Nightingale Holistic Services

Nightingale Holistic Services is a domiciliary care agency which is registered to provide personal care and support to people in their own homes including supported living settings. At the time of our inspection the service was supporting ten people in their own accommodation in one large supported living setting. The Care Quality Commission (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. Ten people were being supported with personal care at the time of our inspection.

People’s experience of using this service and what we found

Right Support:

• The model of care and setting maximised people’s choice, control and independence.

People were encouraged to have control in their daily lives and staff ensured people were able to live as independently as possible. People were encouraged to be as independent as possible which had a positive effect on their self-esteem. Staff were committed to enabling people to live their lives in a way which was as close to their choosing as possible. For example, people had been supported to learn new skills such as preparing meals, budgeting and planning their day to day schedules. Risks were managed well to keep people safe while promoting their independence and staff supported people to access healthcare services when they needed them.

Right Care:

• Care was person-centred and promoted people’s dignity, privacy and human rights.

People experienced continuity of care and we saw they engaged confidently with members of their support team. Staff knew people well and ensured that people received the support they needed to keep them safe and to meet their individual care needs. People's rights were promoted, and they were protected from discrimination. People were treated with dignity and their privacy was respected. Staff were kind and caring, treated people with respect and encouraged them to make decisions about their care and support. The support staff provided was flexible to take into account people's needs and preferences.

Right Culture:

• The ethos, values, attitudes and behaviours of leaders and care staff ensured people

using services lead confident, inclusive and empowered lives.

Staff and the management team ensured that people and their families were at the centre of the delivery of care. People told us they felt they were treated as individuals whose life and experiences were considered and factored into planning their care. Their family members told us they still felt included in their relative’s day to day life. People were involved in planning their own care and were encouraged to give their views about the support they received. People’s families were also able to give their feedback about the support their family members received and their views were listened to.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Rating at last inspection

The last rating for this service was good (published 04 June 2019.)

Why we inspected

The inspection was prompted in part due to concerns received about financial and sexual abuse, poor infection prevention protection and control practice and limited social activities for people. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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.

Nightingale Holistic Services is a community based domiciliary care service that offers a community outreach and a supported living service to people with learning disabilities and autism to live as independently as possible. The service was based within the supported living environment which is a large family home that has been converted into three flats. The supported living scheme was supporting six people and the community outreach service was providing support to two people within their own homes at the time of our inspection. The accommodation is not registered with the CQC, the premises and related aspects were not inspected.

People’s experience of using this service:

The service applied the values and principles of CQC guidance ‘Registering the Right Support’ (RRS). RRS guidance works to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes including control, choice and independence. People were enabled to make choices about their lives and were supported to be as independent as possible. People were a central part of the service and their views and wishes were sought and acted on by staff to provide person centred care to meet their needs and ambitions. People had achieved excellent outcomes based on staff support and a holistic care planning approach.

People and their relatives spoke positively about the service. People told us they felt safe and well supported by staff. Safeguarding and whistleblowing policies and procedures were in place. Staff understood these procedures, how to keep people safe and report any concerns.

People's needs, and preferences were assessed and where risks were identified, plans were in place to manage risks safely in the least restrictive way possible.

There were safe arrangements in place to manage medicines and staff followed appropriate infection control practices to prevent the spread of infections.

Appropriate recruitment checks took place before staff started work. There was sufficient staff available to meet people's needs. Staff had the skills, knowledge and experience to support people appropriately. Staff were appropriately supported through induction, training, supervision and further professional development.

People were supported and encouraged to eat a healthy and well-balanced diet.

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 support this practice.

People and their relatives told us they were fully involved in planning and reviewing their care and support needs. People had access to health and social care professionals as required to maintain good health.

People were outstandingly supported to access community service and to participate in activities of their choosing that met their needs. People told us staff were caring and respected their privacy, dignity and promoted their independence.

Staff worked outstandingly with people to promote their rights and understood the Equality Act 2010 supporting people appropriately addressing any protected characteristics.

