Archived: Nightingale House

Nightingale House 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.

The care home accommodates 30 people over two floors in an older style adapted building. Twenty-one people were living in the service at the time of this inspection.

People’s experience of using this service and what we found

People living in the service were not safe and were at risk of harm. The environment continued to put people at risk, including from the risk of fire. Lessons were not learned, and improvements were not made when things went wrong. Recruitment checks were not robust and failed to keep people safe.

People continued to be restricted from freely moving around the service. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.

The registered provider failed to provide assurance the service was well-led, that people were safe, and their care and support needs could be met. The registered provider failed to act on serious concerns raised at the last inspection and take immediate action.

The last rating for this service was inadequate (published 6 July 2020) The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

The inspection was prompted following our last inspection of the service on 4 March 2020 where significant concerns were found. We did not receive assurances from the registered provider that enough actions were being taken to ensure people were safe and protected from harm. A decision was made for us to inspect and examine those ongoing risks.

We therefore carried out a focused inspection to review the Key Questions of Safe and Well Led only.

We have identified continued breaches in relation to the environment, oversight, governance, dignity and respect. Following the inspection, all those living at the service were supported by Southend Borough Council to find alternative accommodation and care.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Nightingale House is a residential care home. It can accommodate up to 30 people, however the service is currently empty with no people living there.

People’s experience of using this service and what we found

The provider did not have a robust development plan for any future return of safe, good quality care. At the time of this inspection the environment remained unsuitable to ensure the safety and wellbeing of elderly people. This includes those living with dementia.

Some areas had been newly carpeted and decorated. However other areas, including furniture, were worn, unpainted or patched up so did not promote a comfortable environment. The provider could not demonstrate how people’s privacy would be respected in double rooms. We found pictures of people who no longer lived there still up in communal areas for anybody to see.

No action had been taken to update policies and procedures since the previous inspection. Concerns had been raised about medicines, consent, privacy, dignity, respect, quality governance and safety. Certificates for gas and legionella testing were not able to be provided. Although some work had been completed around fire safety, no new fire risk assessment had been completed

The service did not meet national and government guidance for infection prevention and control. The premises were not clean and hygienic. The provider confirmed policies and procedures on infection control had not been updated since the previous inspection. This included COVID-19 policies.

The provider submitted an updated action plan on 6 May 2021 but this lacked detail and was not robust. An updated action plan was shared on 11 May 2021 providing some further details including timescales for action to be taken based on the feedback from this inspection.

The provider had engaged the services of a consultant the week of the inspection visit and intended to have their support to drive improvements. This included supporting a new manager. The provider told us they would be working to update everything about the day to day running of the service.

Rating at last inspection and update.

The last rating for this service was Inadequate (published 6 July 2020) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 & 17 March 2020. Breaches of legal requirements were found. The provider sent to us completed action plans in March and November 2020, to show what they would do and by when to improve Regulation 12 (Safe Care and Treatment), Regulation 10 (Dignity and Respect), Regulation 11 (Need for Consent), Regulation 15 (Premises and Environment) and Regulation 17 (Good Governance). We took enforcement action to urgently restrict new admissions to the service and to make improvements to the environment.

This inspection was carried out to review the progress made by the provider since people using the service were supported to move out, by the local authority, to alternative services.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nightingale House on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to Regulation 12, 10, 11, 15 and 17 at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Nightingale House 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.

The care home accommodates 30 people over two floors in an older style adapted building. 22 people were living in the service at the time of this inspection.

People’s experience of using this service and what we found

People living in the service was not safe and at risk of harm. People’s medicines were not well managed, and people did not receive their medicines as prescribed. The environment was not safe, and people were at risk of harm, including from the risk of fire. Lessons were not learned, and improvements were not made when things went wrong. Recruitment checks were not robust and failed to keep people safe.

Peoples care, and support was not delivered in line with current standards and guidance. People were restricted from freely moving around the service. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider failed to follow and act on restrictions placed on people by the authorising authorities. People were not supported by staff to eat and drink and staff failed to give people choice.

People were not treated with care, compassion, kindness or dignity. We observed staff not supporting people in a way that was caring. Many interactions by staff remained task and routine led. Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care and treatment based on people's needs and preferences. People were not supported or enabled to take part in regular social activities that met their needs. Complaints were not well managed and were not dealt with to ensure learning.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. The provider failed to act where concerns were highlighted by management and others and failed to have appropriate oversight.

Quality assurance and governance arrangements were not in place and did not provide effective oversight.

The last rating for this service was good (published 24 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about care of people, the environments and infection control. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make urgent improvements. Please see the safe sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to medicine management, environment, oversight, governance, dignity and respect and the safeguarding of people.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider and meet with the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The care home accommodates 30 people over two floors in an older style adapted building. There is a passenger lift to provide access to people who have mobility issues and the garden is also accessible. 27 people were living in the service at the time of this inspection.

