We recently undertook an inspection visit to Nightingales Nursing Home. We spoke with five people who used the service and reviewed four people's care records. We spoke with two relatives. We spoke with two visiting health and social care professionals. We spoke with three staff supporting people and reviewed their recruitment and training records. We also reviewed the records in relation to the management of the service. We considered all the evidence we had gathered under the outcomes we inspected.Is the service safe?
People told us they felt safe with the staff that supported them. They had access to medical support from health care professionals when required, which included the doctor and specialist nurses. People told us staff safely helped them with their daily care and support needs. One person said, 'I've known about this home for a long time and told my daughter that when it was time, I would like to come here. The nurses are very caring and good to me.' Another person said, 'I can't do a lot for myself but I do enjoy playing dominoes and will get ready to join in later.' This person told us they 'trusted' the home's staff to keep them safe.
People's needs were met because the home employed suitably qualified nurses and care staff. People were effectively supported because staff were caring and trained to look after people in a dignified and respectful manner. Staff understood people's needs. They were supported in their job role and were confident to raise any concerns they had about a person's health.
People told us they felt both safe and secure because they were cared for in an environment that had been maintained. Equipment used to help support people safely was regularly serviced and maintained. The provider had taken steps to make sure all areas of the home were accessible and safe for people to use. Communal areas were furnished which made it homely and comfortable. People had decorated and personalised their rooms to reflect their interests and what was important to them.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Staff training records showed that relevant staff had been trained in the Mental Capacity Act 2005 and DoLS. The registered manager had acted in accordance with their responsibilities and referred people to the appropriate authority when they had any concerns about their capacity to make decisions. This meant that people could be confident that their best interests would be represented and that their wellbeing would be met assured.
Is the service effective?
People told us they were satisfied with the care that had been delivered and said their needs were met. Records we looked at showed that people's nursing needs were met by the qualified nurses and care staff. People had access to support from a range of health care professionals to ensure their health needs were met.
People were provided a choice of nutritious meals and drinks that suited their dietary needs and preferences. All the meals were prepared by the catering staff who took account of people's preferences to make sure suitable meals were prepared. One person said, 'I have to say the meals are very tasty and there's usually a choice of two or three things." Another person told us, 'I prefer to have my meals in my room because I have to have my oxygen cylinder with me all the time.' We observed staff supported some people to eat their meals in a sensitive manner; offering encouragement and conversation that made the meal time experience enjoyable.
Relatives we spoke with had high praise about the quality of care provided. They told us the home's staff supported people safely to help maintain their health and wellbeing. One relative said, 'We don't worry about my mother because we know she's really well cared for and it's safe. They call us if she's not well but we know they would have already got the doctor in to see her.'
Staff told us they were trained for their job role to help ensure people's needs were met reliably. Staff training certificates and the training matrix we looked at confirmed the provider had taken steps to ensure staff kept their knowledge and skills up to date and in line with current best practice.
Is the service caring?
Our observations of the care provided showed that people were supported by kind and attentive staff. Staff understood people's needs and helped them to do things at their own pace. People were confident to ask for help and the staff listened and acted on requests promptly. Records we looked at showed us that people's wishes for their care and support were taken into account and respected. One person said, 'I've only been here a short while and everyone's been really nice and have helped me to settle in."
Health care professionals told us people were 'well cared for' and that the home's staff understood the needs of people that they looked after. They explained that people's last wishes were respected by the home's staff who also supported their relatives, often at a difficult time.
Is this service responsive?
People's needs had been assessed before they moved into the home and checked regularly to make sure any new needs would be met. Records we looked at showed people were involved in reviewing their care needs and any decisions that they made were recorded. Staff sought appropriate medical advice from the doctor or specialist support from services such as LOROS and the McMillan Nurses, when required. Records we looked at confirmed that care and support had been provided in accordance with people's wishes.
People were confident to raise concerns and make comments to the registered manager about the quality of care they received.
Is this service well led?
People were involved in their care to make sure any new care needs could be met reliably. Care records and other documents we looked at confirmed people's needs were met by qualified nurses and trained staff. Records showed the home's staff worked with other health and social care professionals to help ensure people received care and support that was co-ordinated and managed.
The home had a system in place to assure the quality of service they provided and acted on any feedback and comments received. This included satisfaction surveys to gather the views of people who lived at the home and relatives or their representatives, and meetings to review of people's care needs. Regular meetings were held at the home where people made decisions about social events. They also had the opportunity to comment on any proposed changes to the home that could affect their wellbeing.
People were confident to make complaints and suggestions to help ensure continued improvement to the quality of service that was provided. All complaints were handled and responded to promptly and in a consistent way. Relatives and health care professionals were confident that any concerns or suggestions made to improve the quality of care people experienced would be acted on promptly.
Systems were in place for regular checks to be carried out that ensured the health and safety of everyone was protected. Information from analysis of incidents and accidents had been used to identify changes and improvements to minimise the risk of them happening again. Records showed that the provider acted promptly to improve the service and put right any shortfalls that were found.