We inspected Nightingale Nursing Home on 16 and 18 January 2018. The first day of our visit was unannounced. This meant the staff and the provider did not know we would be visiting.

Nightingales Nursing Home provides accommodation and nursing care for up to 38 older people. The service specialises in caring for older people and those who require palliative and end of life care. All accommodation and communal areas are on the ground floor with the majority of bedrooms having ensuite facilities. There is an enclosed courtyard garden for people to use. On the day of our inspection there were 34 people living at the service.

At the last inspection in December 2015, the service was rated Good. At this inspection we found the service remained 'Good'.

The service had 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.

People using the service told us they felt safe living at Nightingales Nursing Home. Relatives we spoke with agreed they were safe living there.

The staff team had received training on the safeguarding of adults and were aware of their responsibilities for keeping people safe from avoidable harm and abuse. The registered manager and the nursing team were aware of their responsibilities for keeping people safe and knew to refer any concerns on to the local authority and Care Quality Commission (CQC).

The risks associated with people’s care and support had been assessed and reviewed.

There were suitable numbers of staff deployed to meet the current care and support needs of the people using the service and to keep them safe. People we spoke with felt there were currently enough members of staff on duty each day because their care and support needs were being met.

People received support from a staff team that had the necessary skills and knowledge. New members of staff had received an induction into the service when they were first employed and training relevant to their role had been provided.

People were supported with their medicines in a safe way. We recommended the registered manager look into the suitability of the fridge used to store medicines to ensure they were being stored in line with manufacturer’s guidelines.

People were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time with others, or on their own. The staff team had received training in the prevention and control of infection and the necessary protective personal equipment was available.

People’s needs had been assessed prior to them moving into the service to make sure they could be met by the staff team.

The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 and Liberty Protection Safeguards (LPS) ensuring people's human rights were protected. Where people lacked the capacity to make their own decisions, we saw decisions had been made for them in their best interest. Where people required additional support to make decisions, advocacy support was available to them.

People's food and drink requirements had been assessed and a balanced diet was being provided. Records kept for people assessed as being at risk of not getting the food and drinks they needed to keep them well were up to date.

People were supported to maintain good health. They had access to relevant healthcare services and they received on-going healthcare support.

People told us the staff team were kind and caring and treated them with respect. Observations made during our visit confirmed this.

People had care plans in place, the majority of which were up to date and accurate. Those that were not, were updat

We inspected the service on 23 December 2015 and the visit was unannounced.

Nightingales Nursing Home provides accommodation for up to 38 older people. The home specialises in caring for older people and those who require palliative and end of life care. All accommodation and communal areas are on the ground floor. The majority of bedrooms have ensuite facilities. The home has an enclosed courtyard garden for people to use. At the time of our inspection 37 people were using the service.

It is a requirement that the home has 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. At the time of our inspection there was a registered manager in place.

People told us that they felt safe. Staff members knew how to keep people safe and how to report concerns. Equipment was being checked regularly and the provider had a plan of what to do for a range of emergency situations.

Risks had been assessed where these posed a risk to people but these had not always been thoroughly documented. For example, although staff knew the correct equipment people needed this was not recorded.

People told us that there were enough staff to keep them safe. Relatives and observations on the day of our visit confirmed this. We found that the recruitment of new staff included checks to make sure people were kept safe.

Medicines were being handled safely. People confirmed that they had received medicines when they had needed them. However, the recording of medicines was not always clear.

Staff had received support from their manager and had undertaken regular training. People were being supported by staff that knew their needs and preferences.

Staff understood their roles and responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People signed to say that they consented to the care and support offered and where they could not, this was documented.

People were satisfied with the food and drink available. Staff members knew the likes and dislikes of people and had fortified food where this was needed. Where people were at risk of dehydration, records were not always completed fully.

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Access to healthcare professionals was available and we found people’s health needs were being monitored. People’s records were updated daily to show any change to their health needs.

People told us that the staff were caring. The support staff offered was kind and thoughtful. We saw that staff supported people to be involved in decisions about their care. Information on advocacy services was not available.

