We inspected the service on 10 January 2019. The inspection was unannounced.

Nightingale House Care Home is a care home without nursing providing accommodation and personal care for up to 21 older people, including people with dementia. The premises are in the form of a large residential home with ordinary domestic facilities. At the time of inspection there were 16 people living in the home.

At our last inspection on 13 June 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm by a staff team trained and confident to recognise and report any concerns. Potential risks to people were assessed and minimised.

Staff were only employed after satisfactory pre-employment checks had been obtained. There were enough staff to ensure people’s needs were met safely and in a timely manner.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene. Medicines were well managed, with staff displaying a sound understanding of the medicines administration systems, recording and auditing systems.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were understood by the manager and acted on appropriately.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

Staff knew the people they cared for well and understood, and met, their needs. People received care from staff who were trained and well supported to meet people’s assessed needs. Staff had the skills and knowledge to provide effective care.

People were assisted to have access to external healthcare services to help maintain their health and well-being. Staff worked within and across organisations to deliver effective care and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were fully involved in making decisions about their care and support. People and their relatives were involved in the setting up and review of their or their family member’s individual support and care plans.

Staff treated people in a kind and friendly way. Staff respected and promoted people’s privacy, dignity and independence. People’s individual needs were assessed and staff used this information to deliver personalised care that met people’s needs. People’s religious and cultural beliefs were respected and supported.

Staff supported people to have the most comfortable, dignified, and pain-free a death as possible. Staff worked in partnership with other professionals to ensure that people received appropriate care.

People’s suggestions and complaints were listened to, investigated, and acted upon to reduce the risk of recurrence.

Staff liked working for the service. They were clear about their role to provide people with a high-quality service and uphold the service’s values.

The registered manager sought feedback about the quality of the service provided from people. Audits and quality monitoring checks were carried out to help drive forward improvements.

Further information is in the detailed findings below.

We inspected Nightingale House Care Home on 13 June 2016 and the inspection was unannounced.

Nightingale House Care Home is a care home without nursing providing accommodation and personal care for up to 21 older people, including people with dementia. The premises are in the form of a large residential home with ordinary domestic facilities. At the time of inspection there were 18 people living in the home.

The home was managed by a manager who had applied to the Care Quality Commission (CQC) to be registered. 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.

At the last inspection, carried out on 2 March 2015 we found that people were not adequately protected against receiving care or treatment that was inappropriate or unsafe because their needs and preferences had not been taken into account. We also found that the registered manager had not put in place safe moving and handling training for staff and did not have adequate systems to monitor and assess the quality of the service or to have regard to the views of people living in the home.

We asked the provider to submit an action plan detailing the improvements to be made. These actions have been completed and on this inspection we found that the relevant requirements were being met.

People's feedback about the safety of the service described it as good and that they felt safe. People were safe because the service had provided training to staff and had systems in place to protect them from bullying, harassment, avoidable harm and potential abuse.

Staff protected people's dignity and rights through their interaction with people and by following the policies and procedures of the service Feedback from people was that staff were caring in their attitude and responsive to people's needs. A caring attitude was observed during the inspection and personalised care, dignity and respect formed part of staff training.

There was a structure and system in place for regular staff supervision and each member of staff had a training record which was relevant to their role.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene. Medicines were well managed, with staff displaying a sound understanding of the medicines administration systems, recording and auditing systems.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were understood by the manager and acted on appropriately.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

Care, treatment and support plans were seen as fundamental to providing good person centred care. Care planning was focussed upon the person's whole life, including their goals, skills, abilities and support needs.

The service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and companionship. The service enabled people to carry out person-centred activities within the service or in the community and encouraged them to maintain hobbies and interests. This was supported by policies and procedures which emphasised the rights of people which enabled staff to work in a person-centred way.

People and relatives described the responsiveness of the service as good. People received personalised care, treatment and support and were involved in identifying their needs, choices and preferences and how they are met. People's care, treatment and suppo

We inspected Nightingale House Care Home on 2 March 2015 and the inspection was unannounced. A previous inspection had taken place on 28 August 2013 where the home was found to have complied with the regulations.

Nightingale House Care Home is a care home without nursing providing accommodation and personal care for up to 21 older people. The premises are in the form of a large residential home with ordinary domestic facilities.

The home is managed by a registered 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. The registered manager was not running the home on a day to day basis and delegated this task to the deputy manager.

