This inspection was completed on 15, 16 and 17 January 2019 and was announced. The provider was given 48 hours’ notice of the inspection because the service provided was domiciliary care in people’s own homes and we wanted to make arrangements to contact people.

Nightingales Home Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. Not everyone using Nightingales receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were 45 people receiving the regulated activity of ‘personal care’ at the time of the inspection.

There was no registered manager in post at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was in the process of recruiting a new manager who would register with the Care Quality Commission. A representative of the provider was acting as manager at the time of the inspection.

The previous inspection was completed in October 2017 and the service was rated ‘Requires Improvement’ overall. At that inspection we found one breach of the regulations. The records relating to the management of medicines were not always complete, and quality assurance systems at the service were not always effective in identifying shortfalls in the service.

At this inspection, we found improvements had been made and the service has been rated ‘Good’ overall.

People received safe care and treatment. Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient numbers of staff working at the service. There was a robust recruitment process to ensure suitable staff were recruited.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. The staff we spoke with had a good understanding of people’s needs and the risks associated with their care. Where people had suffered an accident, themes and trends had been analysed, and action had been taken to ensure people were safe and plans put in place to minimise the risk of re-occurrence.

Staff had received training appropriate to their role. People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities.

People were supported in an individualised way that encouraged them to be as independent as possible. People were given information about the service in ways they wanted to and could understand.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and could describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. Where required, people were supported to make decisions about end of life care which met their individual needs and preferences.

The service was well led. People, staff and relatives spoke positively about the management. Quality assurance checks were in place and identified actions to improve the service. The service sought feedback from people and their relatives to continually improve

The inspection took place on 11 and 25 October 2017. This was an announced inspection. The provider was given 48 hours’ notice of the inspection because the service provided was domiciliary care in people’s own homes and we wanted to make arrangements to contact people. The service was last inspected in June 2016 and was rated ‘Requires Improvement’ overall. At this inspection we found improvements had been made relating to the shortfalls found at the last inspection. However, further improvements were still required and the service has been rated ‘Requires Improvement’ overall.

Nightingales Home Care was established in 1998. Nightingales Home Care provides care and support to people in their own homes. The service is registered to provide personal care. At the time of our inspection 56 people were using the service.

There was a new manager working at Nightingales Home Care. They told us they had been working for the service for the last four months. An application has been received in respect of the new manager being registered with the Care Quality Commission. 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 on 28 and 29 June 2016, we asked the provider to take action to improve the content of risk assessments to ensure they contained sufficient levels of detail and improve care plans to make them person centred. Following the inspection, the provided submitted an action plan detailing how they would address the shortfalls and meet the requirements of the regulations. The provider told us all of the actions would be completed by March 2017. At this inspection we found this action had been completed and the provider had met the requirements of this regulation.

The service was not always safe. The recording of people’s medicines had not always been completed accurately. People did not always receive care calls at the times agreed in their contract. Risk assessments were implemented and contained clear guidelines for staff on how to support people and minimise risk levels. People were protected from the risk of abuse. Staff had received training around this. There were safe and effective recruitment systems in place.

The service provided to people was effective in meeting their needs. Staff had the relevant skills and had received appropriate training to enable them to support people. Staff received good support from management through regular supervisions and appraisals. People were encouraged to make day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the staff had acted in accordance with legal requirements. Where required, people and relevant professionals were involved in planning their nutritional support. Where required, people were support to access a variety of healthcare professionals and appointments were arranged.

The service was caring. People and their relatives spoke positively about the staff. Staff demonstrated a good understanding of respect and dignity. People’s preferences in relation to their cultural or religious backgrounds were clearly recorded. Equal opportunities and diversity were promoted throughout the service.

The service was responsive to people’s needs. People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities. Where complaints had been made, there was evidence these had been managed appropri

The inspection took place on 28 and 29 June 2016. The last inspection took place in May 2013. There were no breaches of regulation at that time.

Nightingale Home Care was established in 1998. Nightingale provides care and support to people in their own homes. The service is registered to provide personal care. At the time of our inspection around 30 people were using the service.

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 was not always safe. Risk assessments were implemented but did not contain sufficient detail to enable staff to manage risk effectively and provide safe care. People were protected from the risk of abuse. Staff had received training around this. There were sufficient numbers of staff to ensure people received the support they required. Where required, medication administration, recording and storage was safe.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA). Where required, people were supported to meet their nutritional needs.

The service was caring. People and their relatives spoke positively about the staff. Staff demonstrated a good understanding of respect and dignity. It was evident people were receiving a service which was personalised to their individual needs.

The service was not always responsive. Not all care plans were person centred or contained sufficient detail to provide safe and quality care to people. Care plans were not always reviewed regularly. People informed us they were involved in the planning of their care. There was a robust complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

The service was well-led. Quality assurance checks and audits were occurring regularly and identified actions required to improve the service. Staff, people and their relatives spoke positively about the registered manager.

We undertook this inspection to review the response of the agency to compliance actions issued following the previous inspection in January 2013. The agency had completed all of the actions which we asked it to review. We found that Nightingales Home Care was providing a good quality service which had respected the privacy and dignity of people who used the agency. Initial assessments and reviews conducted by the agency had consulted with people who used the service and recorded how they wished to be supported. People told us:” that staff are very, very good" and” that they are the best carers that I have ever come across”. The agency had a stable group of staff and had not been required to recruit new staff. There were sufficient skilled and experienced staff to safely meet the needs of people who used the service, and to enable the agency to accept new referrals. The content of induction and subsequent training for staff was of a good standard. The provider had also reviewed how it ensured that staff were able to attend refresher training sessions. The quality assurance monitoring systems, used to safeguard people using the service and to seek their views of the quality of care, had also been reviewed and updated.

In summary, this inspection found that Nightingales Home Care had provided a good standard of care and support to the people using their services.

We found that Nightingales Home Care was providing a service which had respected the privacy and dignity of people who used the agency. Initial assessments and reviews conducted by the agency had consulted with people who used the service and recorded how they wished to be supported. People told us:” that staff are very friendly" and” that staff listen to me ". There were sufficient skilled and experienced staff to safely meet the needs of people who used the service, and to enable the agency to accept new referrals. There is also a relatively stable and experienced staff group working for the agency. There had been no requirement to recruit new staff over the last year. The content of induction and subsequent training for staff was of a good standard. Staff had not however, always attended refresher training sessions. The quality assurance monitoring systems, used to safeguard people using the service and to seek their views of the quality of care they received, must be reviewed and recorded. In summary, this inspection found that Nightingales Home Care had provided a good standard of care and support to the people using their services.