This was an unannounced inspection that took place on 10 October 2017.

Florence Nightingale Care Home is registered to provide personal care and accommodation for up to 20 older people. The premises, which were purpose-built, are on three floors, all bedrooms are single with ensuite facilities, and there are two lounges and a passenger lift for access. At the time of our inspection there were 17 people using the service.

The service has a registered manager. This 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 told us they felt safe using the service. Staff were trained in safeguarding and understood how to recognise and prevent abuse. Relatives said staff knew how to keep their family members safe and were observant and knew how to reduce the risk of accidents.

There were enough staff on duty to meet people’s needs. People told us staff provided prompt assistance when they needed it. They said the staff were well-trained and knowledgeable. People had their medicines safely and when they needed them. If people needed to see a GP or other healthcare professional staff promptly arranged this for them.

Lunch was served during our inspection. People enjoyed their meal and the atmosphere was relaxed and sociable. Staff knew how to meet people’s nutritional needs. They knew people’s likes and dislikes and ensured people had the opportunity to choose what they ate.

People said the staff were caring, warm and compassionate. Staff knew what made people feel cared for, be it a hug or watching a good comedy on TV, and ensured people had what they needed. People were encouraged to make choices about their daily lives including what to wear, getting up and going to bed times, and activities.

People were pleased with the activities programme which had improved and expanded since our last inspection. Activities were provided morning and afternoon on six days a week and included ball games, pamper sessions, hairdressing, quizzes, dominoes, armchair exercises, and visiting entertainers.

People told us that if they needed to make a complaint about the service they would speak to staff, the managers or the provider. The provider’s complaints procedure told people how to complain and how they would be supported if they did. Records showed complaints were taken seriously and people informed of the outcome and what the staff intended to do to put things right where necessary.

People were happy with the service which they felt was homely and well-managed. They were able to share their views with the provider and registered manager who make changes and improvements in response. The provider and registered manager used audits to check that all areas of the service were running safely and effectively.

We carried out an unannounced comprehensive inspection of this service on 20 October 2015. A breach of legal requirements was found. This was because the provider had not ensured the people using the service were protected from the risk of unsafe care or treatment.

After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection unannounced on 9 September 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting ‘all reports’ link for Florence Nightingale Care Home on our website at www.cqc.org.uk

Florence Nightingale Care Home is registered to provide personal care and accommodation for up to 20 older people. At the time of our inspection there were 19 people using the service.

The home has a registered manager. This 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 told us they felt safe and that they liked and trusted the staff. Staff knew how to support people safely, for example by accompanying them when they were walking.

Since we last inspected people’s risk assessments had been re-written and improved. They identified areas where people might be at risk and what staff needed to do to minimise this. A relative told us their family member’s mobility had improved since they came to the service and they no longer had falls.

Staff were trained in safeguarding (protecting people from abuse) and knew what to do if they were concerned about a person’s well-being. The registered manager knew all the people using the service and spent time with them every day. We saw that people got on well with her and enjoyed her company. The atmosphere at the service was calm and friendly.

There were enough staff on duty to meet people’s needs. They had been safely recruited to help ensure they were suitable for their roles. They had time to provide people with the care and support they needed and also to socialise and support people with activities. This contributed to the positive atmosphere at the service.

Staff supported people to take their medicines when they needed them. Medicines were only administered by staff trained and assessed as being able to do this safely. People told us they had their medicines on time and records confirmed this.

We carried out an unannounced inspection of this service on 17 June 2014. Three breaches of legal requirements were found. This was because the registered person had not always ensured staff were safely recruited, staff had not always have the training and support they needed to provide effective care, and the registered person did not have an effective system to regularly assess and monitor the quality of service that people receive.

At this unannounced inspection on 20 October 2015 we found the provider had met these requirements.

Florence Nightingale Care Home was purpose-built in 2013 and provides residential care to up to 20 older people. It has facilities on all three floors with a passenger lift for access. The home has a large lounges/diner, a smaller lounge, and a seating area adjoining the car park at the rear of the home. At the time of our inspection there were 20 people using the service.

The home has a registered manager. This 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 told us they felt safe in the home, however improvements were needed to the way

risks to individuals were managed at the home. Staff were caring and attentive, although on occasions they appeared too busy to meet people’s needs promptly.

The staff were caring. We saw examples of staff valuing people and making them feel important and cared for. When staff were supporting people they took the time to engage with them and have a conversation. People were involved in making decisions about their care and support. If they wanted to wear particular clothes and use favourite toiletries staff made sure this happened.

Staff provided care that was responsive to the needs of the people using the service and people’s cultural needs were met. During the inspection we observed the staff continually talking with people and checking they had everything they needed.

Staff had the training they needed to provide safe effective care. People were supported in a way that did not restrict them or deprive them of their freedom.

Group and one-to-one activities were provided. A visiting singer entertained the people using the service on the morning of our inspection. In the afternoon people took part in a game of armchair catch. This became quite lively as more and more people joined in and began cheering each other on. The care worker facilitating the game did this well, ensuring as many people as possible were involved.

