About the service: Nightingale House Care Centre is a care home that accommodates up to 45 people in one adapted building, with a dedicated wing for people living with dementia. It was providing personal care to 35 people at the time of the inspection.

People’s experience of using this service: People were protected from harm or injury. Systems for managing incidents, staff and care practices were used to achieve this.

People experienced an effective service. This was because care was delivered in line with guidance and the law, staff were trained and supervised and people were supported with their health and diet. The service was flexible and adaptive in its working arrangements with other organisations.

People received caring and compassionate support that met their needs and was anti-discriminatory. Staff respected people’s privacy, dignity, independence and the choices they made.

People experienced responsive and person-centred care. They exercised choice and control of their lives and were involved in the running of the service. They told us complaints and concerns were addressed. People experienced sensitive support with end of life care needs.

People received quality care from a caring provider. They benefitted from a provider that worked well in partnership with other agencies, organisations and the local community.

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

Rating at last inspection: Good. (The last report was published 13 September 2016.)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 8 August 2016 and was unannounced. Nightingale House provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 45 people who require personal and nursing care. At the time of our inspection there were 40 people living 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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered and stored safely. We saw that staff obtained people’s consent before providing care to them. The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the Dols, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision. People were encouraged to enjoy a range of hobbies and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. Audits were in place for areas such as medicines and infection control. However audits had not been carried out on care plans to ensure they were up to date and complete. Accidents and incidents were recorded. The provider had informed us of notifications as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

A single inspector carried out this inspection. At the last inspection in February 2014, the provider was asked to take action to improve the training, supervision and appraisal of staff. At this inspection we found these issues had been addressed.

We talked with five people using the service and two relatives. We looked at five people’s care records and observed care being provided. We talked with three care staff and the manager. We examined the documentation related to quality audits and staff training.

This helped us to answer the questions below:

Is the service safe?

The home had policies in place to safeguard vulnerable adults from abuse and staff understood their role in safeguarding the people using the service.

There was guidance for staff on obtaining consent and the implications of the Mental Capacity Act. We saw that when people lacked the capacity to make decisions for themselves, processes were in place to ensure best interest decisions were made.

Individual risk assessments had been completed and people’s care plans contained action to reduce the risks identified.

Is the service effective?

Care plans were reviewed and updated regularly to ensure they met the current needs of the people using the service. Care plans indicated that people had been involved in making decisions about the care and support they received because their personal preferences and individual needs were reflected. Most of the care plans had been signed by the people using the service or their relatives.

Equipment was available and utilised to meet the needs of the people using the service.

Visitors we spoke with told us they were able to visit at any time and they could see people in private.

Is the service caring?

We saw staff interacting with people in a caring and professional manner. People told us staff were kind, cheerful and helpful.

People’s preferences and interests were documented and care and support provided in accordance with their wishes.

Activities were available to maintain people’s well being and we saw examples of how their individual interests were identified and catered for.

Is the service responsive?

Staff were alert to the signs of ill health and acted promptly to obtain specialist advice and support for the people using the service.

There was a complaints policy in place and information was provided in the service user guide on how to make a complaint. People told us they had had no need to make a complaint but any small issues they had raised were dealt with by the staff or the manager.

Is the service well led?

There were systems in place to monitor and assess the quality of the service provided. Action plans were developed to address issues identified in the audits and improve the quality of the service.

Staff were provided with access to training and support relevant to their roles. A schedule for supervision and annual appraisal was in place.

When we visited Nightingale House Care Centre 32 people were living there. We spoke with 13 people as well as the manager, members of nursing and care staff, four relatives and visiting health professionals.

We looked at records and observed how staff supported the people living in the home.

People told us staff always asked for their permission before they undertook tasks for them. One person told us, “They (the staff) ask you before they do anything.” Staff spoke about making sure people gave them their consent before they helped to support them. We saw this happened.

People told us they were happy living in the home. One person said, “The care is superb. I have no problems at all.

We found the home had systems in place to manage medicines safely. People told us they received their medicines on time.

Although staff felt supported by the manager, supervision sessions and training were not up to date

We observed that care staff were attentive to people’s needs and their interaction with people was friendly, respectful and professional.

The home was kept clean and free from odour. Towels and flannels were washed each day and that bed linen was washed regularly.

People who lived at the home were well presented and well groomed.

One person's relative told us, “I can’t fault the place. My mum’s been here for over a year and we think it’s just right, it’s really good.”

We saw people were given choices in how they wished to spend their day and were encouraged to join in a programme that offered both group and one-to-one activities each weekday.

We observed people were given a good choice of hot and cold food from a menu and were able to have a cooked breakfast if they wished. Refreshments were available throughout the day.

One person we spoke with told us that the staff were very kind and caring. This person also said they were very warm and comfortable. A relative we spoke with told us that they had always found the staff to be helpful and knowledgeable about the family member who lived at the home. They had been visiting the home regularly for more than five years and had never had any reason to be concerned about anything or make a complaint.