Although the majority of people thought that the staff were kind, not everyone felt safe at the home. Some people felt unsafe due to the way they were assisted by staff, particularly when being physically lifted or moved. One person complained that it hurt when certain members of staff were involved in their moving or lifting and expressed concerns about the way one member of staff spoke to them, which we raised with the manager. The manager began a process to investigate this. Staff records showed that staff had received training in moving and handling and health and safety.

The provider was not fully complying with regulations requiring that providers ensure that each service user was protected against the risks of receiving care or treatment that is inappropriate or unsafe.

You can see what action we told the provider to take at the back of the full version of the report.

The home environment was mainly safe from hazards and tidy. However, the building was not particularly suited for people who used wheelchairs, and some communal areas, such as the area where the public telephone was located posed a risk to people from being knocked by others.

Risks associated with people’s care needs, such as mobility or eyesight, were recorded and staff were aware of these and supported people appropriately. There were sufficient numbers of staff to support the people living in the home and there were adequate recruitment processes to ensure suitable checks were carried out on staff before taking up their post.

People using the service received support with their medicines from trained staff. People received their medicines safely with appropriate records kept. Where people were able to, they were supported in managing their own medicines.

We found care plans to be up to date and people’s changing needs were identified and acted upon appropriately. Staff sought people’s consent before they took action and people were supported to live as they chose in the home. However, none of the residents we spoke with knew what was meant by care planning or recalled having been spoken with about their needs. We discussed with the manager and Vipin Parkash Nayar, the managing director, the scope for developing people’s care records so that they fully involved the person, expressed more explicitly and directly the views and wishes of the people and described the agreed plan of care from their perspective.

People using the service told us that staff treated them with respect and they were happy living at the home. People told us the food was good and we saw that the menu of the day was clearly displayed on the board.

The service had a complaints procedure. However, people were not aware of it and were not clear how they would make a complaint. We observed good professional and friendly relationships between staff and people and staff were knowledgeable about people’s needs.

The provider and manager encouraged an open culture in the home and carried out quality assurance checks of the building and equipment. Residents meetings were held monthly, although several people told us that they thought they focussed too much on food and not enough about life inside the home.

People and visitors spoke warmly about the manager and staff and felt they were committed to people and their care. There was a positive ethos and Statement of Purpose which described the values and aims of the service and the rights of people. However, the provider was not doing enough to ensure that people were more aware of the policies and aims that had an impact on them. The provider was also not doing enough to ensure that the methods it used to seek people’s views and act on them were most appropriate to the needs of the people who live in the home.

The provider was not fully complying with regulations requiring providers to ensure that they regularly seek the views of people that include descriptions of their experiences of care and

treatment. This meant that the provider was not able to come to an informed view in relation to the standard of care and treatment provided to people.

You can see what action we told the provider to take at the back of the full version of the report.

During our unannounced inspection we spoke with 10 people using the service, two family members, a visiting entertainer, visiting professionals and four members of staff. We looked at the care homes policies and peoples care plans.

During our visit we observed that windows and the door to the garden were open and people could go where they wanted to. The home was bright and airy and some areas were being re painted. Staff told us, “People have choice; they choose what they want to do”.

People who used the service and relatives we spoke with told us the staff were kind and always available to chat to and they felt they could raise any concern or suggestion freely.

Visiting professionals told us, ‘we have found people to be well looked after and generally in very good health, people get good personal care here’

We saw that staff had regular team meetings and could access a variety of training.

We spoke with 10 people living at Nightingale House Care Home to find out what their experiences of living at the home were like. People we spoke with told us that the home was comfortable and very homely. One person said “there is plenty to do here and we can choose whatever we want to be involved in”, another person said “staff are lovely and everyone seems to get on with each other really well”. We spoke with one person who said “the home is very well run – it’s like my own home, and the manager and staff are all friendly and helpful”.

We spoke with several staff who told us that they were pleased to be working at the home and how staff worked well together as a team. Staff felt that they received effective support and told us that they could talk to senior staff when ever they needed to.

A relative of someone living at the home told us that they could rely on the home to provide the care and treatment their relative needed. They said “the home is excellent, they keep me informed and phone me regularly to let me know what is happening, I’m delighted with the care and how kind everyone is”.

People were very positive and complimentary about the support they received from the staff. They said they felt well cared for and that any suggestions they made were acted upon.

They told us that the staff were professional and competent in the support they gave them.

The atmosphere within the home was relaxed and friendly, with positive interactions between staff and the people who use the service.