About the service

Nightingales Residential Care Home is a residential care home that accommodates up to 22 older people with sensory loss and physical disabilities. At the time of the inspection 10 people were supported with personal care and some were living with dementia.

At the last inspection in April 2018 we found breaches of regulation and we took enforcement action. At this inspection we found the regulations had been met and a considerable amount of work had been done to ensure people received the support and care they needed and wanted. However, additional work was needed to ensure the improvements were part of staff day to day practise.

People’s experience of using this service

¿ The registered manager had taken responsibility for the day to day management of the home in August 2018. They were very aware of the improvements that were needed and had reviewed the services provided and worked with people, relatives and the staff team to develop these.

¿ A quality assurance and monitoring system had been developed and audits had been completed for some aspects of the services provided. The registered manager knew that additional audits were needed to ensure areas for improvements were identified and action had been taken to address these.

¿ Medicines were managed in line with current guidance, although additional support and training was needed to ensure the improvements were embedded into day to day practise. Staff had attended training in moving and handling and explained how they assisted people to move around the home safely. However, staff did not consistently follow current guidelines and additional training was needed.

¿ People said they felt comfortable and safe living in Nightingales and relatives were confident people had the care and support they needed.

¿ 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. Staff consistently asked for people’s consent before providing assistance and care.

¿ Staff were aware of their roles and responsibilities and were supported by management to complete relevant training and develop their professional practise. Several activities were arranged for people to participate in if they wished and people’s preferences and choices were used as the basis for the care provided.

¿ The management of the service was open and transparent and encouraged people, relatives and staff to be involved in developing the service.

Rating at last inspection

Requires improvement. (Report published 4 August 2018)

At this inspection the overall rating remains Requires Improvement although the effective and responsive domains have improved to Good.

Why we inspected

This was a planned inspection, based on the rating at the last inspection, to assess if the regulations had been met and improvements made.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This inspection site visit took place on 11 and 12 April 2018 and was unannounced.

Nightingales Residential Care Home is registered to provide accommodation for persons who require nursing or personal care, for a maximum of 22 people. At the time of the inspection 14 people were living at Nightingales Residential Care Home, some of whom were living with dementia.

Nightingales Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post at the time of the inspection. However, the registered manager was absent from the service due to maternity leave, of which we had been notified. An acting manager was covering the role, with support from one deputy manager and one acting deputy 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.

We found that the management was not clear and robust in the absence of the registered manager. We saw that staff did not always follow policies and procedures and that the systems of audit and quality assurance did not always identify and address all the areas that required improvement.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard (AIS). The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively.

We have made a recommendation that the provider seeks advice and guidance from a reputable source about Accessible Information Standard (AIS) to ensure staff are aware of their responsibilities.

Staff knowledge and understanding around Deprivation of Liberty Safeguards (DoLS) was not consistent, and staff had not received training in this area. We found that this had impact for at least one person during the inspection.

Staff had not received training to understand the needs of all the people living at the service. For example, one person had a diagnosis of epilepsy, yet staff had not received training on this and were not aware of the type of seizure the person would be likely to experience.

Medicines were not always managed safely in line with current regulations and guidance and the systems to administer medicines were not robust or always followed by staff. We found that administration records were not always correct, that medicines were not always given on time and there were not always guidance documents.

Records were not consistent with the support people were assessed as needing, or that staff told us they had provided. For example, the records for a person who needed support to turn regularly did not match the frequency the turns were assessed to have been needed. People’s care plans were not always updated when their needs changed.

We found that activities were not tailored to people’s interests or past experiences and activity support was not offered consistently to all people living at the service.

People and staff told us there were enough staff on shift. We saw that staff knew people well and had good relationships with people. People told us they enjoyed time with the staff. People knew who to talk to if they had any concerns and we found that concerns and complaints were monitored and complaints acted upon in a timely manner.

People, relatives and staff spoke well of the service. Meetings and other methods, such as resident surveys, were in place to gain feedback from staff and people. People and their relati