CQC report explained · a residential care home
What the CQC found at Nightingales Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Inspectors found improvements to unsafe heaters, lighting, escape routes, infection control and medicines arrangements.
- Effective?
- Good
- People generally received effective care, food, fluids and healthcare support. However, one person's apparent substantial weight loss had not been identified or recorded promptly.
- Caring?
- Good
- This question was not given a separate rating in the report. Inspectors said people liked living at the home and saw positive interactions with staff.
- Responsive?
- Good
- This question was not given a separate rating in the report. The report says people's needs, preferences and choices were assessed and recorded, but it does not provide a separate Responsive rating.
- Well-led?
- Good
- The manager was approachable and closely involved in the service. New audits and improvement plans were in place, although inspectors recommended recording provider visits and developing an audit timetable.
What inspectors found, December 2018
Nightingales Care Home was rated Good; inspectors found major safety and building improvements, with some care records still needing attention.
This was an unannounced follow-up inspection on 27 November 2018. Two inspectors spoke with people, observed care, talked with the manager and staff, toured the building and grounds, and checked care, staff and management records.
The home was rated Good overall. Safe, Effective and Well-led were each rated Good. Inspectors found that earlier problems with the premises, equipment, infection control, decoration and quality checks had been substantially improved. People were described as safe, treated kindly and supported by staff who knew them well.
The inspection also found some areas to improve. One person's apparent weight loss had not been recognised quickly, some cleaning details needed strengthening, and inspectors asked the provider to keep reviewing the building and to record its visits and improvement actions. Caring and Responsive were not given separate ratings in this report.
Safer premises
The provider made substantial changes to reduce risks from the building and equipment. Unsafe heaters, trip hazards, obstructions and unsecured areas were dealt with.
“They had made significant improvements to ensure that people were protected against the risks from the equipment and premises.” from the report
Improved infection control
Cleaning arrangements, equipment and surfaces had improved. The home had an infection control lead and stronger checks.
“The management of infection prevention and control had significantly improved.” from the report
Kind, familiar staff
People received care from friendly staff who knew them. Inspectors saw staff respond promptly when people asked for help.
“People continued to receive care from friendly, dedicated staff who knew them well.” from the report
Better leadership and checks
The manager was involved in day-to-day care and had introduced audits and a development plan to improve quality.
“Appropriate governance processes were in place to ensure quality care for people.” from the report
Ongoing room restriction
needs fixingOne person was restricted to their room for an ongoing 24-hour period. Inspectors asked the manager to consider the continuing impact of this.
“We noted one person who was restricted to their room over an ongoing 24-hour period.” from the report
Some cleaning and building work remained
minorThe home was clean overall, but dust remained in hard-to-reach places. Inspectors also recommended a continuing programme of investment in the building.
“There was some dust in hard to reach places, but the registered manager was already aware of this.” from the report
Quality checks needed organising
minorThe provider had introduced many audits, but inspectors suggested an audit timetable to make sure all checks were clearly scheduled. They also asked for records of provider visits.
“We suggested to the administrator that an audit matrix be developed to serve as an aide memoire of what checks were required and when.” from the report
- 01How do you now record and respond to changes in a person's weight, appetite or nutrition?
- 02How do you review the ongoing 24-hour room restriction mentioned in the inspection report?
- 03What checks make sure care quality remains consistent when the registered manager is not on shift?
- 04How often are cleaning audits completed, and how are hard-to-reach areas checked?
- 05What is the current programme for maintaining and investing in the building and equipment?
This was an unannounced follow-up inspection covering Safe, Effective and Well-led; Caring and Responsive were not given separate ratings in the report. This explanation was written from the published report of 21 December 2018 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, September 2018
Rated Requires Improvement; inspectors found kind, personalised care, but ongoing safety, building and management problems led to two warning notices.