This inspection was unannounced and completed by one inspector on 7 and 8 March 2018.

At our last inspection in November 2016 we rated the service Requires Improvement. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Responsive and Well led to at least Good. At this inspection, we found that they had made the required improvements and the service was rated as Good.

Improvements had been made to people's care plans. There was a new care planning system in place and each person had a care plan. People's individual care needs were recorded and reviewed monthly to ensure they were safe and well. People had better opportunities for social activities and interaction. The registered manager’s understanding of the standards and requirements they were inspected against had improved. An experienced deputy manager had been recruited who provided extra support to the registered manager. Records were more organised and the registered manager had sent us notifications as required to tell us about important events in the service.

Improvements had been made to premises and facilities. New furniture and carpets had been provided in some areas enhancing the safety and quality of the environment for people living there. New equipment was available in the laundry and the changes to the working surfaces in this room supported better infection management.

A registered manager was in post. 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.

People were supported in a safe way and staff knew how to recognise and report any risks to people's safety. Medicines were administered in accordance with the prescriber's instructions. Staff recruitment procedures protected people and there were enough staff to meet people’s needs safely. Arrangements were in place for learning and making improvements when things go wrong.

Staff were provided with suitable training and support to enable them to meet people's needs effectively. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and associated guidance. People were satisfied with the food and drinks available which reflected their lifestyle preferences and nutritional needs. Access to healthcare professionals was well supported. The service worked with other organisations to ensure people received coordinated care and support.

Staff knew what people valued and how they liked to be supported in line with their assessed needs. People’s dignity and privacy was respected and they were supported by friendly and caring staff. Visitors felt welcomed in the service. People told us that they received the care they needed.

People had opportunity to say how they felt about the service and the care it provided. Their views were listened to and actions were taken in response. The provider and registered manager had improving systems in place to check on the quality and safety of the service provided and to put actions plans in place where needed.

Nightingale House is registered to provide accommodation with personal care for 30 older people. People living in the service may have care needs associated with dementia. There were 27 people living at the service on the day of our inspection.

Improvements were noted to the systems to manage the safety and quality of the service since our last inspection. A manager had been appointed and had recently been registered with the commission as required. 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.

Further improvements were needed to the manager’s knowledge of the requirements of their role and to the content and organisation of required records; including care records. Enhancement of the environment and people’s social opportunities were areas for development.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Recruitment procedures were suitable. Risk management plans were in place to support people and to limit risks to their safety. Medicines were safely stored and administered in line with current guidance to ensure people received their prescribed medicines.

People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. Staff were trained and supported in their role. The manager understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).

People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences. Arrangements were in place to support people to gain access to health professionals and services.

Staff were friendly, kind and caring towards the people they supported and care provided met people’s care and support needs overall. People’s dignity, privacy and independence was respected and they found the staff to be friendly and caring. Visitors were welcomed and relationships were supported.

People knew the manager and found them to be approachable and available in the home. People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response.

Nightingale House is registered to provide accommodation for 30 older people who require personal care. People may also have needs associated with dementia. There were 30 people living at the service on the day of our inspection.

A registered manager was not in post. The registered provider had informed us in December 2015 that they had appointed a deputy manager who they planned to put forward for registration as manager for the service. 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.

Risks to people’s health and well-being were not always assessed or were not sufficiently detailed to ensure people’s safety. The provider’s systems to check on the quality and safety of the service provided were limited and not always effective in identifying and acting on areas that required improvement.

Records were not well organised to support the effective management of the service. Staff training and support systems were not demonstrated as being consistently implemented. Care records did always have up to date information on all aspects of people’s care needs to guide staff on how to meet people's assessed needs although staff knew people well and management had made changes to improve this.

Staff had attended training on safeguarding people and were knowledgeable about identifying abuse and how to report it. Recruitment procedures were thorough. Staff understood and complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

People medicines were safely managed and they had regular access to healthcare professionals. A choice of food and drinks was available to people that reflected people’s nutritional needs and took into account their personal preferences.

People were supported by staff who knew them well. People’s dignity and privacy was respected and staff were kind and caring. Visitors were welcomed and people were supported to maintain positive relationships with others.

The provider had a clear complaints procedure in place. People felt able and had opportunity to express their views on the service and to be listened to.

We thought about what we found and asked the questions that we always ask; is the service safe, effective, caring, responsive and well-led?

This is a summary of what we found:

Is the service safe?

When we arrived at the service we were asked to sign the visitor's book and our identity was checked. This meant that people were protected from unwanted visitors such as others who posed a risk to their safety.