There was information about people’s interests. However, we found that people’s life histories were not always documented.

Staff maintained the dignity and privacy of people. For example, staff were careful and discreet when sharing information about people.

Records were available about the support people required. However, the information was not always complete. For example, information on pressure ulcer care had directed staff about the support people needed but any follow-on action was not always recorded.

People could take part in activities which they were interested in if they chose to.

People contributed to the review of their care and support. Relatives confirmed that they had also taken part. We found that the recording of changes to people’s support needs was usually taking place.

People and relatives told us that they knew how to complain. We saw that where concerns had been raised, the registered manager had dealt with these effectively.

Staff told us that they felt supported by the registered manager and there were opportunities to raise concerns if they needed to.

Staff and relatives told us that

We recently undertook an inspection visit to Nightingales Nursing Home. We spoke with five people who used the service and reviewed four people’s care records. We spoke with two relatives. We spoke with two visiting health and social care professionals. We spoke with three staff supporting people and reviewed their recruitment and training records. We also reviewed the records in relation to the management of the service. We considered all the evidence we had gathered under the outcomes we inspected.

Is the service safe?

People told us they felt safe with the staff that supported them. They had access to medical support from health care professionals when required, which included the doctor and specialist nurses. People told us staff safely helped them with their daily care and support needs. One person said, “I’ve known about this home for a long time and told my daughter that when it was time, I would like to come here. The nurses are very caring and good to me.” Another person said, “I can’t do a lot for myself but I do enjoy playing dominoes and will get ready to join in later.” This person told us they ‘trusted’ the home’s staff to keep them safe.

People’s needs were met because the home employed suitably qualified nurses and care staff. People were effectively supported because staff were caring and trained to look after people in a dignified and respectful manner. Staff understood people’s needs. They were supported in their job role and were confident to raise any concerns they had about a person’s health.

People told us they felt both safe and secure because they were cared for in an environment that had been maintained. Equipment used to help support people safely was regularly serviced and maintained. The provider had taken steps to make sure all areas of the home were accessible and safe for people to use. Communal areas were furnished which made it homely and comfortable. People had decorated and personalised their rooms to reflect their interests and what was important to them.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Staff training records showed that relevant staff had been trained in the Mental Capacity Act 2005 and DoLS. The registered manager had acted in accordance with their responsibilities and referred people to the appropriate authority when they had any concerns about their capacity to make decisions. This meant that people could be confident that their best interests would be represented and that their wellbeing would be met assured.

Is the service effective?

People told us they were satisfied with the care that had been delivered and said their needs were met. Records we looked at showed that people’s nursing needs were met by the qualified nurses and care staff. People had access to support from a range of health care professionals to ensure their health needs were met.

People were provided a choice of nutritious meals and drinks that suited their dietary needs and preferences. All the meals were prepared by the catering staff who took account of people’s preferences to make sure suitable meals were prepared. One person said, “I have to say the meals are very tasty and there’s usually a choice of two or three things." Another person told us, “I prefer to have my meals in my room because I have to have my oxygen cylinder with me all the time.” We observed staff supported some people to eat their meals in a sensitive manner; offering encouragement and conversation that made the meal time experience enjoyable.

Relatives we spoke with had high praise about the quality of care provided. They told us the home’s staff supported people safely to help maintain their health and wellbeing. One relative said, “We don’t worry about my mother because we know she’s really well cared for and it’s safe. They call us if she’s not well but we know they would have already got the doctor in to see her.”

Staff told us they were trained for their job role to help ensure people’s needs were met reliably. Staff training certificates and the training matrix we looked at confirmed the provider had taken steps to ensure staff kept their knowledge and skills up to date and in line with current best practice.

Is the service caring?

Our observations of the care provided showed that people were supported by kind and attentive staff. Staff understood people’s needs and helped them to do things at their own pace. People were confident to ask for help and the staff listened and acted on requests promptly. Records we looked at showed us that people’s wishes for their care and support were taken into account and respected. One person said, “I’ve only been here a short while and everyone’s been really nice and have helped me to settle in."

