We inspected Bingley Wingfield on 23 July 2018 and found improvements from our last inspection. At our last inspection in September 2017, medicines were not always administered or recorded safely and properly, staffing levels did not fully ensure people’s care and support needs were met and systems to assess and monitor the quality of the service were not sufficiently robust. This meant the service was in breach of Regulations 12, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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.

We inspected Bingley Wingfield on 3 July 2017 and the inspection was unannounced. At the previous inspection in April 2016 we identified two breaches of Regulation relating to person centred care and good governance. At this inspection, we saw action plans were in place to improve person centred care and some improvements had been made which meant the service was no longer in breach of this regulation. However, we found further shortfalls in relation to the safe management of medicines and a continued breach of the regulation regarding good governance which needed to be promptly addressed.

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 im

The inspection took place on 26 April 2016 and was unannounced. On the day of the inspection there were 36 people living in the home. Bingley Wingfield provides accommodation and nursing care for up to 44 people at any one time. Accommodation in spread over three floors. The client group was mainly older people, some of whom were living with dementia.

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 w

The inspection took place on 21 July 2015 and was an unannounced inspection. On the date of the inspection there were 38 people living in the home. Bingley Wingfield provides accommodation and nursing care for up to 44 people at any one time. Accommodation in spread over three floors. The client group was mainly older people, some of whom were living with dementia.

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 told us they felt safe in the home and did not raise any concerns over their safety. Staff understood how to identify and act on allegations of abuse to help keep people safe. Where safety related incidents had occurred we saw the service had fully investigated and put measures in place to prevent a re-occurrence.

Although we found some risks were appropriately managed, we found two risks to people’s health, safety and welfare which were not adequately controlled. One person with diabetes was not supported to eat safely and some window restrictors on upstairs windows were not sufficiently secure to protect people from the risks of falls.

Safe recruitment procedures were in place to ensure staff were of suitable character to care for vulnerable people. Although we concluded there were enough staff in the building, their deployment could have been better organised to prevent people in some areas of the building experiencing delays in personal care.

People received their medicines safely at the times that met their individual needs. Medicines were appropriately stored. However stocks of medicines were not consistently logged and monitored which meant all medicines were not accounted for. There were no protocols in place describing when staff should support people with “as required” medicines which meant there was a risk of inconsistent administration of these medicines.

We found staff demonstrated a good level of skill and knowledge of the subjects we asked them about. Staff received training in a range of areas to help them deliver effective care. Shortfalls in staff knowledge were addressed through group and individual training sessions.

The service was acting within the legal framework of the Mental Capacity Act, including meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). A number of DoLS applications had been made where the service judged it was depriving people of their liberty. This helped to ensure people’s rights were protected.

People generally told us the food in the home was good and we saw people were provided with a range of food and drinks throughout the course of the day. However nutritional supplements were not appropriately managed as we saw them shared amongst service users rather than given solely to the person they were prescribed for. We also found one person at risk of malnutrition was missing a nutritional care plan and other nutritional care plans did not contain enough information on people’s individual needs and preferences.

People and relatives generally told us that staff were kind and caring and treated them well. We saw some kind and compassionate interactions between staff and people who used the service, however this was not consistently the case, some interactions we witnessed lacked respect towards people who used the service.

People’s healthcare needs were fully assessed to enable staff to deliver appropriate care. Although we found a range of care plans were in place there was a general lack of information on people’s social needs, life histories and preferences which demonstrated their needs were not fully assessed in these areas. This risked that staff may not have sufficient information to ensure they delivered personalised care.

A range of activities were provided to people who used the service through a dedicated activities co-ordinator. People generally spoke positively about the activities on offer.

Complaints were appropriately managed. We saw evidence complaints were logged and responded to promptly. Complaints were reflected on by the service to ensure learning and continuous improvement.

We found the provider had made a number of improvements to the service since the service came under new ownership in 2014. This included changes to the environment, training and the introduction of new policies and procedures. Plans were in place describing further improvements scheduled to the service in the near future, demonstrating a commitment to continuous improvement.

A range of audits and checks were undertaken and we saw evidence these were regularly identifying issues to help continuously improve the service. However we found a number of areas where checks were not sufficiently robust, for example care plan audits, medication audits and checks on bed rails and window restrictors.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.