Bingley Wingfield Nursing Home

Bingley Wingfield Nursing Home is a care home providing personal and nursing care to older people, some of whom may be living with dementia, mental health conditions and/or physical disability. The service accommodates up to 44 people in one adapted building. At the time of the inspection 27 people were using the service.

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

The management of risk had improved and risks to people were assessed and reviewed on a regular basis. We have made a recommendation about the management of thickeners.

Systems were now in place for the safe handling, administration and storage of medicines. People’s individual choices and needs were considered when administering medicines.

Safe recruitment practices were now followed when employing new staff. Recruitment files were well organised and contained appropriate background checks. There were enough staff deployed to meet people's needs safely. However, we received mixed feedback from people and their relatives regarding staffing levels, particularly on evenings and weekends.

Systems were in place to safeguard people from abuse. Staff received training in safeguarding and were able to demonstrate a good understanding of safeguarding people from abuse. People told us they felt safe. Infection control measures were in place.

At the time of our inspection, a new home manager had recently been appointed and staff spoke positively of the support they received from management. Systems were in place to obtain feedback from people and staff, which was used to improve the quality of the service.

Quality oversight had improved at this inspection. The provider had implemented systems of audit, to assess, monitor and improve the quality of care. We found actions for improvement were being identified and completed in a timely manner. The service worked effectively in partnership with other agencies, to ensure good outcomes for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 7 January 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 14 May 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced focused inspection of this service on 9 November 2021. Breaches of legal requirements were found in relation to safe care and treatment, good governance and fit and proper persons employed. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bingley Wingfield Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bingley Wingfield Nursing Home is a care home providing personal and nursing care to older people and people living with dementia, a mental health condition and physical disability. The service accommodates up to 44 people in one adapted building. At the time of the inspection 26 people were using the service.

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

The service had made some improvements since the last inspection, but they were still not managing medicines safely. Time specific medicines were not always given safely including Paracetamol doses that were given too close together. People were still at risk of harm as the provider had not identified, assessed or mitigated some risks to people. Some care records contained inconsistent and inaccurate information. Government guidance on prevention and control of infections in care homes was not always followed. This put people at risk of harm.

A robust recruitment process was not always followed. Some checks had not been completed before staff started working at Bingley Wingfield Nursing Home.

We received a mixed response about the staffing arrangements. Some people felt there were enough staff, but others said they were too busy. The service had experienced some problems with staffing but following a successful recruitment drive they were in a much better position.

The service had made some improvements around how they monitored the service but they were still not always identifying, capturing and managing quality and safety. The service carried out a range of checks, but these did not identify some key issues and secure improvements. People’s meal experience was sometimes poor. The registered manager had identified this as an area to improve and had started taking action.

The provider monitored some areas well such as training which did show staff received appropriate support. The provider had introduced a robust system for monitoring and reviewing accidents and incidents.

The service had systems in place to gather people’s views. Staff told us communication was good and the service was improving. Feedback from people who used the service varied. People told us most staff were kind and caring. We observed warm and friendly interactions on the day of our site visit although in the main lounge staff made little effort to have meaningful conversations with people.

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

Rating at last inspection and update: The last rating for this service was inadequate (published 14 May 2021) and there were two breaches of regulation. At this inspection we found that actions had been taken to improve some areas of the service, but not enough improvement had been made and the provider was still in breach of regulation 12 and 17. They were also in breach of regulation 19.

Why we inspected

We undertook this focused inspection to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bingley Wingfield Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, good governance and safe recruitment practice at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Bingley Wingfield Nursing Home is a care home providing personal and nursing care to older people and people living with dementia, a mental health condition and physical disability. The service accommodates up to 44 people in one adapted building. At the time of the inspection 26 people were using the service.

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

People were not safe. Risks to individuals were not appropriately assessed and managed. Medicines were not managed safely. Systems for recording and monitoring accidents and incidents were unsafe. Lessons were not always learned when things went wrong. There were sufficient staff to keep people safe but sometimes people had to wait for support. A member of staff said, “Residents are looked after but they could be looked after better with more staff, it is draining.” The provider was signposted so they could develop their approach to infection prevention and control.

Staff were recruited safely. The management team understood how to report safeguarding concerns and the staff team were all familiar with the whistle-blowing procedure.

The provider's quality management systems were not effective and did not identify areas where the service needed to improve. The manager who had only been in post for four weeks had started to make changes. Overall, people who used the service, relatives and staff provided positive feedback about their experience. The management team were responsive to the inspection findings and shared plans to improve their systems and processes.

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 13 August 2018).

Why we inspected

We received concerns in relation to medicines, staffing and management of risk. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bingley Wingfield Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing and managing risks to individuals and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of ‘is the service good’ and ‘is the service is well led’ to at least good. At this inspection we found sufficient improvements had been made which meant the service was no longer in breach of Regulations. The registered manager and provider shared actions they were working on to maintain and further improve the service for people living at Bingley Wingfield.

Bingley Wingfield is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 44 people in an adapted building, over three storeys. At the time of our inspection there were 27 people living at the home and one person was admitted on the day of our inspection.

We found the provider had effective systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements. Medicines were being stored and managed safely. We found there were enough staff to take care of people and to keep the home clean.

