Archived: Nightingale Nursing Home

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

People spoke positively about their care. We spoke with two people and one person's relative. One person told us, 'The staff are very good. You wouldn't get any better.' Another person said, 'It's very nice. The staff help me. It's a very good little place.' A person's relative commented, 'It's excellent, I couldn't fault it.'

Is the service responsive?

People accessed the services of health professionals as required. One person told us, 'They are very good at getting the doctor.' A person's relative said, 'I have spoken to the matron this morning and she is talking to the doctor regarding my dad's medication later.' We found that contacts with healthcare professions such as the GP and dieticians were recorded in people's care records. The registered manager told us that they had contact with the tissue viability nurses to assist with people's skin care needs.

Is the service safe?

Care delivery did not always ensure people's welfare or safety. For example, we saw that a number of people had bed rails fitted to their beds. Not all people who had bed rails had bumpers fitted. Bumpers are used to reduce the risk of entrapment and injury. One person had bed rails that were incorrectly fitted or maintained and were fitted at an angle that increased the risk of entrapment. Care was provided for this person in their bed. This bed did not raise or lower which increased the risk of poor moving and handling. We raised these issues with the registered manager, who told us that they were looking into purchasing new beds and bed rail bumpers. However, this equipment was not on order and there was not a fixed date for delivery.

The home was clean and smelt fresh. We spoke with two people and one person's relative. One person told us, 'It's perfectly clean, it's beautiful.' A person's relative said, 'The cleanliness is very good. It is very clean and tidy.'

There were sufficient numbers of staff to meet their needs. We spoke with two people and one person's relative. One person told us, 'When I press my bell they come quickly, one or two minutes.' A person's relative said, 'I have never noticed them being short of staff. If you want to see a member of staff they are always there. They have a few agency staff, but they seem to know what's going on.'

People's care records did not always contain accurate information. We looked at four people's care records and found that they contained either inaccurate or conflicting information. For example, one person's care records contained conflicting information regarding the consistency of their food and fluids. The registered nurse confirmed that the records were conflicting and that the person was receiving food and fluids at the required consistency. Another person's care record did not contain accurate information as to the amount of drinks they had consumed. A further person's care record stated that they had a pressure sore; however, this had since healed.

The provider had not protected people from the risks of unsafe use and management of medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS), which apply to care homes. No applications had been submitted. The registered manager told us they were in the process of reviewing a recent Supreme Court judgement in respect of DOLS and the impact this may have on the service.

Is the service effective?

Care was not always delivered to meet people's needs. For example, people's daily fluid requirements were assessed. However, people's fluid recording charts indicated that they had not taken the required amount of fluid. The registered nurse confirmed that there had not been a review or evaluation of people's care as a result of them not consuming sufficient fluids.

A notice was displayed in the office that directed staff not to give people food or drink if they were due to have a fasting blood test. We spoke with the registered nurse who told us that this instruction related to all fasting blood tests. We were told that people would not receive fluids from the evening until their blood test the following morning. However, drinking water is usually permitted for fasting blood tests unless specifically advised by the medical practitioner. This meant that people may have been at risk of dehydration.

People's urinary catheters were not always managed appropriately. The registered nurse told us that seven people had urinary catheters. We looked at three people's catheter care records. We found that people's urinary catheters were changed at regular intervals. However, one person did not consistently have the same size catheter. We spoke with the registered manager and the registered nurse. We were told that this person had been assessed as requiring a size of catheter, which had not been available and therefore a different size had been used. This meant that care was not delivered to meet their needs, as the provider had not ensured that equipment was available.

Is the service well led?

The provider did not effectively monitor risks. The provider undertook a number of audits of the service. However, these audits had not identified a number of the risks we had identified during our inspection. For example, an audit of one person's urinary catheter concluded that the plan was clear and concise. We found that this person's plan lacked key information such as the size of catheter and the frequency of change. An audit of a person's room concluded that their bed rails were in the prescribed position. We found that this person's bed and rails were not in working order.

The registered manager told us that they had identified a number of pieces of equipment that were required to maintain a safe service. However, this equipment had not been obtained. For example, a number of people had bed rails fitted to their beds without protective bumpers. The registered manager told us that a number of beds required replacing. However, there was no fixed date for these to be replaced. The medicines refrigerator required a thermometer and defrosting, however, no action had been taken to address this.

Another relative told us "I'm confident that my wife makes her views and wishes known and she'd soon let them know if something was wrong."

"We had questionnaires to complete about what he liked and didn't like, about his background and history and all that sort of thing." one relative told us. We looked at the documentation and saw how the information provided had assisted with the plan of care laid out.

There had been no notifications of abuse but evidence we had confirmed that the provider had arrangements in place which would ensure that any allegation of abuse was responded to appropriately.

The evidence we saw, read and heard confirmed that the provider had had suitable arrangements to ensure that staff were supported to care for people who used the service safely and to the appropriate standard.

We asked the Registered Manager for examples of service change which demonstrated that people who used the service and their representatives were asked for their views and these were acted on. We were told about a pet rabbit which now lived in the garden, after a request from one of the people who had completed the annual questionnaire.

People living at Nightingale Nursing Home were very positive about their experience of living at the home. No one had any complaints or concerns about how the home was run and managed.

People told us that they had good relationships with the staff, who were described as 'nice and kind'. They told us that the home was kept clean and warm. People said there were activities to keep them occupied.

We used the Short Observational Framework for Inspection (SOFI). It is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We observed that people were in positive or neutral moods and frequently smiled with each other and staff. People freely approached staff and had good relationships with them.

People were protected from harm, by thorough recruitment processes and procedures followed when recruiting staff.

Prescribed medicines were given to people appropriately.

We found the home had a quality assurance system in place to ensure standards in the home were maintained.