The inspection was unannounced and took place on 19 June 2018. Inspectors looked at the building, care, records and how the home was managed. They spoke with people, relatives and staff, reviewed seven care records and observed care.
People were treated kindly and with respect. Their care plans were detailed and personalised. Staff supported people with medicines, eating, drinking and health appointments. Staffing levels had improved, and inspectors found people's care risks were generally well assessed.
However, parts of the building and equipment were unsafe or poorly maintained. Inspectors found trailing wires, unlocked electrical access, broken fixtures, trip hazards, stained carpets and poor cleaning. Activities were limited, and some people said they were bored. Audits did not reliably identify and follow up problems.
The overall rating was Requires Improvement. Safe, Effective and Well-led were also Requires Improvement. Caring and Responsive were rated Good. Two regulations were still breached, and the CQC issued warning notices about safe care and treatment and premises and equipment.
Personalised care
Care plans described people's preferences, routines and risks in detail. Staff knew how people liked to be supported.
“People received highly-personalised care and support, tailored to their individual needs, preferences and requirements.” from the report
Kind staff
Inspectors saw patient and respectful care. Staff sought consent, protected privacy and encouraged people to do what they could for themselves.
“Staff demonstrated positive relationships and interactions with the people they supported, and showed good understanding of their individual needs and requirements.” from the report
Hydration support
The home took part in a hydration project, offered frequent drinks and used a drinks trolley to encourage people to drink. The report recorded fewer urinary tract infections.
“We consistently saw people enjoying drinks, and drinks offered to people.” from the report
Improved staffing
Staffing arrangements had improved, including an additional night care worker and evening care worker. Inspectors found there were enough staff to meet people's individual needs safely.
“The addition of a second night care worker and evening care worker had a positive impact on staff morale and ensured people had access to timely care.” from the report
Unsafe building and equipment
seriousInspectors found trailing wires, an unlocked electricity supply area, a broken bathroom window and unguarded portable radiators. These hazards could cause harm.
“However, people and others remained at risk of avoidable harm from the premises and equipment.” from the report
Infection control
seriousCleaning was not good enough in all areas. Inspectors found contaminated catheter equipment, dirty washing bowls, dust and food debris, and damaged surfaces that could not be cleaned properly.
“People were placed at risk of infection from failure to maintain the premises and clean all areas.” from the report
Poor condition and accessibility
needs fixingSome carpets were stained or created trip hazards. Lighting was poor in some bedrooms, bathrooms were not well arranged and the home was not sufficiently adapted for people with dementia.
“There remained some residual deep stains.” from the report
Limited activities
needs fixingPeople had few meaningful activities and limited opportunities to use the garden or go into the community. Some people told inspectors they were bored.
“People told us they would like to venture into the community more often.” from the report
Weak quality checks
needs fixingAudits were carried out but were not robust enough. They did not always identify incomplete work or ensure that actions were completed and reviewed.
“Effective scrutiny of the results did not always occur.” from the report
Unpopular meals
minorPeople had choices and alternatives, but several people disliked the ready-made meals supplied to the home.
“Food is awful. It tastes terrible” from the report
- 01What has been done to remove the trailing wires, secure electrical areas, repair broken fixtures and guard the portable radiators?
- 02How have you improved cleaning and infection control, including carpets, catheter equipment, washing bowls and hoist equipment?
- 03What work has been completed to improve carpets, lighting, bathrooms and the dementia-friendly design of the building?
- 04What meaningful activities and community outings are now available, and how often can residents use the garden?
- 05How do your current audits identify problems and make sure actions are completed and checked again?
This was an unannounced comprehensive inspection covering the premises, care and management across all five CQC questions, with some improvements checked against earlier breaches. This explanation was written from the published report of 28 September 2018 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 Nightingales Care Home
5 rated inspections over 3 years: the service has held its Good rating throughout.
- December 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvement
- May 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
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.
- November 2010
Registered with the Care Quality Commission on 25 November 2010.
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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