Staff were recruited safely and received appropriate training. They told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving topic specific supervisions although individual supervisions to discuss their ongoing development needs required further development.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion. People told us they felt safe living at the service and we saw people’s healthcare needs were being met.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was very good. There were plenty of drinks available for people in between meals.

Activities were on offer to keep people occupied. Visitors were made to feel welcome and were offered refreshments.

The home was clean, well decorated and tidy. All the bedrooms were single occupancy and contained personal items such as ornaments and photographs.

The complaints procedure was displayed. Records showed complaints or minor concerns received had been dealt with appropriately.

Everyone spoke highly of the registered manager and said they were approachable and supportive.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Bingley Wingfield provides accommodation and nursing care for up to 44 people at any one time. At the time of inspection there were 32 people living in the home. Accommodation is spread over three floors with a number of communal areas and outside space including an enclosed garden area. A registered manager was in place. 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 felt safe living at the service and safeguarding processes were in place. Assessments to mitigate risks to people had been completed but some required updating to reflect current needs. The provider had identified and commenced work to address this. Accidents and incidents were documented with actions taken to reduce the risk of recurrence.

There were not always sufficient numbers of staff deployed at peak times where interactions were mostly task focussed. However, robust recruitment processes were undertaken to ensure staff were safe to work with vulnerable people.

The premises was mostly managed safely and a number of improvement plans were underway. However, we saw water temperature checks had not been undertaken recently although the registered manager put plans in place to address this following our inspection.

Some improvements were required with the safe management of medicines, particularly regarding documentation. As a result we were unable to confirm all people received medicines as required.

A range of training was in place to equip staff with the necessary skills to provide effective care and support. Staff were subject to regular supervision, discussions and annual appraisal. Staff said they received good support from the registered manager and provider. Meetings were in place to discuss updates, concerns and highlight areas for improvement.

The service was acting within the legal framework of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). People were supported to make choices although better evidence of consent and involvement in care planning and reviews needed to be documented. The provider had identified this and work was underway to improve this documentation.

People's dietary needs were met although more better documentation of who had received meals was required by the kitchen staff.

We saw people were treated with dignity and respect and staff knew people's care and support needs. Some caring interventions were observed.

Care records had been audited and an action plan was in place. Newer care plans contained more person centred information. However, actions needed to be taken to involve people and/or relatives in decisions and reviews relating to care and support. This had been identified by the provider and work was underway to address this.

A good range of activities were available to people either on a group or one to one basis, according to their choice. The service enjoyed input from a volunteer group to enhance the activities programme.

Complaints were seen to be taken seriously and managed appropriately.

People and staff praised the management team who were a visible presence in the home and committed to service improvement. Systems and processes were in place to assess and monitor the quality of the service. Although some of these had identified areas for improvements, we found other areas had not been identified prior to our inspection.

We identified three breaches of Regulation relating to safe management of medicines and good governance. You can see what action we told the provider to take at the back of the full version of the report.

A registered manager was in place. 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 in August 2015 we identified two breaches of regulation associated with ‘Safe care and treatment’ and ‘Meeting nutritional and hydration needs.’ At this inspection, overall we found action had been taken to address the issues we previously identified, and we found a number of improvements had been made to the service. However, we found further shortfalls which needed to be promptly addressed.

People and relatives spoke positively about the service and said they received a high standard of care and support from appropriately skilled staff.

People told us they felt safe from abuse living in the home. The service had taken appropriate action to identify and act on allegations of abuse to protect people from harm. Risk assessments were in place which assessed and mitigated some risks to people’s health and safety and we saw examples of staff acting appropriately to keep people safe. However, the action taken to protect people from harm was not always robustly documented.

Safe recruitment procedures were in place to ensure staff were suitably experienced to work with vulnerable people. Although we found no direct evidence there were insufficient staff on duty, some staff told us that staffing levels were not sufficient at certain times of day. We asked the provider to investigate this and ensure that they could evidence staffing levels were based on the dependency of people who used the service.

The premises was managed safely. The service was partway through refurbishing the building and we saw a number of improvements had been made since the previous inspection; with further work planned to other areas in the near future.

Medicines were managed safely and we saw people received their medicines as prescribed.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to make choices and involved in decisions relating to their care and support.

Staff received a range of training and support to help maintain and develop their skills and knowledge. Staff told us they felt well supported by the provider and manager.

Following the previous inspection improvements had been made to the mealtime experience. People told us the food was good and we saw there were a sufficient range of options available.

People told us staff were kind and caring, treated them with dignity and respected their privacy. This was confirmed in the interactions of care and support that we observed.

We saw some good examples of staff providing responsive care that met people’s individual needs. However, we identified a couple of care omissions where the required care was not provided. We also found some care plans were missing key information which meant the service was unable to demonstrate people’s needs had been fully assessed.

A range of activities were available to people and we saw these were well received by people who used the service. The home also had a volunteer group whose input enhanced the social activities programme.

A system was in place to log, investigate and respond to complaints. Complaints were managed appropriately and used as an opportunity to continuously improve the service.

The provider was committed to further improvement of the service and they assured us that they were taking prompt action to address the issues we raised with them.

A number of positive systems were in place to assess and monitor the quality of the service. We saw these had been identifying and rectifying issues.

However, oversight of the lunchtime meal allocation process and people’s fluid intake was not sufficiently robust.

We identified two breaches of the health and social care act 2008 (Regulated Activities 2014) Regulations. You can see what action we asked the provider to take at the back of this report.