About the service: Nightingale Social Care Staffing Agency is a domiciliary care agency. It provides personal care to people in their own flats and houses in the community. At the time of the inspection it was providing personal care to 48 people.

Following the previous inspection in August 2018, a condition was placed on the provider’s registration to ensure all staff were provided with regular support mechanisms. This included checks on their competency, supervision and appraisal. At this inspection we found the service had arranged for staff to receive these checks and support, but they had not consistently been kept up-to-date in line with the provider’s policy. Following the inspection, we removed the condition on the provider’s registration but found a continued breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s experience of using this service:

Whilst the service had introduced systems to assess staff competency, supervision and appraisal these had not been consistently kept up-to-date in line with the provider’s own policy.

People provided positive feedback about the agency. They said staff were kind and caring and treated them well. Most people said they were happy with call times and received appropriate person-centred care and support.

Risks to people’s health and safety were appropriately assessed and mitigated. The service had electronic call monitoring in place to enable office staff to monitor staff in real time, helping to improve the safety of the service.

Staff received a range of training and support. However, the turnover rate was high with some staff saying they did not feel fully supported by management.

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 generally supported this practice.

There were enough staff deployed in the right places to ensure people received a reliable service. Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people.

A range of audits and checks were undertaken to help monitor the quality of the service. Some of these needed to be made more robust to ensure that the service consistently met CQC standards.

We made a recommendation for the provider to put in place a strategy to help support and retain staff.

Rating at last inspection: The service was last rated Requires Improvement in August 2018.

Why we inspected: We inspected Nightingale Social Care Staffing Agency to follow up on the conditions placed on the provider’s registration in December 2018 and to re-rate the service following the pervious inspection in August 2018.

Follow up: We will request an action plan detailing how the provider aims to make improvements to its governance arrangements. We will meet with the provider to discuss the improvements they intend to make to the service. We will re-inspect the service in the future to determine whether improvements have been made.

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

The inspection of Nightingale Social Care Staffing Agency Limited took place between 1 and 20 August 2018. We previously inspected the service on 13 December 2017 and 3 January 2018, at that time we found the registered provider was not meeting the regulations relating to safe care and treatment, staffing, fit and proper persons employed and good governance. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. At this inspection we found sufficient improvement had been made to meet the regulation relating to safe care and treatment and fit and proper persons employed. The regulations relating to staffing and good governance had not been met.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to adults, on the day of our inspection 46 people were receiving care and support from Nightingale Social Care Staffing Agency Limited.

The service had a registered manager in place. 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.

People we spoke with told us they felt safe. Staff were clear about their responsibilities in keeping people safe and we saw relevant risk assessments were in place.

People we spoke with told us staff were often late for their calls. Staff we spoke with told us their rotas did not always allow them sufficient time to travel between calls. When we reviewed electronic call logs we found the time allowed between calls was not always sufficient.

Staff received regular face to face medicines training, but an assessment of their ability to manage people’s medicines when supporting people was not always completed. The system in place to audit people’s medicine records was not robust.

Staff supported people to have maximum choice and control of their lives, although we identified one person where records did not evidence that the full requirements of the Mental Capacity Act 2005 were being followed.

People told us staff were kind and caring. People were predominantly supported by people who knew them well. Staff respected people’s privacy, took steps to maintain their dignity and maintained confidentiality.

Care plans recorded when people needed support with meals and drinks. We saw evidence staff left people with drinks and snacks to eat between their scheduled calls.

People had a care plan in place which was detailed and person centred. There was no system in place to ensure care plans were reviewed at regular intervals, where changes had been made to people’s call times, care plans had not been updated to reflect this.

The service provided care and support for people whose primary need was end of life care. There was no information recorded regarding the persons preferences and not all staff had received appropriate training. We have made a recommendation regarding end of life care.

People knew how to complain and we saw information was provided to people and their relatives regarding the complaints procedure.

Most of the staff we spoke with were unhappy with how the service was being run. Staff received induction and training was updated at regular intervals, although we have made a recommendation about training in end of life care. However, staff had not received regular supervision, appraisal or had based assessments of their performance completed on a regular basis. There had been no staff meetings for community staff since September 2017.

The registered manager had not addressed all the shortfalls identified at the previous two inspections. The registered manager had failed to implement a systematic and robust system of audit. An action pl

The inspection of Nightingale Social Care Staffing Agency Limited took place on 13 December 2017 and 3 January 2018. We previously inspected the service on 27 October 2016; at that time we found the registered provider was not meeting the regulations relating consent, safe care and treatment, managing complaints, safe recruitment and good governance. We rated the service Requires Improvement. The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

This service is a domiciliary care agency. It provides personal care to older adults living in their own houses and flats in the community. At the time of our inspection Nightingale Social Care Staffing Agency Limited were providing care and support to 41 people.

The service had a registered manager in place. 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 also the registered provider; they were involved on a daily basis in the management of the service.

Although people told us they felt safe, we found aspects of the service that were not safe. We found concerns identified at the previous inspection had not been addressed. Where staff had to use a hoist to move people, a risk assessment was not put in place until an assessment had been completed by an occupational therapist; this meant there was a delay..

Staff recruitment was not robust, a risk assessment had not been completed for a staff member regarding a disclosure from the Police National Database and a gap in a candidate’s employment history had not been explored. Staffing levels were sufficient to meet people’s needs.

