Rosie Nightingale Homecare provides care to 49 people living in their own homes, including; older people, people living with dementia and people with physical disabilities. The service is based in the Harwood, Horwich and Westhoughton areas of Bolton with a head office in Bolton.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service continued to protect people from the risk of harm or abuse. Safeguarding policies and procedures were robust and had been followed when required. Staff could identify safeguarding concerns and knew how to raise them appropriately.

Risk assessments had identified the individual risks people needed support to manage and plans had been developed to minimise the potential for harm. Environmental risk assessments ensured staff were aware of potential hazards at each property they visited.

Staff had been recruited safely with all necessary checks being completed prior to them starting to work with people. Staffing was sufficient to support people safely. No one told us they felt rushed.

Medicines were managed safely. Staff had received training in medicines. Regular spot checks and audits ensured records were accurate.

People were protected from the risk of infection. Staff were trained in infection control and had access to appropriate equipment, including gloves and aprons which had been supplied by the service.

The service learned from their experience and improved their practice in response to incidents. One example had been developing a more effective system for recording variable dose medicines such as warfarin.

People's needs had been assessed prior to their package of care starting. Care plans had been developed to meet people's needs which reflected good practice guidance.

Staff had received appropriate training and had the necessary skills and knowledge to provide care and support effectively. Some staff had completed further qualifications, including NVQ 2 and 3.

People received support to maintain their nutrition. The service had introduced cooking skills in their recruitment processes to ensure staff could provide meal support as preferred by the service users.

The service worked cooperatively with other organisations and services to ensure people received a coordinated level of care and support.

The service had supported people to access health services in a timely way. They had also promoted health and wellbeing by addressing broader issues such as isolation, communication needs and emotional wellbeing.

People signed their care plans to indicate they had consented to them. Staff were aware of the importance of gaining consent before providing care and support. The service was working within the principles of the Mental Capacity Act (2005) and had considered people's capacity in relation to specific decisions about their care and support.

People told us staff were caring and kind and went the extra mile for them. Relatives praised the commitment and dedication of the staff and service.

People's rights were included in the service user guide which was kept in the care record in people's homes. These rights included statements in relation to dignity, respect and equality.

The service had made efforts to understand people's communication needs and preferences. There had been several examples of individual communication strategies being developed to maximise individuals choice and control.

People's views on the care they received were sought through an annual survey and also informally throughout the year.

People continued to receive care which was personalised and responsive to their needs. Care plans were person cent

This inspection took place on 14 and 16 March 2016 and was announced. The provider was given 48 hours’ notice of the inspection because the location provides a domiciliary care service and we needed to be sure that someone would be in to facilitate the inspection. The service has not been inspected since re-registering at a new location address on 16 January 2015.

Rosie Nightingale Home Care is a domiciliary care service, registered to provide personal care within people’s homes. The office is situated in Bolton. Services are provided across Bolton via private arrangements or through local authority and clinical commissioning group (CCG) contracts.

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.

People we spoke with told us they felt safe using the service. The service had appropriate systems and procedures in place to protect people who used the service from abuse. The service had a safeguarding policy and associated procedures which were up to date. Staff we spoke with were able to tell us about the different forms of potential abuse.

The service had a whistleblowing policy in place and this told staff what action to take if they had any concerns.

Care and support records of people who used the service were very comprehensive, well organised and easy to follow. We saw that the service communicated regularly with peoples’ relatives who did not live nearby or who lived in another country.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure that people who used the service were safe. We looked at the medicines administration record (MAR) charts for people when we visited them in their own homes and found that these had all been completed correctly, were up to date and stored securely. All staff administering medication had received training.

There was an appropriate and up to date medicines administration policy in use which included information on medicines to be taken ‘as required’ (PRN).There was an up to date accident and incident policy and procedure in place and details of any accidents and incidents were recorded appropriately, including any remedial action required to reduce the risk of any future potential harm. There was an up to date business continuity plan in use.

People who used the service told us they felt that staff had the right skills and training to do their job. There were robust recruitment procedures in place and required checks were undertaken before staff began to work for the service. There was a comprehensive process of staff induction in place which was used to audit the progress of new staff relative to the induction process.

We found that all staff had completed training in the Mental Capacity Act in general as part of the process of induction. At the time of the inspection no person using the service was subject to any restrictive practices.

We reviewed the service’s training matrix and staff training certificates, which showed staff had completed training in a range of areas, including dementia, safeguarding, first aid, medicines, infection control and health and safety.

Staff received supervision and appraisal from their manager and the service which kept a record of all staff supervisions that had previously taken place.

The service used an electronic staff scheduling and planning tool called ‘People Planner’. This system enabled real-time live updates to be sent to care staff members which reduced the potential for missed or late visits.

We looked at the way the service managed consent for any care and support provided and found that before any care and support was given the service