Nightingale Court is a residential care home for 43 older people who may have a diagnosis of dementia. At the time of our inspection there were 41 people living at the home.

At the last inspection the service was rated Good. At this inspection we found the service remained Good with a rating of Outstanding in Responsive. At this inspection we found improvements in the commitment and individualised approach to responding to people’s ambitions showed by the registered manager and staff, provided clear therapeutic benefits for people living with dementia which was outstanding.

The management staff team were highly committed to ensuring people’s lifestyle choices were responded to with careful planning so people could succeed in their different ambitions. People were encouraged to maintain or develop interests which held important meaning in their lives so people were not disadvantaged because of their mental health needs.

People’s end of life care needs were met by staff who were committed in working alongside healthcare professionals. This assisted people to access therapeutic interventions to support people with their experiences. People also had opportunities to make their end of life care wishes known so there was no risk of these not being followed at this important time of their lives.

People maintained positive links with their community which enhanced their lives. People were encouraged to retain relationships important to them and develop friendships. People's religious and spiritual needs were recognised and embraced which supported people to continue to practice their religions and meet their spiritual needs in ways they wished to do so.

People who lived at the home and their relatives worked in partnership with staff to plan their care. Care records were personalised and contained detailed information about what was important to people. There was a consistent staff team who knew and respected people as individuals and provided extremely responsive care which put people at the heart of all the care offered.

People who lived at the home and their relatives were encouraged and felt confident to voice their views and opinions. The registered manager listened to what people had to say and took action to resolve any issues. There were systems in place for handling and resolving complaints which focused upon opportunities for learning lessons.

Staff cared for people with kindness, patience and understanding. Staff had time to meet people's needs and to spend time in conversations with people individually, without rushing. People were provided with care which was respectful, dignified and took into account people’s right to privacy and confidentiality.

Staff listened to people and had a detailed understanding of their needs and preferences. This supported staff to assist people in having positive dining experiences at the home and staff were aware of people's dietary requirements.

People were supported to make safe choices in relation to taking risks in their day to day lives which helped people to maintain their own levels of independence. This was because staff made sure people had the equipment and aids they required to meet their needs. Staff had been trained and understood how to support people in a way which protected them from harm and abuse. There were arrangements in place to make sure staff were trained and competent in medicine administration which reduced risks to people’s safety and welfare.

Staff received regular training which provided them with the knowledge and skills to meet people's needs in an effective, responsive and personalised way. The management team supported staff to gain additional knowledge within their various champion roles to promote a greater awareness and understanding of the diverse needs of people who they provided care and support to.

The management team and staff shared common values about the aims and objectives of the service people were provided. These were based arou

We inspected Nightingale Court and spoke with three people who lived at the home. We were unable to hold conversations with the people who lived at the home due to their communication difficulties. We spent time and observed the care and support people received. We looked at their care files and other supporting documents. We had discussions with the registered manager and four staff about how people were being supported. We saw that people looked comfortable in their home and with the staff that supported them. We saw that staff had been kind and caring in their approach to people who lived in the home.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person’s needs and how to give care and support to meet those needs. People told us: “Yes, I’m OK here” and: “I like it here, it’s nice”.

The home had a complaints policy in place and demonstrated that they listened to and responded to peoples’ comments about the home.

We carried out an inspection on 29 October 2012. We found failure to take proper steps to ensure that people received appropriate care and to fully assess the quality of the services provided.

During this inspection we reviewed the improvements had been taken to address the shortfalls. We found that a range of actions had been made and that the registered provider was meeting the standards.

The registered manager showed us the various improvements that had been introduced to ensure that people received appropriate care and support. We found that extra measures had been put in place for assessing the quality of the services that people could expect to receive.

Most people were unable to express their views verbally, so we spent time observing how staff supported them. We saw that staff were checking that people were appropriately dressed and walking safely to reduce the risk of them falling. Staff were observed giving people support and advice about how they needed to walk to protect them from having accidents.

The two care files that we looked at confirmed that they had been updated to match the care that people were receiving.

