What life is like for people using this service:

Fire safety procedures and checks were not effective and maintenance of fire doors did not keep people safe from the risks of fire.

People did not always receive effective and safe support with their medicines.

Care and support plans for people did not reflect their current needs and did not give sufficient instructions to the care team on how best to support them. Care and support assessment and planning did not follow best practice.

People did not have effective and personal end of life care plans.

People’s individual protected characteristics were not clearly identified. The instructions to staff on how to promote people’s identity was unclear.

People’s privacy was not always respected by those working at the home.

People’s individual communication needs had not been assessed in line with best practice.

The provider did not have effective systems in place to monitor the quality of the service they provided or to drive improvements where needed.

The provider and registered manager failed to submit notifications of important events to us in a timely manner.

People’s privacy was not always respected by those working at Nightingales Residential Home.

People felt that the activities that were available were limited and that at times they felt unstimulated.

Staff members had access to training and felt supported in their role. New staff members completed a structured introduction to their role.

People were referred to additional healthcare services when it was required.

People received help and support from a kind and compassionate staff team with whom they had positive relationships with.

The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

People were protected from the risks of abuse and ill-treatment as the staff team had been trained to recognise signs of abuse or risk and knew what to do to safely support people.

The provider followed effective infection prevention and control procedures.

The provider and management team had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection: Good (Last report published 02 March 2016).

About the service: Nightingales Residential Home is a residential care home that accommodates up to 23 older people some of whom were living with dementia. At the time of our inspection there were 20 people living at the home.

Why we inspected: This was a planned inspection based on the rating at the last inspection, ‘Good.’ At this inspection we found concerns with the service and the support provided. Therefore, we have rated the service requires improvement overall.

This inspection took place on 4 January 2016 and was unannounced. The provider is registered to provide accommodation and personal care to 23 people at Nightingale Residential Home. On the day of our inspection 15 people lived at the home.

There was a registered manager in post and she was present during 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 and associated Regulations about how the service is run.

People told us they were happy with the services provided. They felt staff understood their needs and they felt safe. People were assured that there were sufficient numbers of staff that had acquired the skills they needed through training and experience to meet their needs. Recruitment procedures were robust and protected people from the poor practice of unsuitable staff compromising their safety.

Medicines were securely stored and medicines were competently administered to people by staff in a timely way. Community healthcare professionals were appropriately consulted, and their advice and prescribed treatments acted upon, to help sustain people’s health and wellbeing.

People said they enjoyed their food and had plenty to eat and drink. They enjoyed a varied and balanced diet to meet their nutritional needs. Meal portions suited people’s appetites and choices of food suited people’s individual preferences and tastes. People who needed support with eating or drinking received the help they required.

People were given choices about their care and support. This enabled people to be involved in the decisions about how they would like their care and support delivered. Staff understood their caring roles and responsibilities and were motivated to do a good job. Their manner was friendly and they encouraged people to retain as much independence as their abilities allowed. There were spontaneous as well as regularly organised social events to stimulate people’s interests.

We saw people were treated with dignity and respect. People told us that staff looked after them well and were kind. It was evident to us from what we saw that staff knew what mattered to people, were polite.

People knew how and who to complain to. They were assured that they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction.

People’s quality of care was effectively monitored by the audits regularly conducted by the management team and the provider which showed they were continually looking at how they could provide better care for people.