This inspection took place on 6 and 11 July 2016 and was unannounced. Nightingale Holistic Services provides supported living accommodation for younger adults on the Autistic Spectrum. At the time of our inspection nine people were using the service. At our last inspection in January 2014 the service was meeting the regulations inspected.

The service had 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 told us they were safe. Staff had good knowledge about how to identify abuse and report any concerns. People had risk assessments which helped staff make sure people were safe at the service and in the community by managing people's risk and taking steps to reduce those risks while still encouraging their independence.

People were supported by staff who received appropriate training and support to do their job well. Staff felt supported by managers. There were enough qualified and skilled staff at the service. Staffing was managed flexibly to suit people's needs so that people received their care and support when they needed it. Staff had access to the information, support and training they needed to do their jobs well.

The service strived to be known as outstanding and innovative in providing person centred care based on best practice. Information was shared with staff so people received the support they needed when they needed it.

Staff had an excellent understanding of people’s needs and were able to encourage people to overcome their fears and engage in activities to improve their health and wellbeing. The service actively encouraged people to become involved in the local community and worked hard to empower people to make choices and have control over their lives.

People were involved in the service in a meaningful way and were encouraged to contribute their thoughts and ideas at any time. Care records focused on people as individuals and gave clear information for people and staff using a variety of communication methods including easy to read and pictorial information. Staff supported people in a way which was kind, caring, and respectful.

Staff helped to keep people healthy and well, they supported people, when necessary, to attend appointments with GP’s and other healthcare professionals. Medicines were stored safely, and people received their medicines as prescribed. People were encouraged to make healthy food choices and to be as independent as they could be with buying food and meal preparation.

Staff said the managers were supportive and listened to them. People who used the service were comfortable talking with staff and the managers.

The service had a quality assurance system in place to help them understand the quality of the care and support people received. Accidents and incidents were reported and examined. The managers and staff used information about quality of the service and incidents to improve the service.

We visited Nightingale Holistic Services to look at the care and welfare of people who used the service.

This was a follow up visit to see if the provider had made improvements to documenting the lifestyle plans and risk assessments for people who used the service. We spoke with three people who used the service, a relative and the registered manager.

People told us they were very happy with the support they received, and that it met their needs. A relative told us “This is the first service we have been involved with where we feel we are part of the team. They really understand my family member. It is brilliant.”

We saw that lifestyle plans had been reviewed and updated since our last visit. Where risks of harm had been identified there were associated risk assessments in place.

We visited Nightingale Holistic Services to look at the care and welfare of people who used the service. We spoke with five people who used the service and three members of staff, including the registered manager.

All the people we spoke with said they liked the support they received. One person said “I’m independent here. I was ready to start my own life when I lived at home, and I can do that now I am here.” Another person said “They are there for me when I need them. They bend over backwards to help me, no matter what the situation is. They give me all the support I need.”

We saw that systems were in place to ensure staff worked with the consent of people. All the people we spoke with said staff asked for their consent before they did anything.

People told us they were very happy with the support they received, and that it met their needs. Risks to people had been identified in care plans. We saw that not all of these had documented assessments to protect the welfare and safety of people.

We saw that staff had an understanding in their responsibilities around infection control. We saw there were systems and procedures in place to manage the control of infection. People who used the service told us that staff always wore gloves when they were cleaning.

All the staff we spoke to said they felt supported to do their job.

People told us they had the opportunity to express their views about the service, and that the provider took action where needed.

We made an unannounced visit to Nightingale Holistic Services and looked at the care and welfare of people who used the service.

During our visit we spoke with four people who used the service and four members of staff (including the registered manager and duty manager). We spent time observing how staff interacted and supported people.

One person told us that "It’s like a family here.” Another said “Staff know what they are doing and I feel safe here.” A third person told us that “Staff have helped me to build up my independence.” People told us that they had been involved in the planning of their support.

We saw staff treated people with respect, for example by asking permission before taking us into the accommodation areas, calling people by their preferred names and engaged them in conversations throughout the time we spent at the service. People appeared relaxed and happy.

We saw that the provider supported workers by the use of supervisions and appraisals. Quality assurance was being monitored and feedback received by the service was responded to in a timely manner.

People who used the service expressed themselves very happy with the provisions. All are tenants within the scheme with their own flats. All commented on the positive improvements to their lives that had followed their placement at the service. They were full of praise for the staff and frequently said that they were independent in a manner that they could not have contemplated before coming to the service. Families we spoke were also fulsome in their praise of the service, the staff and the manager.