Nightingale House

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.

Nightingale House is residential care home providing personal and nursing care. The home can accommodate up to 215 older Jewish people across six self-contained units, each with separate adapted facilities. People were allocated to the units according to their needs and the level of support they required such as nursing or residential and personal care. One unit had been closed since June 2020. At the time of our inspection 130 people were using the service, the majority of whom were living with dementia.

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

People received sufficient food suitable to meet their nutritional and hydration needs. Risks were regularly assessed and managed to minimise weight loss and malnutrition. Care plans and risk assessments were detailed. Staff had received additional training and support to meet people’s complex nutritional needs. The registered manager worked closely with family members and other health and social professionals to discuss concerns about people’s health and well-being including weight loss.

We were assured the provider was working within the national guidance on good infection prevention and control guidelines in relation to the COVID-19 pandemic. Management plans were in place to mitigate risks in relation to COVID-19 pandemic and protected from the risk of acquiring infections. The admissions process of people in the home was robust. Staff followed guidance to respond to Covid-19 and other infection outbreaks effectively. Staff had access to sufficient Personal Protective Equipment and used it appropriately. Visitors underwent COVID-19 checks to minimise the risk of spreading of infection.

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

The last rating for the service was Outstanding, published on 21 August 2018. The overall rating for the service has not changed following this targeted inspection and remains outstanding.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns about the service in relation to the infection control. In addition, we received concerns about nutrition and hydrations needs of people using the service.

The Care Quality Commission have introduced targeted inspections to check specific concerns. A decision was made for us to inspect and examine those risks.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. This Nightingale House Inspection report does not look at an entire key question, only the part of the key question we are specifically concerned about. At this inspection, we only looked at part of the key questions safe and well-led where we had specific concerns.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care homes 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 until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

Nightingale House is a ‘care home’. People living in the care home receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home can accommodate up to 215 older Jewish people across six self-contained units, each with separate adapted facilities. Three of the units known as Ronson, Sampson and Wohl specialised in providing nursing care to people, while the units known as Sherman, Wine and Osha were residential and provided people with personal care. At the time of our inspection 180 older people resided at the care home, the majority of whom were living with dementia.

At our last inspection of the service in February 2016 we rated them ‘Good’ overall and for four five key questions, ‘Is the service safe, effective, caring and well-led?’ and ‘Outstanding’ for the key question, ‘Is the service responsive?’

At this inspection we have increased their overall rating from ‘Good’ to ‘Outstanding’ and for the two key questions, ‘Is the service caring and well-led?’ The service remains ‘Outstanding’ for the key question, ‘Is the service responsive?’ and ‘Good’ for the two key questions, Is the service safe and effective?’ This was because we found the provider continued to drive improvement, particularly in relation to the service being caring and well-led.

The service continued to have a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We received extremely positive feedback about the standard of care provided at the home from people living there and their visiting relatives and professional health and social care representatives. We observed staff continued to be compassionate and kind throughout our two-day inspection.

People nearing the end of their life received compassionate and supportive care at Nightingale House. The service retains their Gold Standards Framework (GSF) award with ‘Beacon’ status. The Gold Standards Framework is a professional accreditation awarded to care homes in recognition of their high-quality end of life care practices. Beacon status is awarded to those services who have maintained best end of life care practices. The provider worked closely with all the relevant community health and palliative care professionals and respected the wishes of people nearing the end of their life. Staff received end of life care and bereavement training, which included a specific module on understanding death and dying from the perspective of the Jewish faith.

The service had built up strong links with the wider community. Since the last inspection, the service had embarked upon an innovative inter-generational project which had led to the opening of an on-site nursery to bring children and people living in the home together on a daily basis to participate in shared social activities. The service also had good links with other local community groups and institutions. For example, entertainers, drama groups, musicians and a mother and toddler group regularly visited the home to perform or just interact with people living at the home. The service also employed a community outreach worker who kept people updated about what was happening in the local Jewish community.

