Wingates Residential Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to the seeking of consent from people and adhering to the Mental Capacity Act 2015, where people lacked capacity, as well as the way people’s modified dietary needs were managed.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider did not follow legislation and current evidence-based good practice and standards, which placed people at risk of harm.

Where people required a modified diet, for example pureed meals or softer options, we found these were not being provided safely or in line with guidance. We were told the home’s cooks used a whiteboard in the kitchen to document people’s dietary needs, to ensure these were met. However, we found not everyone requiring a modified diet was listed on the whiteboard, and for some who were, the information was incorrect. As a result, we were not assured food was being prepared in line with people’s modified dietary needs.

We reviewed electronic records, where staff documented what people had eaten. Records indicated people had been served and consumed foods contrary to modified dietary guidance, which placed them at risk of choking. For example, one person required a level 5 minced and moist diet. Any food provided needs to be soft, moist, and easy to chew with lumps no larger than 4 milimetres.Foods should not require biting, are easily scooped onto a fork without liquid dripping, and contain no mixed or separated textures, tough bits, seeds, skins, or sticky foods. Records indicated this person had recently been given toast, cake, biscuits, sandwiches, fish and chips, pie and beans.

During the second site visit, we observed lunch service and observed the modified meals being issued from the kitchen. We noted this did not fall in line with guidance, as the chunks of meat were too large and were served in a runny sauce, which dripped from the fork when eating.

One person required thickened fluids, due to swallowing difficulties which put them at risk of aspiration; the inhalation of liquid into the airways and lungs, which can lead to lung injury or infection. Providers are required to consistently document the use of thickener, including how much has been added and to what amount of liquid, whenever a drink is made, to demonstrate it has been made in line with the person’s prescription. The deputy manager told us staff recorded this information on the person’s fluid chart; however, we found no evidence this was being done.

We also found thickening powder was being stored in an unlocked cupboard, within the dining room. NHS England issued a safety patient alert in 2015 about the secure storage of thickening powder, after a care home resident died due accidental ingestion of thickening powder that had been left within their reach.

Following our site visits, we received confirmation action had been taken to address the shortfalls in the management of modified diets and thickened fluids. A new whiteboard had been installed, which accurately listed people’s diets, a lock had been added to the cupboard where thickener is stored, work had been done with staff around record keeping and training on meeting modified dietary needs had been arranged with the local Speech and Language Therapy team.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider did not seek people’s consent, nor acted in accordance with the Mental Capacity Act 2005, where people lacked capacity.

People’s care records contained a ‘consents and capacity’ section, within which signed consent forms should be stored. Consent should be sought for a range of decisions and actions, such as provision of care, assistance with medication and allowing professionals access to people’s care records. Aside from one person, we found there was a lack of signed consent forms in the care records we reviewed. Some people had none present at all, whilst others only had a document which confirmed they had seen their care plan. We were not assured of the validity of this document, as a different person’s name was recorded on the form. This same person’s name was found on at least 3 other people records, which suggested it had been cut and pasted onto multiple people’s care records.

Where people lack the mental capacity to make decisions and consent to their care and treatment and have not appointed a person to legally make decisions on their behalf, the best interest process needs to be followed. This is a requirement under the Mental Capacity Act 2005 and involves family members and professionals meeting to discuss the decisions which need to be made, and ensuring what is decided is in the person’s best interest. We found no evidence to show the best interest process had been followed, with no reference to this within care plans or documentation.

During our site visits, we observed staff verbally seeking people’s consent before providing care. People confirmed this happened consistently.