The inspection took place on 12 December 2016 and was announced.

Nightingales (Chichester) is a family run, domiciliary care service providing support to 72 people living in their own homes, 22 of whom were in receipt of the regulated activity of personal care. The service supports older people and people who are living with dementia or other conditions, to enable them to continue living in their own homes. Some people privately funded their care whilst others had their care funded by the local authority. The service is based in Bognor Regis and provides a service to people within the local area as well as Pagham, Chichester and Selsey in West Sussex.

The service was owned by two providers, one of which was the registered manager. 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 were asked their consent and were involved in day to day decisions. However, practice and the lack of records confirmed that there was a lack of understanding in relation to the practical application of the Mental Capacity Act 2005 (MCA). There was a lack of mental capacity assessments and best interests decisions, in relation to specific decisions for people who lacked capacity.

People were protected from harm and abuse as they were supported by staff who had undertaken the relevant training and who knew what to do if they had concerns about peoples’ safety. Risks had been assessed and managed to ensure peoples’ safety. People told us that they felt safe, one person told us, “Definitely, when I go in to have a shower, I don’t have to worry about slipping, I just feel very safe when they’re there”. Another person told us, “I’m not very good on my legs and they make sure I’m safe, I’ve not fallen down for a long time”. People received their medicines on time from staff with the necessary training and who had their competence assessed. Peoples’ health needs were assessed and met and they had access to medicines and healthcare professionals when required.

People were supported by skilled, experienced and competent staff that had access to relevant training. One person told us, “Oh yes, they’re very proficient, they do everything I want them to do”. People and their relatives, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. Care plans documented peoples’ needs and these were reviewed and updated regularly to ensure that they were current. One person told us, “Oh yes, somebody came to the house to discuss what I wanted done and things like that”. Staff worked in accordance with peoples’ wishes and people were treated with respect and dignity. It was apparent that staff knew peoples’ needs and preferences well. Positive relationships had developed amongst people and staff. One person told us, “I can only talk about my own carer, but they’re a wonderful person, they’re like a best friend”. People were treated with respect and dignity and their privacy was maintained. One person told us, “Yes. It’s a very private sort of thing, having a shower isn’t it? But they’re always very pleasant and understanding”. Another person told us, “I’ve had no bother yet. I’ve had over 20 people in a year and I’ve had no trouble with my dignity yet”. People, when required, received appropriate support with their nutrition and told us that they were able to choose what food they had to eat.

The registered manager welcomed feedback and used this to drive improvement and change. People and relatives were aware of the procedures they needed to follow to make a comment or complaint. There were quality assurance processes in place to enable the registered manager to have an oversight of the servi