Activities provision within Nightingale House remained person-centred and innovative, which enabled people to live active and fulfilling lives. The service had its own concert room, well-equipped activity centre with pottery kiln, cooking facilities and internet-café, a library, cafe, well-kept gardens and a pet’s corner with rabbits, guinea pigs and an aviary. People who preferred or needed to stay in their bedroom were also protected from social isolation. People regularly participated in outings and activities in the local community. Furthermore, the service had introduced the Namaste programme which was designed to improve the quality of life for people living with dementia. Each unit had designated Namaste trained staff and a purpose-built Namaste sensory room which was a calm space for people to relax in.

People, relatives, community health and social care professionals and staff were very complimentary about the service’s management team. They said managers and senior staff were all highly regarded by everyone and worked well together as a team, which had a positive impact on the quality of the service provided at the home. People and staff said managers were ever present on the units, approachable and always interested to what they had to say.

The provider continued to work closely with numerous other professional agencies and academic institutions to review joint working arrangements and to share best practice including, Springfield University Hospitals team of psychiatrists who Furthermore, several university students were in the process of carrying out PhD research projects at the home, looking specifically at dementia, bowel and bladder care, end of life care, spirituality and staff interaction with people.

Managers at all levels ensured the company’s values and vision for the home were fully embedded in the service's systems and processes and demonstrated by staff through their behaviours and actions. There was clear oversight and scrutiny of the service. They used well-established quality assurance systems to ensure all aspects of the service were routinely monitored and could be improved for people. This helped them to check that people were consistently experiencing good quality care and support. Any shortfalls or gaps identified through these checks were promptly addressed.

Managers encouraged and supported staff to deliver high quality care and recognised and rewarded them when they demonstrated excellence in the work place. Staff told us Nightingale House was an excellent place to work, were very proud of the high standard of care they provided there and felt well-supported by their line managers and co-workers. People and their relatives felt there was a strong commitment within the staff team to continuously improve and develop their working practices. This ensured staff continued to deliver high quality personalised care to people living in the home.

People and their relatives told us the provider understood their Jewish Faith and culture. The service had their own religious co-ordinator and on-site synagogue. Staff completed equality and diversity training, which included a module about understanding what it meant to be Jewish, and the Jewish faith and culture in general. In addition, specially trained volunteers regularly presented seminars to people living in the home, their relatives and staff on Jewish history and specifically the Holocaust. The catering staff also demonstrated a good understanding of how to prepare kosher food to conform with Jewish dietary law and practices.

The provider used imaginative ways to meet the needs and wishes of people living with dementia at the home. We saw an old Morris Minor car had been put in the garden specifically for a person who had expressed a fondness for this type of car, an office had been created for another person who missed working and a former architect was encouraged to participate in planning meetings about building projects at the home. The service also used new technology well to support people living in the home. For example, people had been provided with their own iPod and headphones so they could listen to personalised playlists of music of their choosing, and access email, Skype and the internet.

People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. Assessments were regularly undertaken to review people’s needs and any changes in the support they required. Staff continued to receive regular and relevant training and supervision to help them to meet people's needs. Staff were aware of people’s communication methods and provided them with any support they required to communicate to ensure their wishes were identified and they were enabled to make informed decisions and choices about the care and support they received. People were also supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to maintain relationships with those that mattered to them and relatives and visitors were warmly welcomed when they came to the home. Staff had developed caring relationships with people and their relatives, and ensured people received the right levels of care and support in a dignified and respectful way.

Staff were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. People were supported to eat and drink enough to meet their dietary needs and preferences. Staff ensured mealtimes were an enjoyable and personalised experience. Staff regularly monitored people's general health and wellbeing. Where there were any issues or concerns about a person's health, they ensured they received prompt care and attention from the relevant health care professionals, which included the five on-site GP’s and eight occupational therapists and physiotherapists. People said Nightingale House was a homely and comfortable place to live.

People said they felt safe at t

Nightingale House is a care home with nursing for up to 215 older Jewish people. There are five units at the home, each overseen by individual unit managers who are accountable to the Director of Care who is the registered manager of the home. Sampson and Ronson units provide care to people with advanced nursing needs. Sherman and Wine units provide residential care for people with dementia. Wohl unit provides residential care for people with advanced dementia needs.