People were aware of the service’s complaints procedures and knew how to raise a complaint. There were systems in place to assess and monitor the quality of the service. The service worked extremely well in partnership with health and social care professionals and other organisations to plan and deliver an effective service. The service took people, their relatives and staff’s views into account through surveys and informal feedback to help drive service improvements.

Rating at last inspection:

Good overall with Outstanding in Responsive (Report was published on 10 August 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect the service sooner.

For more details, please see the full report which is on the website at www.cqc.org.uk

The service had a registered manager in post. 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 told us they were safe. Staff had good knowledge about how to identify abuse and report any concerns. People had risk assessments which helped staff make sure people were safe at the service and in the community by managing people's risk and taking steps to reduce those risks while still encouraging their independence.

People were supported by staff who received appropriate training and support to do their job well. Staff felt supported by managers. There were enough qualified and skilled staff at the service. Staffing was managed flexibly to suit people's needs so that people received their care and support when they needed it. Staff had access to the information, support and training they needed to do their jobs well.

The service strived to be known as outstanding and innovative in providing person centred care based on best practice. Information was shared with staff so people received the support they needed when they needed it.

Staff had an excellent understanding of people’s needs and were able to encourage people to overcome their fears and engage in activities to improve their health and wellbeing. The service actively encouraged people to become involved in the local community and worked hard to empower people to make choices and have control over their lives.

People were involved in the service in a meaningful way and were encouraged to contribute their thoughts and ideas at any time. Care records focused on people as individuals and gave clear information for people and staff using a variety of communication methods including easy to read and pictorial information. Staff supported people in a way which was kind, caring, and respectful.

Staff helped to keep people healthy and well, they supported people, when necessary, to attend appointments with GP’s and other healthcare professionals. Medicines were stored safely, and people received their medicines as prescribed. People were encouraged to make healthy food choices and to be as independent as they could be with buying food and meal preparation.

Staff said the managers were supportive and listened to them. People who used the service were comfortable talking with staff and the managers.

The service had a quality assurance system in place to help them understand the quality of the care and support people received. Accidents and incidents were reported and examined. The managers and staff used information about quality of the service and incidents to improve the service.

This was a follow up visit to see if the provider had made improvements to documenting the lifestyle plans and risk assessments for people who used the service. We spoke with three people who used the service, a relative and the registered manager.

People told us they were very happy with the support they received, and that it met their needs. A relative told us 'This is the first service we have been involved with where we feel we are part of the team. They really understand my family member. It is brilliant.'

We saw that lifestyle plans had been reviewed and updated since our last visit. Where risks of harm had been identified there were associated risk assessments in place.

All the people we spoke with said they liked the support they received. One person said 'I'm independent here. I was ready to start my own life when I lived at home, and I can do that now I am here.' Another person said 'They are there for me when I need them. They bend over backwards to help me, no matter what the situation is. They give me all the support I need.'

We saw that systems were in place to ensure staff worked with the consent of people. All the people we spoke with said staff asked for their consent before they did anything.

People told us they were very happy with the support they received, and that it met their needs. Risks to people had been identified in care plans. We saw that not all of these had documented assessments to protect the welfare and safety of people.

We saw that staff had an understanding in their responsibilities around infection control. We saw there were systems and procedures in place to manage the control of infection. People who used the service told us that staff always wore gloves when they were cleaning.

All the staff we spoke to said they felt supported to do their job.

People told us they had the opportunity to express their views about the service, and that the provider took action where needed.

During our visit we spoke with four people who used the service and four members of staff (including the registered manager and duty manager). We spent time observing how staff interacted and supported people.

One person told us that "It's like a family here.' Another said 'Staff know what they are doing and I feel safe here.' A third person told us that 'Staff have helped me to build up my independence.' People told us that they had been involved in the planning of their support.

We saw staff treated people with respect, for example by asking permission before taking us into the accommodation areas, calling people by their preferred names and engaged them in conversations throughout the time we spent at the service. People appeared relaxed and happy.

We saw that the provider supported workers by the use of supervisions and appraisals. Quality assurance was being monitored and feedback received by the service was responded to in a timely manner.