This inspection took place on 20 November 2017. We gave the provider 3 days’ notice of the inspection as we needed to make sure the manager would be available. At our last inspection on 31 March 2017 the service was rated good.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service mainly to older adults. Not everyone using Nightingale Home Care receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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.

The service had safeguarding and whistle-blowing procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work. There was enough staff on duty to meet people’s needs. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals. People were protected from the risk of infections because staff had received training in infection control and food hygiene, and were aware of the steps to take to reduce the risk of the spread of infections.

Assessments of people’s care and support needs were carried out by managers before people started using the service. Staff had completed an induction when they started work and received training relevant to the needs of people using the service. People were supported to maintain a balanced diet and were involved in decisions about what they ate. People had access to a GP and other health care professionals when they needed them. Staff were aware of the importance of seeking consent from the people they supported and demonstrated an understanding of the Mental Capacity Act 2005 and how it applied to the support they gave people to make decisions. 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 support this practice.

Staff treated people in a caring, respectful and dignified manner. People had been consulted about their care and support needs. People were provided with appropriate information about the service. This ensured they were aware of the standard of care they should expect. People could communicate their needs effectively and could understand information in the current written format provided to them. Information was available in different formats when it was required.

People received personalised care that met their needs. People and their relatives, where appropriate, had been involved in planning for their care needs. People knew about the provider’s complaints procedure and said they would tell staff or the registered manager if they were unhappy or wanted to make a complaint. Staff had received training on equality and diversity. Staff said they would support people according to their needs.

The provider recognised the importance of monitoring the quality of the service provided to people. They took into account the views of people using the service through satisfaction surveys. They carried out spot checks to make sure people were being supported in line with their care plans. Staff said they enjoyed working at the service and they received good support from the registered manager and office staff. There was an out of hours on call system in operation that ensured man

This inspection took place on 31 March 2017 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. Nightingale Home care is a domiciliary care agency that provides care and support for people living in the London Borough of Bromley and the surrounding areas.

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 and associated Regulations about how the service is run.

This was a focused inspection of Nightingale Home Care and was completed to check if improvements had been made to meet the legal requirements for the breach to regulations we found at our comprehensive inspection 19 and 22 October 2015. We inspected the service against one of the five questions we ask about services: is the service well led. This is because the service was not meeting legal requirements because the provider had failed to notify the Care Quality Commission of an allegation of abuse in relation to a person using the service. This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Nightingale Care Home' on our website at www.cqc.org.uk.

We found that action had been taken by the provider to ensure that notifications as required under the Health and Social Care Act 2014 including safeguarding concerns were submitted to the CQC as required by law. We could not improve the rating for 'well led' from requires improvement as not all areas of the key question were covered during this focused inspection. The overall rating remains the same. We will check this during our next planned comprehensive inspection.

We did not speak with people who used the service at the follow up inspection; however, we did review the satisfaction survey the provider had completed in December 2013. Overall people stated that they were happy with the service and comments included “there’s nothing they could improve, the service is very good” and “I am very happy with the care, the staff are excellent”.

At our follow up inspection on 23 January 2014 we found the provider had made the required improvements to meet the appropriate standards of care. The care plans and risk assessment had been reviewed and were individualised and reflected people's needs.

People we spoke with were generally happy with the care they received from the agency. One person told us “I have no complaints at all”. Another person described their carer as "brilliant and keeps me company and I enjoy the walks". A person said "I get fairly regular staff who are good" and the person said they met their needs. Most people told us the carers arrived on time and were reliable, but a small number of people had experienced missed calls, although they received a phone call from the office to inform them if staff were going to be late.

We found that people were asked for their consent verbally before care was carried out. Some care was planned and delivered in a way that met people's needs. However, some risk assessments and care plans were not individualised and did not always reflect people’s needs. People told us they were happy with the care and the supervisor checked on them regularly to monitor the quality of the service and ensure the care plans were up to date. Staff were recruited in line with the provider’s policy and we found that the agency had carried out the appropriate pre-employment checks. There had not been any formal written complaints within the last year. However, any concerns were logged and responded to promptly. Records were legible and adequately maintained

People we spoke with told us that they had service contracts and they had been made aware of the costs prior to agreeing to use the agency. They said they had copies of their care plans and were involved in planning their care.

People told us that staff respected them and were polite and courteous at all times and referred to them by their name at all times. We were told by some people that they had been asked for their views on the care they received and that spot checks were carried out from time to time.

A relative told us that the regular carer was very conscientious and went out of her way to ensure her relative was safe at all times,

You can see our judgements on the front page of this report.

This inspection took place on 19 and 22 October 2015 and was announced. At our previous inspection on 22 October 2013 we found a breach in relation to people’s safety as risk assessments were not comprehensive and reflective of people’s needs and risks. At our follow up inspection 23 January 2014 we found the provider had reviewed the risk assessments and care plans for all the people using the service.

Nightingale Home care is a domiciliary care agency that provides care and support for people living in the London Borough of Bromley and the surrounding areas. At the time of this inspection 96 people were using the service. 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 and associated Regulations about how the service is run.

We found the service had appropriate safeguarding adults procedures in place and that staff had a clear understanding of these procedures. However the provider had failed to notify the Care Quality Commission of an allegation of abuse in relation to a person using the service. You can see the action we have told the provider to take at the back of this report.

People said they felt safe and staff treated them well. Appropriate recruitment checks took place before staff started work. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People had access to health care professionals when they needed them and were supported, where required, to take their medicines as prescribed by health care professionals.

Staff had completed training specific to the needs of people using the service and they received regular supervision. The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. People’s care files included assessments relating to their dietary support needs.

Assessments were undertaken to identify people’s support needs before they started using the service. People had been consulted about their care and support needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. People were aware of the complaints procedure and said they were confident their complaints would be listened to, investigated and action taken if necessary.

The provider sought the views of people using the service and staff through surveys. They recognised the importance of monitoring the quality of the service provided to people. Staff said they enjoyed working at the service and they received good support from the manager. They said there was an out of hours on call system in operation that ensured management support and advice was always available when they needed it.