Lunch was observed during our inspection. People had their meals in either the lounge or the dining area depending on their preference. They had a choice of two main courses and two puddings. We checked the food stocks and found a good range of fresh, frozen, and tinned products available. Both hot and cold drinks were being offered to people throughout the day.

People had access to a range of health care professionals including GPs, mental health practitioners, district nurses, chiropodists, opticians, and dentists. Staff understood the health needs of the people they supported and had taken action to ensure people had medical attention if they needed it.

People told us they were happy at the home. Staff told us they liked working there and felt well-supported by the provider and registered manager. We observed that people using the service were in an out of the registered manager’s office and the staff office to see what was going on. They were always made welcome and given the sense that the home was theirs and they could go where they liked within it providing it was safe for them.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were six people using the service which was registered for up to 20 adults over 65 years. This was the service’s first inspection since the provider’s registration in 2013. Our inspection was unannounced and because of concerns raised we responded to the concerns by bringing the inspection forward. The service was in a state of transition as it had removed nursing care from its provision on 13 June 2014. The registered manager was no longer employed by the provider. This meant the provider was in day to day charge of the service. The provider was also responsible for the daily meals of people who used the service. Staff told us being responsible for the shifts was a new challenge for them and they needed time to adjust to this. People using the service told us that they “missed the nurses for advice”, although the care staff were helpful to them. This meant there were levels of uncertainty for people using the service and staff about how the service was to be run.

As part of our inspection we spoke with six people who used the service. We also spoke with two health care professionals, four members of staff and the provider who was managing the service daily with a senior care worker.

We considered all the evidence we gathered under the outcomes we inspected. We used the information we always ask;

Is the service safe?

We looked at the suitability of the environment to ensure people lived in a home where the décor and environmental standards were appropriate. We found the home was clean, safe and well maintained but there was a smell from the downstairs drains that lingered in the corridor. The provider told us he would attend to it.

All the necessary recruitment checks had been completed prior to staff commencing their employment at the home before the changes. Following the changes the recruitment practices in place were not as safe as new staff had not been through a thorough vetting process. This meant there was a potential risk to vulnerable adults of unsuitable staff working with them.

Medicines used at the home were stored and administered safely. On talking with staff they told us that they would benefit from further training information around the management of medicines. One person spoke about their medication they said “They’re very, very good with that”.

This meant people were appropriately supported and we found medications were administered and stored in a safe way. We found a small number of recording errors for when medicines were administered and for the return of some prescribed items. We bought these to the attention of the senior and provider for further investigation.

During the day time to ensure people were safe there was at least one member of staff in the lounge area.

One person told us “Everyone tries to help you” and another person said “Staff are around when you need them and this makes me feel safe”.

Another person told us there were “Enough staff on duty when they needed them and if they ever had to wait for assistance the staff were always pleasant and helpful”. This meant people were supported by staff who could meet their needs.

The Mental Capacity Act 2005 (MCA) is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. We were told by the provider there was no one who needed a Deprivation of Liberty Safeguard. This is where a person is restricted of their freedom and considerations are made in the person's best interest.

Is the service effective

Staff were not always supported to provide care to the people using the service. This was because they had not had sufficient time to prepare for the transition for being in charge of the shifts now that nurses were no longer employed at the service. The provider was also busy covering shifts in the kitchen whilst supporting senior care workers with the management of medications, should one of their experienced managers not be available at the home.

We found that less experienced care workers were not always being supervised by senior staff and we saw a staff member who applied a topical medicine for a person without wearing protective equipment for their hands. This meant the ability to monitor staff’s performance was difficult to oversee on a regular basis and further development of the systems in place for staff support was needed.

Is the service caring?

We observed staff during the inspection. We saw staff had warm and friendly relationships with people using the service. We observed people's care and support during the visit and saw that they were well supported. People we spoke with told us they were satisfied with the care and support they received and we saw they were usually treated respectfully.

Is the service responsive?

During the inspection visit we spoke with a person who was receiving specific treatment. They told us staff gave them their medicines when they needed them and checked that they were not experiencing any problems by checking their treatment levels twice a day. People told us staff supported them when they needed their help. This included applying medicated creams when they were in discomfort.

People told us they had no cause to complain as their needs were being met by helpful supportive staff. A complaints procedure was available for people to use although we found that it may need to be placed in a number of prominent positions throughout the home due to the home’s design and being built on three floors.

Is the service well led?

Not all quality monitoring systems were available for us to see during the inspection. The provider explained that they helped to monitor the medications with the senior care worker in charge. This was done by checking medicines were handled correctly and kept safely. People told us they were given their medicines when they needed them. Information to confirm the employer’s liability insurance was up to date was sent to us as requested following our visit. Other information to confirm that servicing at the home took place and was up to date was also sent to us by the provider. The quality of the service that people received was managed in their best interests although the documentation for this was not always organised for the purposes of monitoring.

Below is a summary of what we found. To see the evidence supporting our summary please read the full report.