CQC report explained · a residential care home
What the CQC found at Nightingale House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe recruitment, safe medicines management and systems to assess risks and learn from incidents. Infection prevention arrangements were also found to be effective.
- Effective?
- Good
- People's needs were assessed before admission and staff had suitable training and supervision. People were supported with food, health care, equipment and day-to-day choices.
- Caring?
- Good
- Staff knew people well and treated them with kindness, dignity and respect. People and relatives were involved in decisions about care where possible.
- Responsive?
- Good
- Care plans were personalised, reviewed and gave staff detailed guidance. People could take part in activities, maintain relationships and raise concerns or complaints.
- Well-led?
- Good
- The home had improved its audits, records and checks. Inspectors found an open culture, regular feedback and management involvement in monitoring and improving care.
What inspectors found, November 2022
Rated Good; inspectors found kind, safe and personalised care, with clear improvements since the previous inspection.
This was a follow-up inspection after the previous rating of Requires Improvement in July 2022. Inspectors checked whether the home had acted on earlier concerns about safety and record keeping. They spoke with people, relatives, managers and staff, observed care, and checked care plans, medicines, staff files, training and audits.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines management, suitable training, kind care and personalised support. People were involved in decisions, supported with activities and helped to keep in touch with relatives.
The previous breaches had been corrected. Risk assessments, medicines records, incident reviews, care plans and confidential records had improved. Some flooring and redecoration work was still under way, and feedback from satisfaction surveys was mixed.
Safe medicines
Medicines were administered at the correct times and records were complete. Protocols explained when medicines prescribed as needed should be given.
“At this inspection, we found medicines were managed safely in line with national guidance.” from the report
Kind care
People were treated respectfully and staff understood their care needs, preferences, beliefs and cultural needs.
“Throughout our visit, we saw staff as well as the management team interacted with people who used the service in a kind and courteous way.” from the report
Personalised support
Care plans included people's likes, dislikes, health conditions and preferences. Staff were knowledgeable about how to support individuals.
“During this inspection, we found care plans had been reviewed and provided staff with detailed guidance about the individual care and support needs of the person.” from the report
Improved oversight
The home had strengthened its checks on care plans, medicines, training, health and safety, risks, incidents and records.
“Effective systems were in place to quality assure the services provided, manage risks and drive improvement.” from the report
Building work still under way
minorSome flooring and redecoration work had not finished at the time of the inspection. The provider was asked to tell inspectors when the work was complete.
“Works was on-going to replace other flooring and to redecorate other areas within the service.” from the report
Mixed survey feedback
minorThe latest satisfaction surveys included both positive comments and comments about areas for improvement. The manager had analysed the feedback and taken action where needed.
“We saw comments from the recent completed satisfaction surveys were mixed.” from the report
- 01What flooring and redecoration work is still outstanding, and when will it be completed?
- 02What issues were raised in the mixed satisfaction survey feedback, and what action has been taken?
- 03How will you make sure my relative's care plan is reviewed when their needs or preferences change?
- 04How will you support my relative to take part in activities and maintain contact with family?
- 05How are medicines given and checked if my relative needs a medicine at a particular time or as needed?
This was a follow-up inspection focused on action from the previous inspection, while infection prevention and control was also checked under Safe; the report gives ratings for all five key questions. This explanation was written from the published report of 30 November 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.
What inspectors found, July 2022
Nightingale House was rated Requires Improvement; inspectors found unsafe medicines and weak record-keeping, although staff were caring and there were enough staff.
Inspectors visited on 18 and 25 May 2022. They spoke with people, relatives and staff, observed care, and checked care plans, medicines records, recruitment files and other records. They could not speak with everyone, so they also used observations.
The home was not consistently safe. Medicines were not always given as prescribed. Risks were not always reviewed after falls, and incidents were recorded without enough evidence that lessons had been learned. Inspectors also found a water contamination risk from two shower heads and some flooring that needed cleaning or replacement.
All five areas were rated Requires Improvement: Safe, Effective, Caring, Responsive and Well-led. The previous overall rating was Good, published in September 2020. The report says the home must provide an action plan, and CQC will monitor progress.
Enough staff
People and relatives said there were enough staff, and recruitment checks were completed before staff started work.
“People were protected from the risk of receiving care from unsuitable staff.” from the report
Kind and respectful care
Inspectors saw caring interactions. Staff supported privacy, dignity, choice and independence, and people and relatives spoke positively about how they were treated.
“During our visit, we saw people were relaxed around staff and the interaction between them was of a caring nature.” from the report
Good partnership working
The management team worked with GPs, district nurses, opticians and other professionals to support people's changing needs.
“The management team worked well with other health and social care professionals to support people using the service.” from the report
Choice and communication
People were supported to make day-to-day choices, follow their interests and communicate in ways that suited them.
“Communication plans were incorporated into people's care plans and provided guidance to staff on how to communicate with people effectively” from the report
Medicines not always given safely
seriousThree people were prescribed medicines before food, but staff said these were given with or after breakfast. This meant people might not receive the intended benefit from their medicines.
“People's medicines were not always managed safely because we found shortfalls around the provider's arrangements to make sure people received their medicines as prescribed.” from the report
Risks and accidents not followed up
seriousRisk assessments were not updated after falls, and the home did not show how it reviewed incidents or learned from them to reduce repeat risks.
“Lessons were not learned from incidents and accidents to help prevent their re-occurrence.” from the report
Weak care records
needs fixingSome care plans had not been reviewed since January 2022. Paper and electronic records were inconsistent, and daily care records did not always clearly record what had happened.
“Some people's care records had not been reviewed since January 2022 and there were some inconsistencies between paper care plans and the electronic system.” from the report
Possible water contamination risk
seriousTwo shower heads could fall below the water level when used, creating a possible backflow and contamination risk.
“This could create a backflow (an unwanted flow of water in the reverse direction) and could contaminate the water supply.” from the report
Quality checks missed problems
needs fixingThe home's audits did not identify several of the problems found by inspectors, including medicine errors, outdated risk assessments and incomplete records.
“The provider's quality assurance systems and checks were not always robust.” from the report
- 01How are you now checking that each person's medicines are given at the prescribed time, especially medicines that must be taken before food?
- 02What changes have you made so risk assessments are reviewed after every fall, accident or incident?
- 03How do you check that care plans and daily records are complete, current and consistent across paper and electronic systems?
- 04Have the two shower heads and the flooring identified by inspectors now been repaired or replaced?
- 05What action has been taken in response to the two Warning Notices, and how can families see evidence that the changes are working?
This inspection covered all five key questions, with infection prevention and control also reviewed as part of Safe; inspectors could not obtain the views of some people because of their needs. This explanation was written from the published report of 30 July 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 House
6 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- November 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2022Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2020Inspected but not ratedSafe: Inspected but not rated
- March 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2016Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2016Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- June 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- July 2013
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 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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