We inspected Nightingales Home Care on 17 and 18 July 2018.

Nightingales Home Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection the agency was providing personal care to seven people.

The last inspection was carried out on 8 and 9 March 2016. Whilst we rated the service as overall “Good”, we found there were shortfalls in the recruitment of new staff. During this inspection, we found the necessary improvements had been made and the service was meeting all the current regulations.

At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were happy with the care and support they received and made positive comments about the staff. They told us they felt safe and staff were caring. People had developed positive trusting relationships with staff. Staff understood how to protect people from abuse.

The information in people's support plans was sufficiently detailed and risks to their health and safety had been identified and managed safely. People's care and support was kept under review and they were involved in decisions about their care. Staff worked in partnership with relevant health and social care professionals when people's needs changed.

A safe and robust recruitment procedure had been developed since our last inspection. The management team were aware of the process to be followed to ensure new staff were suitable. Arrangements were in place to make sure staff were trained and competent. People considered there were enough staff to provide them with a reliable, flexible and consistent service.

People had choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff respected people's diversity and promoted people's right to be free from discrimination; people's dignity and privacy was respected.

People's nutritional needs were monitored as necessary and staff knew their likes and dislikes. People told us they were happy and did not have any complaints but were confident they would be listened to. Staff administering medicines had received training and supervision to do this safely.

There were effective systems for assessing, monitoring and developing the quality of the service being provided to people. People and staff were consulted and their views were acted upon.

Further information is in the detailed findings below.

This was an announced inspection which took place on 8 and 9 March 2016. We had previously carried out an inspection in January 2014. We found the service to be meeting the regulations we reviewed at that time.

Nightingales Home Care is a domiciliary care agency which at the time of our inspection was providing personal care to 20 people who lived in their own homes.

The service had a registered manager in place as required under the conditions of their registration with the Care Quality Commission. 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 registered manager was supported in the day to day running of the service by an office manager.

During this inspection we found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because the recruitment processes in place were not sufficiently robust. You can see what action we have told the provider to take at the back of the full version of the report.

On the first day of the inspection we found the provider’s recruitment policy needed to be updated to ensure it met the requirements of our current regulations. On the second day of the inspection we saw that this policy had been updated as required. One of the staff personnel files we reviewed did not contain any evidence that references had been sought for the person concerned. This meant people who used the service might not be protected against the risk of unsuitable staff.

Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service report any poor practice they might observe. They told us they were certain any concerns would be taken seriously by the registered manager.

People who used the service told us staff always visited at the time agreed and stayed for the correct amount of time. They told us that staff did not appear rushed during their visits and always took the time to complete any tasks they asked of them. One staff member told us, ““It’s the little things that matter and make a big difference to people. It’s respecting people in their own homes. You treat people how you would like to be cared for.”

People told us they received the support they needed to take their medicines as prescribed. Staff had received training in the safe handling of medicines. Regular medication audits were completed but these needed to be more robust to ensure any errors on medication administration record (MAR) charts were promptly identified.

Risk assessments for physical health needs and environmental risks helped protect the health and welfare of people who used the service. Arrangements were in place to help ensure the prevention and control of infection.

Where necessary people who used the service received support from staff to ensure their nutritional needs were met. Records we reviewed showed staff had contacted health and social care professionals as appropriate if they had any concerns regarding a person they supported.

Staff told us they received the induction, training and supervision they needed to be able to deliver effective care. We noted that staff were supported to continue their professional development through gaining additional qualifications.

All the people we spoke with gave positive feedback regarding the kind and caring nature of staff. People who used the service told us they were able to make choices about the care they received and staff enabled them to maintain their independence as much as possible.

People told us they had been involved in agreeing their plan

We spoke with four people using the service, including a friend of a person receiving care. Some people were able to tell us they had been involved in planning their care and support and had agreed to the service provided. They felt the support met their needs and therefore agreed and consented to it. We saw people had signed their care plan to indicate their agreement. One person said, "Oh yes they discussed my care plan with me". Another person said, "We all got together to plan the care and she (the service user) signed her care plan". People could give their views about the agency and their support through formal and informal service reviews and through survey questionnaires.

People told us they were generally very satisfied with the service and that the carers were reliable, flexible and good to get on with. Those we spoke with made the following comments: "I'm looked after really well; it's excellent", "It's marvellous, they (the carers) are grand, like my own daughter", "She (the service user) is perfectly happy with all the girls" and "There is nothing I don't like; nothing to grumble about". We also found carers assisted people appropriately with their medication and meals. One person said, "They help me take my pills".

We found there were enough staff to maintain a reliable service who all had relevant qualifications for people working in care, and who had up date training in essential matters such as safeguarding and moving and handling.

We spoke to four people using the service on the telephone, including a friend and a relative of those receiving care. Everyone said they had been involved in the planning and setting up of the service and in the ongoing development of care, according to changes in need. One relative said, "They (a senior member of staff) came to talk to us to find out what was needed and to put the (care) plan in place". People also said there were some choices in the service, such as changing the times of visits and making changes to the care needed. People said the care staff treated them respectfully and delivered care safely and properly. One person said, "They (the carers) are a good crowd". Another person said, "They all treat me well". People felt they had been given sufficient information about the agency and knew who to contact if they had concerns.

All the people we spoke with said they were satisfied with the service. They said the service was reliable, with carers on the whole being punctual and not letting them down. People also said they knew all the carers who supported them and that changes to their team of carers were only made when necessary. Two people commented on carers being determined to carry on with their work in spite of recent bad (snowy) weather. One person said, "Even in this bad weather they have always turned up; it's very impressive". One person using the service said, "The service is excellent, absolutely fine", and "I get on with all the carers".

People using the told us they were satisfied with the way the agency delivered care.

People said the service was reliable and they knew who was visiting them.

People made comments about the staff, who they said were mostly "friendly", and they were “more than happy” with the service they received.

People told us they all had a file that detailed their care plans including emergency contact details.

People felt most of the staff was approachable and accessible and they could contact the management if they had any concerns or queries.