Health care professionals told us people were ‘well cared for’ and that the home’s staff understood the needs of people that they looked after. They explained that people’s last wishes were respected by the home’s staff who also supported their relatives, often at a difficult time.

Is this service responsive?

People’s needs had been assessed before they moved into the home and checked regularly to make sure any new needs would be met. Records we looked at showed people were involved in reviewing their care needs and any decisions that they made were recorded. Staff sought appropriate medical advice from the doctor or specialist support from services such as LOROS and the McMillan Nurses, when required. Records we looked at confirmed that care and support had been provided in accordance with people’s wishes.

People were confident to raise concerns and make comments to the registered manager about the quality of care they received.

Is this service well led?

People were involved in their care to make sure any new care needs could be met reliably. Care records and other documents we looked at confirmed people’s needs were met by qualified nurses and trained staff. Records showed the home’s staff worked with other health and social care professionals to help ensure people received care and support that was co-ordinated and managed.

The home had a system in place to assure the quality of service they provided and acted on any feedback and comments received. This included satisfaction surveys to gather the views of people who lived at the home and relatives or their representatives, and meetings to review of people’s care needs. Regular meetings were held at the home where people made decisions about social events. They also had the opportunity to comment on any proposed changes to the home that could affect their wellbeing.

People were confident to make complaints and suggestions to help ensure continued improvement to the quality of service that was provided. All complaints were handled and responded to promptly and in a consistent way. Relatives and health care professionals were confident that any concerns or suggestions made to improve the quality of care people experienced would be acted on promptly.

Systems were in place for regular checks to be carried out that ensured the health and safety of everyone was protected. Information from analysis of incidents and accidents had been used to identify changes and improvements to minimise the risk of them happening again. Records showed that the provider acted promptly to improve the service and put right any shortfalls that were found.

We spoke with one person who used the service and two relatives of two other people. All three were enthusiastic and complimentary about the care provided by the home. All three told us that they had chosen the home above others they had visited because it specialised in palliative (end of life) care.

The person who used the service told us they had been involved in the assessment of their needs and discussions about how they wanted to be supported. They spoke to us about the choices they had and told us, "I can get up when I want and go to bed when I want. I choose my meals and where I eat them. No one tells me what to do."

Relatives were very complimentary about the quality of care that had been provided. One relative told us, "The home has dealt really well with health issues. Lots of love has been shown by the staff. I've no concerns about the care. I can go to bed at night knowing she is safe and cared for." Another relative said, "I'm wholly and absolutely satisfied with the care my mother receives. Everyone from the manager to cleaning staff has been positive."

What people told us about their experience of the care was consistent with evidence we saw in care plans, other documentation and our observations. Staff were attentive to people's needs and spoke and supported people in a kind and reassuring manner.

The provider's recruitment procedure required improvement

The provider had effective processes for monitoring the quality of care provided.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience” and a "practising professional" (people who have experience of using services and who can provide that perspective).

We spoke with six people who used the service and three relatives who visited the home during our inspection. All of the people we spoke with made positive comments about the home. Comments which were representative of what people who used the service told us included: “Staff are very attentive, anything I want or need they will do it”; “I feel very safe here. The staff treat me with respect and care for me well here”; “I enjoy the food and there are always alternatives”; “There always seems to be plenty of staff on duty, even at night.”

One relative told us, “I couldn’t fault the care. Staff are marvellous, the food is marvellous. I’m here every day. I don’t miss anything.”

We spoke to some of the people who used the service and to some people’s relatives. People told us that they were very satisfied with the quality of the service they received. The comments these people made included;

“Everything here is good.”

“This place is brilliant, they have been fantastic.”

“All the staff seem very good.”

We spoke to some of the people who used the service and to some people’s relatives. People told us that they were very satisfied with the quality of the service they received. The comments these people made included;

“Everything here is good.”

“This place is brilliant, they have been fantastic.”

“All the staff seem very good.”