Nightingale House

Updated 17 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of three inspectors, a specialist nurse advisor and three Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Nightingale House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Nightingale House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with 25 people who used the service and 18 relatives about the care they experienced. We spoke with 22 members of staff including the registered manager and director of care. We also spoke with nurses, health care assistants, team leaders, dietician, chef, physiotherapists, wellbeing coordinators, head of engagement and activities, head of therapies, administrator, occupational therapists, head of estates and facilities, relationship centred care coordinator, household managers, spiritual leader, tissue viability lead nurse and volunteers.

We reviewed a range of records. This included 30 people’s care records including risk assessments and support plans and medication records. We looked at 20 staff files in relation to recruitment, staff training and supervision. A variety of records relating to the quality assurance, audits related to the management of the service, including policies and procedures were reviewed.

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

Updated 17 January 2023

About the service

Nightingale House is a residential care home providing personal and nursing care to up to 215 people. The service provides support to older people some living with dementia. At the time of our inspection there were 119 people using the service.

Nightingale House accommodates older Jewish people across six self-contained units, each of which has separate adapted facilities. The units specialise in providing care to people living with dementia, residential and nursing care.

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

People and their relatives described care as outstanding. They told us, “The staff are unbelievably caring” and “The staff are exceptional, so kind, thoughtful, and caring.” People were treated with kindness. A relative told us, “I knew instantly when [person] was admitted that I would have peace of mind and I have not once been disappointed.” Staff involved people in making decisions about their daily living and respected their choices. People’s privacy and dignity were respected. Staff supported people to develop and to maintain new skills to promote their independence.

People benefitted from innovation through intergenerational activities. Nightingale House had a pre-school and day care for children on its premises, a first of its kind in the U.K. People using the service and the nursery children took part in daily intergenerational activities such as singing, gardening and cooking. They told us the interactions uplifted them, brought endless joy to their lives and took the focus away of an ageing mindset.

People received person centred care that reflected their support needs and lifestyle choices. People were supported to express their individuality and their strengths. Their skills were displayed and celebrated. People enjoyed living at the service and took part in activities meaningful to them. People felt confident to make a complaint and knew their concerns would be listened to and resolved. People received outstanding end of life care and the support also extended to those that mattered to them.

People were supported to eat and drink healthily. Staff put great effort in ensuring people experienced good dining. People were involved in menu planning and used opportunities to feedback their views and share recipes and food preferences with the catering team. People’s quality of life was enhanced by the building, gardens and grounds which were impeccably maintained. Refurbishments were done when needed. People benefitted immensely from the use of innovative technology which also aided inclusion.

People were supported to access healthcare services. They enjoyed provision of in-house facilities and immediate access to professionals such as a general practitioner, physiotherapist and dietician. An enabling environment ensured people followed a healthy lifestyle which aided recovery and had a positive impact on their wellbeing.

People, their relatives, friends, staff described the leadership as exceptional and they enjoyed an inclusive and supportive culture. Staff told us the registered manager and management team had a visible presence at the service and ensured people were at the centre of everything they did. Staff were enthusiastic, motivated and felt well supported in their roles. The provider championed the well-being of staff and offered opportunities to progress their careers. The quality of care underwent robust multi-layered checks which enabled the provider to develop and sustain an outstanding service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they felt safe at the service. One person told us, “Oh God! It is safe! They keep me safe. Everything here is set up to keep you safe.” Staff knew how to identify and report abuse or poor practice. They understood their responsibilities to escalate concerns and whistleblow to keep people safe. Sufficient numbers of skilled staff who knew people well provided care. A relative told us, “There are a lot of staff so I know there are people around looking out for [person].”

People were supported by staff who underwent safe recruitment processes. People’s medicines were managed and administered safely by competent and trained staff. Risks to people were identified and managed whilst supporting them in a manner that least restricted their freedoms and respected their choices. Staff minimised the risk of infection and promoted the prevention and control of spread of disease which enabled people to keep safe from avoidable harm.

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

Rating at last inspection

The last rating for this service was outstanding (published 21 August 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.