People told us that they felt safe living in Nightingale House. One person said, 'I can go out and leave all my things here and I don't have to worry as they are all here when I get back.' Another person said, 'I am happy here but would rather be at home, I do feel safe as the staff are always around when you need them.' Another person said, 'The manager is really lovely and always has the time to stop and speak with me, I do feel safe here.'

Staff had received training in safeguarding vulnerable adults from abuse (SOVA). Senior staff had undertaken training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). The manager was aware of recent changes to guidance about DoLS. Other staff were due to attend MCA 2005 and DoLS training when it becomes available. This meant that staff had been given the information that they needed to ensure that people were cared for safely. Health and safety checks had been carried out and issues had been dealt with appropriately. This showed that the service was safe.

Is the service effective?

People told us that they felt that the service met their needs. One person who used the service said, 'The staff are very quick to come when I call them, I have never had to wait too long for help.' Another person said, 'This is a great service, the staff are all so good and they make sure that I get my meals when I want them. They serve a good meal here and they offer me plenty of choice.'

People's care records showed that care and treatment was generally planned and delivered in a way that was intended to ensure their safety and welfare. There were risk assessments together with clear management plans on most of the care files that we looked at. However, on one care file we found that a low risk had been identified but there were no plans on how it was to be managed. The care records were handwritten and provided personalised details such as 'put toothpaste on the brush and hand to [person's name]' and, 'support to choose appropriate clothing.'

Care records and risk assessments had been reviewed and updated on a three monthly basis. This may not be regular enough to ensure that staff have up to date information on how to meet people's needs.

Is the service caring?

Staff's interaction with people who used the service was good. They spoke with people respectfully and supported them in a kind and caring way. Staff had a good knowledge of people's likes and dislikes. People told us that all of the staff treated them well. One person said, 'The staff are ultra-caring, they can't do enough for you. If I was an employer, I would employ any of the staff who work here as they are all so good and reliable.'

People told us that the staff treated them respectfully. They said that they were always given choice in what to eat and what to do. One person said, 'The staff are very respectful, they always knock on the door and ask if it is OK for them to come in. They take the time to listen to what I have to say and they all have time to talk with me when I need it.' One visiting relative said, 'This is an excellent service, the manager and staff are so kind and caring. I am very happy with my relative's care and I now have peace of mind that they are cared for safely.'

We saw 'thank you' cards from the relatives of people who had used the service in the last three months. They contained compliments about the care provided and expressed their thanks for making their relative comfortable in a kind and caring environment.'

People's preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by kind and caring staff.

Is the service responsive?

People told us that they had plenty to do. One person said, 'I go out quite a bit and there is plenty to do in the house if I want it.' Another person said, 'We have a dog visit quite regularly and it is lovely.' Another person said, 'I have had my nails done today and I really like the colour. I enjoy pampering days.'

People told us that staff were quick to respond if they called them. They said that their call bells were always within easy reach when they were in their rooms. We saw that there was plenty of staff on duty who acted swiftly when people who used the service called for assistance.

People were supported to see other professionals such as general practitioners, psychiatric nurses, chiropodists, opticians, and district nurse. This showed that people's general health care needs were met and that the service responded to people's changing needs.

Is the service well-led?

There was a good quality assurance system in place. The service had sought the views of people who used the service, their relatives and visiting professionals. They had analysed the information and carried out any necessary actions.

People told us they were happy with the service they received. One person said, 'This is a really good service, the staff are kind and caring and they always take the time to listen to me.' Another person said, 'They care, and they listen to what I have to say.' One visiting relative said, 'The manager is excellent, they are all good communicators, they keep me informed and my relative is doing well.'

The manager had carried out regular quality and safety checks such as for the building, incidents/accidents, medication and complaints. The complaints procedure was clear and it showed timescales for when complaints would be responded to. People told us that they knew how to complain. There was a range of information, including the complaints procedure, available in the entrance hall. This showed that there was an effective quality assurance system in place and that the service was well-led.

We found that the required improvements had been made to the service.

There were effective arrangements in place to protect the people from health care related infections. All areas of the home were clean and tidy and cleaning schedules were in place. Food was prepared and cooked safely and they followed the guidance 'Safer Food Better Business' which helped keep people safe.

There were effective arrangements in place to monitor and improve the quality and safety of services. People who used the service were able to influence the management of the service in relation to their care. Their views and comments were obtained and used as part of the systems for improving the service.

People we spoke with told us that staff were ''kind'' and ''caring'' and that they received the help and care they needed.

We saw that staff had a good understanding of each person's needs in relation to their physical, mental and general health. There were detailed assessments and care plans in place to help staff care and support people appropriately and risks to the health, safety and welfare of people were generally well managed.

Improvements were needed to ensure that the premises were properly cleaned and that risks of infection were assessed and managed. Improvements were also needed to ensure that the quality and safety of the service provided was monitored effectively and improved where needed.