A care co-ordinator had completed an audit of people’s medicine records and subsequent changes had been made but improvements were still needed to ensure the management of people’s medicines were safe. There was no evidence to show staffs competency to administer medicines was assessed and records lacked information regarding some people’s medicines.

New staff were supported in their role, which included training and shadowing a more experienced staff member. We saw evidence staff had received regular ongoing training in a variety of subjects. Staff had not received regular supervision or field based observational assessments of their performance.

People received support to eat and drink although we reviewed the care file for one person which lacked information regarding their specific dietary needs and how staff needed to support them with drinks to reduce the risk of choking. This matter had been addressed when we visited the service for the second day of the inspection.

Staff were able to access relevant healthcare professionals if their input was required.

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. We saw evidence people had given their consent to the care and support they were receiving. Where people lacked capacity, a capacity assessment had been completed and there was evidence of best interest’s decision making.

People we spoke with told us staff were caring and kind. Staff treated them with respect and took steps to maintain their privacy. Staff were able to tell us about the actions they took to maintain people’s dignity and ensure people’s private information was kept confidential.

People had a care plan in place which was person centred and provided sufficient detail to enable staff to provide the care and support required by each individual. Staff made a record of the care they p

The inspection took place on 27 October 2016 and was announced. The manager of Nightingale Social Care Staffing Agency Ltd was given 48 hours' notice of the inspection. We did this because we needed to be sure that the manager and some office staff would be present to talk with.

Nightingale is a domiciliary care agency that provides personal care and support approximately 1000 hours per week to people in their own homes in the Barnsley area. They are registered to provide the regulated activity of personal care.

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.

The service did not have safe recruitment procedures as there were not adequate pre-employment checks carried out, and where risks were found these were not investigated and mitigated.

We found the management of medicines was not in line with good practice. The management of medicines was not safe, and the records relating to medicines were not always correctly completed or audited.

People's needs had been assessed when they started to use the service but not all care plans were reviewed and up to date.

There were some systems in place to assess and monitor the quality and safety of the service provided. However some of these were not effective, and in some cases information was not acted upon to ensure care provided was adequately monitored, risks were managed safely and the service achieved compliance with the regulations.

Staff told us they received supervisions and appraisals, however not all staff received an annual appraisal of their performance.

There was no system to monitor accidents and Incidents . This meant there was no process for managers to learn from such events and put measures in place to try and ensure they were less likely to happen again.

Generic risks to people were identified. However, specific risks and the measures required to protect people were not always evident. Moving and handling care plans did not include detailed methods for staff to follow.

The registered provider had not understood their responsibilities under the Mental Capacity Act 2005 and no capacity assessments or best interest decision had been recorded.

There was no evidence of best interest arrangements being pursued where people lacked the capacity to consent, meaning that decisions were made for people without appropriate legal processes being followed.

Our inspection confirmed staff had received training in how to keep people safe. The staff we spoke with showed they understood their role in safeguarding people from abuse. They told us they had undertaken safeguarding training and would know what to do if they witnessed bad practice or other incidents that they felt should be reported.

Staff received regular training to develop skills and knowledge in their role.

Staff knew how to ensure privacy and dignity were protected at all times.

Staff spoke highly of the registered manager and the organisation and told us they were supported in their role.

We found six breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 12; Safe Care and Treatment, Regulation 11; Need for consent and consent, Regulation 16; Receiving and acting on complaints, Regulation 17 Staffing; Good governance. Regulation 18;Staffing, Regulation 19 Fit and proper persons employed.

At the time of our inspection, Nightingale Social Care provided support to approximately 127 people. We spoke with 16 people via telephone who were using the service and eight relatives of people using the service to obtain their views. We spoke with the registered manager and seven members of staff. The seven staff members consisted of two care co-ordinators (one of whom also worked as a senior support worker) and five support staff.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People told us about staff, “They know what to do, if they’re unsure they ask”, “They always ask (my relative), they don’t rush.”

People experienced care, treatment and support that met their needs and protected their rights. People told us, "I won’t hear a bad word said about them, they’re absolutely fantastic with me”, “Quite satisfied” and “They’re very efficient.”

Where people were assisted and/ or prompted with their medication, people told us, “They give me my medication, it’s never been missed yet”, “They put my tablets in a pot, always been ok.” Staff were appropriately trained and appropriate policies and procedures were in place around medication.

There were enough qualified, skilled and experienced staff to meet people’s needs.

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

We talked to three people who used the service including two relatives by telephone during our inspection visit. People told us peoples privacy and dignity was respected, they were happy with the personal care they received and liked all the staff that provided care for them. The people we talked to also confirmed they had been involved in the planning of their care. They confirmed that members of staff generally came at the agreed time and stayed and looked after them for the agreed period of time. Some comments captured included, "They (Staff) are really nice carers", "[staff] are brilliant", they (Staff) are second to none and "I could not have picked a better agency.” We talked to two relatives of people who used the service who explained how they were very happy with their family member's care. Some comments captured included, "My wife is very well looked after", "we've built up an excellent relationship with the care staff "and "I can't fault them, really good (staff)."

People told us that they felt safe, and if they had concerns they would speak with a family member, friend or somebody from the office.