did not always strictly adhere to government guidance on visiting and self-isolating after visits out of the service.” from the report
- 01How do you decide when visiting or self-isolation arrangements need to differ from government guidance, and how will you explain the risk controls to families?
- 02Which onsite healthcare professionals are available, and how quickly can they assess someone whose health changes?
- 03How will you support my relative's Jewish religious, cultural and dietary needs, including kosher meals and religious observance?
- 04How do you record and follow a person's wishes about end of life care, including who should be present and where they wish to remain?
- 05How will you involve my relative in choosing activities and in reviewing their care as their needs change?
This was an unannounced inspection of all five key questions, including checks on infection prevention and control; all five ratings were reviewed. This explanation was written from the published report of 17 January 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. The report was longer than we could read in one go; the later sections may not be reflected.
What inspectors found, August 2021
Previous overall rating Outstanding; this targeted inspection was not rated and found safe infection control and good support for nutrition.
The inspection took place on 29 June 2021. Inspectors looked at specific concerns about infection control, nutrition and hydration. They spoke with staff, reviewed seven care plans and other records, and received feedback from 19 relatives and two health professionals.
The inspectors found that people's nutrition and hydration needs were assessed and monitored. Staff recorded weights, food and fluids, sought specialist advice when needed, and had training to support people with complex needs.
The home had measures to reduce the spread of COVID-19. These included testing, protective equipment, visitor checks, cleaning and plans for outbreaks. Relatives and people were involved in decisions about visiting and restrictions.
This was a targeted inspection, so it did not give new ratings. Safe and well-led were marked 'Inspected but not rated'. The previous overall rating of Outstanding, published in 2018, remained unchanged.
Nutrition monitoring
People at risk of malnutrition had their weight, food and fluid intake checked. Staff involved healthcare professionals and relatives when concerns arose.
“People at risk of malnutrition were identified and had their nutritional and hydration needs assessed and reviewed regularly.” from the report
Infection control
Inspectors found suitable COVID-19 measures, including testing, protective equipment, cleaning and outbreak arrangements.
“We were assured the service was following safe infection prevention and control (IPC) procedures, including those associated with COVID-19.” from the report
Safe visiting
The home used risk assessments and an Essential Care Giver scheme to support contact with loved ones while reducing infection risks.
“These ECGs were treated as a member of staff, provided with Personal Protective Equipment (PPE) and subject to regular PCR and LFD tests” from the report
Family involvement
People and relatives were involved in care planning and decisions about restrictions during the pandemic. Regular newsletters helped maintain communication.
“People and their relatives were involved in the planning and delivery of care in the home.” from the report
Inspectors raised no specific concerns in this report.
- 01How are people's weights, food intake and fluid intake monitored now, and how quickly are changes acted on?
- 02What training do staff currently have for complex nutritional needs, including PEG feeding?
- 03What infection control and outbreak arrangements are currently in place for residents, staff and visitors?
- 04How does the home currently support Essential Care Givers and other visitors?
- 05How are residents and relatives involved in decisions about care, visits and any restrictions?
This was a targeted inspection of specific parts of Safe and Well-led, mainly nutrition, hydration and infection control; the other areas were not assessed and the previous ratings carried over. This explanation was written from the published report of 17 August 2021 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 House
3 rated inspections over 7 years: the service has improved, from Good to Outstanding.
- January 2023Outstandingcurrent ratingSafe: GoodEffective: GoodCaring: OutstandingResponsive: OutstandingWell-led: Outstanding
- August 2021Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- August 2018Outstandingup from GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: OutstandingWell-led: Outstanding
- June 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- February 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- April 2012
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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