This announced inspection was carried out on 29 and 30 May 2018. Nightingales Homecare provides support and personal care to people living in their own homes in the Oldham area of Greater Manchester. At the time of our visit there were over 150 people using the service

The service had a registered manager in place at the time of our inspection. 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.

This was the first inspection of this service at their current address, but we had inspected Nightingales Homecare in December 2014. At that inspection we found a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) in that the recruitment records for new staff did not contain enough information to determine their suitability to work with vulnerable people. At this inspection we found that safe recruitment policies had been adopted, with all employment checks undertaken.

During this inspection however, we found that there were no systems in place for the registered manager and owner to evaluate and improve practice, or undertake audits and checks to monitor and improve service delivery This was a breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014.

People who used the service and their relatives told us that they felt safe. They said that staff were attentive to people’s safety, especially when leaving people’s homes. Care staff understood how to keep people safe, and any potential risks were assessed as an ongoing process. We saw that care staff were given time to complete their tasks, and had some flexibility with their rotas so that they could arrange visits at times most convenient to the people they supported. When we asked, people who used the service and their relatives were happy with the times of their visits and the continuity of their care.

All staff new to care completed the Care Certificate, and we saw all staff employed by Nightingales Homecare had, or were working towards appropriate health and social care qualifications. Staff understood the importance of infection control and had been trained to administer medicines safely. They were knowledgeable about diet and nutrition, and when we asked people for whom care staff prepared meals they told us the food was cooked to their liking.

People were well cared for by friendly and accommodating staff, who, we were told, always asked for consent before completing tasks. Staff were not rushed and spent time talking with the people they supported, and ensured that care was delivered the way people wanted it to be. The care staff we spoke with could tell us how they had supported people nearing the end of their life to die with compassion and dignity. The service had received few complaints, but when people did complain about the service we saw that appropriate action was taken to follow up and respond to the complainants.

There was information in people’s care records to guide staff on the care and support needs required and this included information about their likes and preferences. However, care plans kept in people’s own homes were not always up to date, and contained some incorrect details about the care and times of visits. Although care plans were reviewed on a regular basis, the reviews emphasised the delivery of care rather than focussing on any changes in need for the person.

People who used the service and the staff we spoke with told us the service was well run. They informed us that they were listened to, and felt comfortable speaking to any of the staff if they had any concerns. Staff worked in small teams which meant that the number of people providing care and support was kept to a minimum and