Nightingales Nursing Home

There was a proactive culture of safety and learning from any safety incidents. People were supported to stay safe, and staff understood their responsibilities to protect people from abuse and avoidable harm.

Risk assessment tools were used for managing skin integrity, malnutrition and risks associated with swallowing difficulties. Care plans were developed to support risk management, and these were reviewed with the person and/or their family members Care plans were comprehensive and told staff how to meet people’s needs safely and in the way they preferred. Some risk assessment records we reviewed provided generic advice which was not applicable to the individual. The provider agreed to review these records and update them accordingly.

Staff followed people’s care plans and risk assessments and managed risks appropriately. For example, people were supported to change their position to reduce the risk of pressure sores. Where people had moved into the service with pressure sores, they had healed. Each person had access to an alternating airwave mattress designed to reduce the risk of pressure sores developing.

People’s food and fluid intake was monitored and where there was an identified nutritional risk, additional snacks and fortified drinks were offered. Staff monitored people’s weight and took action such as referring to the community nutrition team or GP for any weight changes. A varied and nutritional diet was provided, and people had a choice of meals or snacks. All meals were home cooked and fresh fruit and vegetables were available.

People had their medicines at the right time and in the right way. Staff had training and had their competency to manage people’s medicines assessed to ensure it was safe and met best practice guidance. Medicine administration records were accurate and up to date. People had their medication reviewed by the prescriber to ensure they remained effective. Medicines were stored safely and securely in line with manufacturers requirements. Additional air-cooling systems had been installed to manage room temperatures during the recent heatwaves. The provider had syringe drivers to support the management of pain and sickness when people where at the end of their life. Staff had additional training and had their competency assessed before having responsibility to administer medicines through the syringe driver. There was no one receiving end of life care at the time of this assessment.

The service provided nursing care and always had qualified nurses on duty. Qualified nurses were supported to keep their practice up to date and to meet the registration requirements of the nursing and midwifery council. They followed best practice advice and guidance; nurses received additional training and had their competency assessed to make sure their practice remained safe and met expected standards. Staff worked closely with external specialist teams to support specific care such as tracheostomy care and gastrostomy feeding.

We received positive feedback from external agencies. They told us how outcomes for one person had significantly improved since they moved to the service. They said managers always ensured a smooth transition when people moved in through thorough assessment and involvement in ongoing reviews. Another said, “We get some lovely feedback from families, and the home staff always provide very thorough assessments.”

The local authorities contract monitoring visit identified areas where improvements were required and asked the provider to follow up on minor actions. The provider had taken action or was in the process of taking action to address these areas.

Staff described the physical and emotional changes they were alert to and required to report for further escalation and attention from a healthcare professional. Staff used a nationally recognised tool to support recognition of deteriorating health and gave us examples of how this tool had been used to support people receiving medical attention in a timely manner. Records showed appropriate referrals to healthcare professionals were made and staff were following the advice and guidance provided. Care staff told us if they reported any deteriorating health to the nursing team, prompt action was taken. A relative told us, “I am so impressed with the communication. They suspected a urine infection last week called the GP and got antibiotics.”

People had choice and autonomy over their lives. Staff understood consent and decision-making requirements. People had their capacity to make decisions assessed and where a person lacked this capacity, a best interest decision was made and recorded.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff and management worked within the MCA. DoLS authorisations were appropriately applied for and overseen. People were not subject to unlawful or excessive restrictions they had choice, control and freedom over their lives.

There were enough staff to meet people needs. Managers monitored peoples experience daily and adjusted staffing levels as when this was required. Staff told us they had time to meet people’s needs and keep them safe. Staff received the training and supervision they required to carry out their roles and to meet people’s needs. Staff were recruited in a safe way to make sure, as far as possible, only staff with the right skills and experience were employed.

People were supported by staff who felt valued by their leaders and their colleagues. They have a sense of belonging and the ability to contribute to decision making. Staff had access to personalised support that recognised the diversity of the workforce with proactive and reactive measures. There was a low staff turnover of staff with many staff having been employed for many years.

Routine maintenance and safety checks were carried out as required. The provider had a business continuity plan for staff to follow in the event of any incident or emergency. The service was clean and fresh throughout. Separate cleaning staff were employed. Staff had access to the personal protective equipment such as gloves and aprons they required. The provider’s policy followed national guidelines for the prevention of infection.

Complaints were investigated and action was taken. For example, following a complaint about communication, a set of guidelines was developed based on the person’s preferences and this was shared with staff, so they understood what was expected of them and the impact this had on the person. The care manager had taken action to encourage more feedback from people and from staff and to make sure that making a complaint was not viewed as negative, but rather as an opportunity to improve and make sure care and support was meeting individual preferences. This demonstrated the providers person centred and open approach.

Managers and staff had a shared vision, strategy, and culture. The culture of the service was person-centred. Leaders, managers and staff had a well-developed understanding of equality, diversity and human rights, and they prioritise safe, high-quality, compassionate care. Staff were motivated to achieve good outcomes for people. They were proud of the service and valued their managers and colleagues. A staff member told us, “The team are like a family.” Another staff member said, “We are a close team and support each other.”

Staff were confident managers would always listen and take action to make improvements where required. They told us they felt supported and were encouraged to learn and develop. Staff praised the new care manager and said the changes they were making were positive.

Mangers had clear and robust governance and oversight of the service. Checks and audits were carried out along with the analyses of risk indicators such as complaints, incidents, accidents and safeguarding. This was used to develop improvement plans which included peoples and staff feedback and views.