We talked with two senior care workers who described the improvements that had been made. One senior care worker said, “They have made a big difference.”

During our inspection of this home we were restricted to a limited number of people who we were able to speak with because of their illnesses. We spoke with a relative, the registered manager, the deputy manager, a senior care worker, a care worker and the activities organiser. We gathered information about how people were being supported by looking at people's care files, observing staff practices and their interactions with people. We reviewed staff training records and the numbers of staff allocated to care for people.

We saw that people were treated with respect and staff maintained their privacy and dignity. A person told us, "I like it here." We looked at the care records of five people who used the service. We spoke with a relative who said, "They look after X well." The accident records told us that there was a high incidence of people who had fallen, we brought this to the attention of the registered manager and requested a review of practices within the home.

We spoke with staff that had different roles. They told us they enjoyed their work and were well supported. They said they were provided with training opportunities to meet the specific needs of the people who used the service and to keep them safe.

We found that the registered manager had arrangements in place to monitor the quality of the services that people received but they had not taken appropriate action to reduce the risks of people falling.

This inspection took place on 14 and 15 September 2015 and was unannounced.

The provider of Nightingale Court is registered for accommodation and personal care for up to 43 people who may have a diagnosis of dementia. At the time of our inspection 37 people lived at the home.

There was a registered manager in post. 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 practices around the administration and management of people’s medicines did not consistently reduce the risks of people not receiving their medicines as prescribed to meet their health needs. This included making sure all people’s ‘as required’ medicines was consistently available to them should they choose to have this.

People’s care and risk plans did not always have all the information for staff to refer to when they were at risk of not eating enough. This could result in delayed action being taken by staff in response to any changes in the risks to people’s health needs.

People were supported by staff who knew how to protect them and reduce accidents and incidents from happening by ensuring people’s needs were met in a safe way.

Staff knew how to recognise and report any concerns so that people were kept safe from harm and abuse. Recruitment checks had been completed before new staff were appointed to make sure they were suitable to work with people who lived at the home. People were supported by sufficient numbers of staff with the right skills to meet their needs and reduce risks to their safety.

Staff had been supported to assist people in the right way, including people who lived with dementia and who could become anxious. People had been helped to eat and drink enough to stay well. We saw people were provided with a choice of meals. When necessary, people were given extra help to make sure that they had enough to eat and drink. People had access to a range of healthcare professionals when they required specialist help.

People, who lived at the home, and or their representatives, were involved in making decisions about their care and support. Staff were aware of people’s individual communication needs and used these to support people to give their own consent to their care and make everyday choices about the care provided where possible. Where this was not possible specific decisions about aspects of people’s care were made with people who knew them well and who had the authorisation to do this in their best interests.

Staff understood people’s needs, wishes and preferences and they had been trained to provide effective and safe care which met people’s individual needs. Some people’s care and risk plans had missing information when people’s needs had changed either in the short or long term but this had not impacted upon how staff positively responded and met people’s needs.

People were treated with kindness and respect. Conversations between staff and people who lived at the home were positive in that staff were kind, polite and helpful to people. People were able to see their friends and families when they wanted. There were no restrictions on when people could visit and they were made welcome by staff.

People who lived at the home and their relatives had been consulted about the care they wanted to be provided. Staff knew people they supported and the choices they made about their care and people were supported and encouraged to do fun and interesting things. This included creating an environment which was dementia friendly which provided stimulation and enhanced people’s sense of wellbeing.

Staff supported people who lived at the home and their relatives to raise any complaints they had. The registered provider had a complaints procedure which included investigating and taking action when complaints were received.

People who lived at the home and their relatives knew who the registered manager was and felt they were approachable. Staff understood their roles and responsibilities and felt that they were supported by the management team.

People benefited from living in a home where quality checks were completed on different aspects of the service to drive through improvements. This included improvement plans to the home environment to benefit people who lived there and staff. The registered manager was open and responsive to continually improving people’s experiences of the care provided so that people consistently received good standards of care and treatment.