This unannounced inspection took place on 23 February 2017. At the last inspection, the service was rated with an overall good although some improvement was needed regarding the provider’s understanding of Deprivation of Liberty Safeguards. We found there had been an improvement.

Nightingales is a residential home providing accommodation for up to 13 people with support needs including some people living with early onset dementia. At the time of our visit 11 people were living at the home.

The manager, who is also the provider, was registered with the Care Quality Commission (CQC), as required by law and was present during the day. 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 improvement was needed because we found that some people, living at the home, were being restricted without the correct legal processes being in place. The provider’s and staff members’ understanding of what could constitute a restriction of somebody’s liberty also required some improvement. At this inspection we found the provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests and staff had received updated training.

People and relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes. Risks to people were being monitored and staff identified risks to people and explained how those risks should be managed. Staff had a good understanding of the risks and the action that was required. Appropriate equipment was in place to ensure the risk of harm to people was minimised. The care plans and risk assessments were reviewed and updated regularly.

We saw all staff were busy but were available to provide support to people when needed. This included support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. The provider’s recruitment processes ensured suitable staff were safely recruited.

People received appropriate support to take their prescribed medicines and records were kept of the medicine administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.

People were assisted by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff were knowledgeable on how to support people effectively and that staff possessed the necessary skills.

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.

People were complimentary about the quality of food and were supported in their choice of meal. We saw people accessed snacks and hot and cold drink at regular times throughout the day. Health care professionals visited the home on a regular basis and people received treatment when needed which helped to promote their health and well-being.

People's care records contained information relating to their specific needs and there was evidence that the care plans were updated when people's needs changed. People and relatives

There were 11 people living at the home on the day of our visit, no one knew we would be visiting. We spoke to four people who lived at the home, two relatives, three staff, one visiting professional, and the manager.

Some of the people who lived at the home had dementia care needs. People with dementia are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them.

People told us and we saw that that people's views were sought and acted upon. Staff spoken to was able to tell us about people's needs so that they received care in a way that they preferred. Both relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care. One relative said “I have been involved in the care planning of my relative’s care.’’

Medicines were prescribed and given appropriately to the people who used the service. One person said, “I always get my medicines on time.’’

There were systems in place to monitor how the home was run, to ensure people received a quality service. A relative told us, “They provide an excellent service.’’

People's complaints and concerns were fully investigated and resolved where possible. One person said, “If I had any concerns it wold be sorted straight away."

There were 11 people living at the home on the day of our visit, no one knew we would be visiting. We spoke to four people who lived at the home, two relatives, three staff, one visiting professional and the manager.

Some of the people who lived at the home had dementia care needs. People with dementia are not always able to tell us about their experiences so we looked at records relating to their care and observed staff caring for them.

People told us and we saw that that people's views were sought and acted upon. Staff spoken to was able to tell us about people's needs so that they received care in a way that they preferred. Both relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care. One relative said ‘’I have seen X’s care plan and attended care reviews’’

We saw that people were relaxed in their environment and that systems were in place to keep people safe from harm. A relative told us ‘’Staff are friendly and helpful.’’ Staff received a range of training so that they had up to date knowledge and skills in order to support the people who lived in the home.

There were systems in place to monitor how the home was run, to ensure people received a quality service.

The inspection took place on 17 and 18 December 2014 and was unannounced. At the last inspection in August 2013 we found that the provider was meeting the requirements of the Regulations we inspected.

Nightingales is a residential care home providing accommodation for up to 13 older people. At the time of our inspection 11 people were living there.

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 and associated Regulations about how the service is run.

Everyone who lived at the home told us they felt safe. Relatives and staff spoken with all said they felt people were kept safe. We saw that the provider had processes and systems in place to keep people safe and protected them from the risk of harm and ensured people received their medication as prescribed.

We found that there were enough staff to meet people’s identified needs because the provider ensured staff were recruited and trained to meet the care needs of people.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Acts protect the human rights of people by ensuring that if there are any restrictions on a person’s freedom and liberty, they have been appropriately assessed. Staff showed they had a good understanding of the MCA 2005; however, some staff had limited knowledge of DoLS legislation.

We saw that people were supported to have choices and received food and drink at regular times throughout the day. People spoke positively about the choice and quality of food available. Staff supported people to eat their meals when needed.

People were supported to access other health care professionals to ensure that their health care needs were met.

People told us the staff were very caring, friendly and treated them with kindness and respect. We saw staff were caring and helpful.

We found that people’s health care needs were assessed and regularly reviewed. People and their relatives told us they were confident that if they had any concerns or complaints, they would be listened to and addressed quickly.

The provider had well established management systems to assess and monitor the quality of the service provided. This included gathering feedback from people who used the service, their relatives and health care professionals.