This unannounced inspection took place on 23 February 2017. At the last inspection, the service was rated with an overall good although some improvement was needed regarding the provider’s understanding of Deprivation of Liberty Safeguards. We found there had been an improvement. Nightingales is a residential home providing accommodation for up to 13 people with support needs including some people living with early onset dementia. At the time of our visit 11 people were living at the home.
The manager, who is also the provider, was registered with the Care Quality Commission (CQC), as required by law and was present during the day. 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.
At the last inspection improvement was needed because we found that some people, living at the home, were being restricted without the correct legal processes being in place. The provider’s and staff members’ understanding of what could constitute a restriction of somebody’s liberty also required some improvement. At this inspection we found the provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests and staff had received updated training.
People and relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes. Risks to people were being monitored and staff identified risks to people and explained how those risks should be managed. Staff had a good understanding of the risks and the action that was required. Appropriate equipment was in place to ensure the risk of harm to people was minimised. The care plans and risk assessments were reviewed and updated regularly.
We saw all staff were busy but were available to provide support to people when needed. This included support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. The provider’s recruitment processes ensured suitable staff were safely recruited.
People received appropriate support to take their prescribed medicines and records were kept of the medicine administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.
People were assisted by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff were knowledgeable on how to support people effectively and that staff possessed the necessary skills.
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 supported this practice.
People were complimentary about the quality of food and were supported in their choice of meal. We saw people accessed snacks and hot and cold drink at regular times throughout the day. Health care professionals visited the home on a regular basis and people received treatment when needed which helped to promote their health and well-being.
People's care records contained information relating to their specific needs and there was evidence that the care plans were updated when people's needs changed. People and relatives told us they were involved in developing and reviewing their care plans. People were supported by caring and kind staff who demonstrated a positive regard for the people they were supporting. Staff understood how to seek consent from people and how to involve people in their care. We saw staff interacting with people in a friendly and respectful way and that staff respected people's choices and privacy.
We found there had been no complaints about the service since our last inspection. People and relatives told us they had no complaints but were confident if they did, that the provider would deal with the issue effectively.
The registered manager/provider carried out audits and checks to ensure the home was running properly to meet people's needs and to monitor the quality of the care people received.