There was a registered manager at 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.

Staff had completed medicines administration training within the last year and were clear about their responsibilities. Pain assessments were carried out appropriately and these were monitored by the GP.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or where the person’s care needs had changed.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act (MCA) 2005.

Staff demonstrated an outstanding understanding of people’s life histories and current circumstances and supported people in an exceptionally caring way. Staff took time to get to know people to deliver empathic care that produced positive results for their well-being. One person had a newspaper activity group created specifically for them that other people also enjoyed as it allowed them to continue a pastime they had always taken part in. The service employed a ‘Person Centred Care Facilitator’ who helped care workers to provide a specifically tailored approach to people’s individual needs. There were numerous examples of this being delivered in practice.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs. These were clear and easy to follow.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met. The service employed a religious adviser who provided formal and informal guidance and friendship.

People were supported to maintain a balanced, nutritious diet. Staff and volunteers had participated in training called ‘Meals Matters’ which allowed them to understand the dining experiences of people with dementia and how they could improve this. People were supported effectively with their health needs and were supported to access a range of healthcare professionals. The service had access to many in-house services including occupational therapists, physiotherapists, dentists, GP’s and an in-house pharmacy.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Complaints were taken very seriously and there was evidence of considerable planning to implement learning from complaints. This included reflective meetings and further advice from external experts whose recommendations were implemented.

Activities were innovative, creative and bespoke. People were encouraged to participate in activities they enjoyed and people’s feedback was obtained to determine whether they found activities or events enjoyable or useful. An activities programme was in place which spanned seven days a week and this included a mixture of one to one sessions and group activities. Activities were tailored to meet people’s cognitive and physical needs. The service also used numerous volunteers to help deliver the activities programme.

The organisation had thorough systems in place to monitor the quality of the service. Feedback was obtained from people through residents meetings and we saw evidence that feedback was actioned. There was evidence of auditing in many areas of care provided as well as significant monitoring from senior members within the organisation which included a care governance board that had overall responsibility for the running of the home.

There was evidence of considerable joint working with outside organisations including City, Kings College London, Kingston and also Surrey Universities and St George’s Hospital. The service had also been awarded ‘beacon’ status by Trinity Hospice under the Gold Standards Framework which is the highest status offered, which meant they delivered innovative and established good practice in end of life care.

The majority of comments from people using the service were positive about the care and support provided to them with individuals confirming that they were treated with dignity and respect by care staff. Comments included "they are all nice people", "respectful? remarkably so, very patient" and "they all treat me nicely". One person told us "you feel as though you're safe, you're looked after" and "staff are helpful, it may take time but it gets done".

We saw some very good practice in the way some staff interacted with people using the service however this was not uniform across the home. Now that the project with the University of Bradford was drawing to a close, the commitment to on-going staff development will need to be supported in order to fully embed person centred care across the home.

The planned move of Kingsley unit (previously called Main Building) to a newly renovated floor in a different part of the home will be a positive one for people using the service, their relatives or friends and staff. The current environment of Kingsley unit compared very poorly with the high standard of Wohl Wing which was purpose built for people living with dementia.

Comments from people who use the service included: 'fantastic', 'the people are very nice', 'I came because it was recommended', 'we were told it was the best', 'it lives up to its reputation', 'I'm glad I can be here ' it's a nice place' and 'it's a blessing that I am here'. Family members or carers told us "I don't think there's a better care home" and "very pleased, on the whole they are very good".

Staff spoken to said that they had access to good training and support to help them do their job. Feedback included "they look after the staff" and "they really support staff with their skills to ensure the best quality of care".

We noted the positive work taking place at Nightingale in conjunction with the University of Bradford. The project aim is the provision of 'excellent person-centred care' and staff told us "it has really improved care here", "it's been a huge shift" and "we are on a journey".

Further consideration should be given to the service provided to people living with dementia within the two units on Main Building. This is with particular reference to the mealtime experience and the impact of the environment on the provision of high quality person centred care.