Background to this inspection
Updated
29 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was completed by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that someone would be in the office to support the inspection. Inspection activity started on 3 July 2019 and ended on 9 July 2019. We visited the office location on 9 July 2019.
What we did before the inspection
We used information the provider sent us in the Provider Information Return (PIR). Providers are required to send us key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed notifications sent to CQC about important events at the service and information sent to us from other stakeholders for example the local authority and members of the public.
What we did during the inspection
We spoke with five people who used the service and 10 of their relatives, the registered manager and four members of staff. We pathway tracked the care of four people. Pathway tracking is where we check that the care detailed in individual plans matches the experience of the person receiving care. We reviewed records including accident and incident logs, quality assurance records, compliments and complaints, policies and procedures and two staff recruitment records.
Updated
29 August 2019
About the service
Nightingales is a domiciliary care service providing personal care to approximately 29 people at the time of the inspection. People using the service were living with a range of care and support needs such as dementia and physical disabilities. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
People were not always supported to have maximum choice and control of their lives. It was not clear if staff were supporting them in the least restrictive way possible and in their best interests as they had not ensured representatives making decisions on people’s behalf had the legal authority to do so. This is an area of practice that requires improvement.
People were protected from the risk of abuse and felt safe. A relative told us they felt their loved one was, “completely safe, I have no concerns whatsoever.” People’s medicines were well managed, and lessons learned when things went wrong.
People received care from well trained and knowledgeable staff. People’s nutritional needs were understood and met by staff. Staff worked well with other professionals to meet people’s health and wellbeing needs in a timely way.
Staff were kind and caring to people and knew them well. One person told us, “They are all really kind.” People’s privacy and dignity was respected, and their independence promoted. People were supported to express their views by staff who understood their communication needs.
Staff were responsive to people’s needs and delivered their care in the way they preferred. People understood how to make complaints but had not needed to. People were supported compassionately at the end of their lives.
The service was well managed. People, their relatives and staff were complimentary of the management of the service. One person told us, “they are nice, helpful people and I have faith in them as they have never let me down.” Quality assurance and audit processes were in place and actions taken to improve the quality of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection The last rating for this service was good (published 10 January 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.