This inspection took place on 12 October 2016 and was unannounced. Nightingale Lodge is a care home providing personal care for up to 29 people, some whom live with dementia. On the day of our visit 19 people were living at the service.

The home has had the current registered manager in post for 18 years. 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.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and action was taken to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been obtained before new staff members started work.

Medicines were securely stored. Medicines were safely administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity, best interest decisions had been made.

People enjoyed their meals and were able to choose what they ate and drank. Staff members contacted health professionals to make sure people received advice and treatment quickly.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and support was always available. Care plans contained enough information to support individual people with their needs. They did not always provide staff with enough guidance about behaviour that may challenge or upset others. Visitors said that their relatives were happy at the home and that they were able to be as independent as possible.

A complaints procedure was available and people were happy that they did not need to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with her at any time.

The provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

People received care and support that was based upon their assessed care needs. People were supported to maintain their independence but only where this was safe to do so.

People were provided with a choice of food at meal times. People could be assured that they would be provided with a balanced and nutritious diet. People's health was monitored on a regular basis to ensure that they were not losing weight.

People were prescribed medication and this was administered safely by staff who had been assessed as being competent to administer medication.

Staff felt confident to speak with the provider's managers and they would be supported whenever this was required. People told us that they felt the staff were competent and confident in providing their care.

Views from people who used the service, staff and relatives were used to improve the service wherever this was practicable. The provider used a variety of methods to identify ways to improve the service.

On the day of our visit on 18 May 2012 we were told that staff did provide support and assistance when needed. Three people told us that staff were very good but they would like to have more time to talk with staff. We saw staff providing support and assistance with due consideration for the dignity and choice of the individual. One person told us that Nightingale Lodge was one of the best homes in the area.

People were happy with the care they received but thought staff were often rushed and kept very busy. They liked the meals that were now being provided and explained that the provider had listened when they had previously thought the food was not very good.

We saw that staff did work in a relaxed way and they were laughing and talking with people on our arrival at the home. People told us that they thought staff were helpful and caring. People living in the home felt they would be taken seriously if anything was troubling or worrying them, but again said that staff often did not have time to talk with them at length.

People with whom we spoke told us that they felt their needs were appropriately assessed and met.

People felt that a particular advantage for them was the option to walk out of the home and reach the sea side at the bottom of the road. One person stated that they go out “almost every day”. They explained that the only condition for going out was to inform staff before they go and to tell them the rough time they would be back.

Everyone was very complimentary regarding the staff and stated that staff were excellent.

People were satisfied and stated that they had all that they needed in their bedrooms and that they liked the communal areas. “We can sit together and talk, it is never boring here”, as one person commented.

Several people commented that they would quite like to have a shower in addition to baths provided in the home.

They all liked the food and were happy with the choice and quality of food provided. One person explained that they could choose what to eat for breakfast and lunch and added that supper was always a cooked meal.

People stated that they could see a doctor or a nurse or any other health professional if they needed to. One person explained that some people go to the surgery that is very close by, some are taken there in a wheelchair, while a GP also visits if someone cannot go to the local surgery.

People knew about their medication and were happy for staff to look after it. A person with whom we spoke stated that they knew all their medication, for Parkinson’s disease, and that they discussed medication with the GP.