Nightingale is a purpose built, two-storey care home situated in the Ecclesfield area of Sheffield. It can accommodate up to 40 people who require personal care for older people and those living with dementia. It is located near a shopping area and is close to a supermarket, a chemist and a bank. It is accessible by public transport.

This inspection took place on 6 April 2017 and was unannounced. This meant the people who lived at Nightingale and the staff who worked there did not know we were coming. On the day of our inspection there were 39 people living at the home.

There was no registered manager at the time of this inspection. The previous registered manager had left and the provider had appointed a new manager, who had started the process of applying to be registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Nightingale took place in May 2016. At that time we found two breaches of the Health and Social Care Act 2008 regulations in regard to staffing, and person-centred care. At this inspection we saw that the provider had made real improvements in these areas, in that there were enough staff to meet everyone’s needs. Staff received regular supervision and appraisal. People’s needs were being considered and met and they were being offered a good choice of food and drinks.

We found that people were protected from abuse. Staff we spoke with had a good understanding of safeguarding people.

People told us they liked living at Nightingale.

Thorough staff recruitment procedures were in place, which meant that people were cared for by suitably qualified staff who had been assessed as safe to work with vulnerable people.

The service had systems in place for the safe storage and administration of medicines.

We found the service to be meeting the requirements of the Mental Capacity Act. The provider had ensured that applications were made to the Local Authority for Deprivation of Liberty Safeguards (DoLS) to be authorised when appropriate.

People were supported to maintain good health, have access to healthcare services and they received on going healthcare support.

Care records were personalised and contained relevant information to enable staff to provide person-centred care and support. People and their advocates had been involved in their care and support planning.

The care records we looked at included risk assessments, which identified any risks, associated with people’s care. Detailed plans were in place to support people to minimise these risks.

There was an activities coordinator and a varied programme of activities and entertainment was made available to people.

The provider had a complaints procedure in place. People felt they could speak with the manager if they had a concern and get a good response.

People living at Nightingale and staff working there, told us the new manager was approachable and responsive to any concerns they had.

There were effective systems in place to monitor and improve the quality of the service provided.

Staff, people who lived at the home and their relatives were regularly asked for their thoughts and opinions of the home, and were given opportunities to give suggestions to improve the home.

Nightingale is a purpose built, two-storey care home situated in the Ecclesfield area of Sheffield. It can accommodate up to 40 people who require personal care for older people and those living with dementia. It is located near a shopping area and is close to a supermarket, a chemist shop and a bank. It is accessible by public transport.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Nightingale took place on 5 November 2013. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 30 March 2016 and was unannounced. This meant the people who lived at Nightingale and the staff who worked there did not know we were coming. On the day of our inspection there were 38 people living at the home.

We found that people were protected from abuse. Staff we spoke with had a clear understanding of safeguarding people and they were confident their managers would act appropriately to safeguard people from abuse.

People told us they liked living at Nightingale. One person told us, “I love it here.”

Thorough staff recruitment procedures were in place, which meant that people were cared for by suitably qualified staff who had been assessed as safe to work with vulnerable people.

Staff received training and some support to undertake the job they were employed to do. However, not all staffed received regular supervision or a yearly appraisal.

The service had systems in place for the safe storage and administration of medicines.

There were not enough staff to meet everyone’s needs in a timely manner. Staff we spoke with told us there weren’t enough staff available. We saw people having to wait for support to go to the toilet, and waiting when two carers were needed to support a person to move safely.

We found the service to be meeting the requirements of the Mental Capacity Act. The registered manager had applied to the Local Authority for Deprivation of Liberty Safeguards (DoLS) to be authorised for several people living at Nightingale.

People were supported to maintain good health, have access to healthcare services and receive on going healthcare support.

Care records were personalised and contained relevant information to enable staff to provide person-centred care and support. People and/or their advocates had been involved in their care and support planning.

The care records we looked at included risk assessments, which identified any risks, associated with people’s care. Detailed plans were in place to support people to minimise these risks.

People were offered a limited selection of food and drinks. People told us they would like more choice, and more drinks to be served with their meals.

There was an activities coordinator employed at Nightingale and a programme of activities available to people.

The complaints process was clear, up to date and readily available to people living at Nightingale and their visitors. We saw a record was kept of all complaints that were received, the response given to the complainant and any action taken to rectify the complaint.

People living at Nightingale and staff working there, told us the registered manager was approachable and responsive to any concerns they had.

There were effective systems in place to monitor and improve the quality of the service provided.

Staff, people who lived at the home and their relatives were regularly asked for their thoughts and opinions of the home, and were given opportunities to give suggestions to improve the home.

During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Acti

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Food and drink met people’s individual dietary needs. One person said, “The food is alright, there’s a choice of food. We get plenty of drinks throughout the day.”

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People we spoke with said that they felt safe and supported by the staff.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

Some people living at the home had complex needs and required dementia care and were not able to verbally communicate their views and experiences to us. Due to this we used a formal way to observe people at this inspection to help us understand how their needs were supported. We call this the 'Short Observational Framework for Inspection (SOFI).

During the observation we saw some examples of good communication skills by some staff that utilised eye contact and touch to engage people who used the service. We did see some practices by staff though that did not engage or communicate with people effectively.

People that we could communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People's comments included "the food is very good, we get a drink mid morning. We’re well cared for," "they’re (staff) very good, no complaints," "they’re (staff) very nice, we have a chat," “they’re (staff) friendly and polite.

We spoke with one relative who was visiting the home and they confirmed that they were very happy with the care provided. They told us, "the (cleanliness) is very good. Anything I want to know the staff will help, or I’ll go to the manager. They’ve been very good. I’m happy with everything so far."

Due to people’s medical conditions they were unable to tell us much, however we observed positive interaction between people and staff. People were smiling and joining in with activities. One person showed us their room and said they were happy.

We spoke with some relatives who said they were happy with the care received and staff were very approachable.

We spoke to four people who use the service during our inspection. People told us they were happy with the care provided and were able to ask for help and support when they needed it.

One person told us they were able to choose what time they got up and went to bed and they were given choice about the food they ate. However, one person told us the food was nice but there was not enough of it. They also told us they did not get involved with their care plan or reviews of their care and welfare needs. None of the other people using the service we spoke with referred to food shortages.

One relative told us that they had not been involved in the development of their relatives care plan, but this had been their choice. However, they had completed a questionnaire earlier in the year which contributed to meeting the care needs of their family member. Another relative told us they did not receive any communication from the home regarding their relatives care and had not been invited to any meetings.

One relative we spoke to told us the staff were very good, caring, and approachable. They had no complaints and would recommend the home. They also told us they are contacted by the home straight away if their family member requires any treatment. Two relatives confirmed they would talk to the manager if they had any concerns.