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 relatives told us they were involved in their care planning. People had regular access to healthcare and other professionals.
We found that the atmosphere at Nightingales Residential Care Home was homely, people told us they felt safe and their visitors were welcomed.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version 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.