Bings Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bings Hall provides accommodation and personal care for up to 17 older people. Some people also have dementia related needs.

At the last inspection on 28 October 2015, the service was rated ‘Good’. At this inspection we found the service was now rated overall ‘Requires Improvement’. This is the first time the service has been rated ‘Requires Improvement’.

The inspection was completed on the 24 August 2018 and was unannounced. At the time of the inspection, there were 14 people living at Bings Hall.

The service had a registered manager in post and they were formally registered with us in June 2018. 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.

We were advised during the inspection by the registered manager that Bings Hall was newly registered with a new provider five days before our inspection. The shortfalls identified as part of this inspection relate to the previous registered provider and not the new owners of the service.

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. The current arrangements had not identified the issues we found during our inspection. The registered provider lacked oversight as to what was happening within the service to make the required improvements. They also had not provided suitable support to the registered manager to ensure compliance with regulatory requirements and the fundamental standards.

Improvements were required to the recruitment practices to ensure these were robust. Not all staff had up-to-date manual handling training. Improvements were also required to ensure newly employed staff received a robust induction, formal supervision and an annual appraisal of their overall performance. Medication practices and procedures required strengthening to ensure these were in line with good practice procedures and guidance. Not all people’s care and support needs were recorded and detailed within a care plan. However, we did note there was no impact to demonstrate people’s care and support needs were not being met.

People were protected from abuse and they said they were safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff and the registered manager to safeguard people. Risks to people were identified and managed to prevent people from receiving unsafe care and support. Staffing levels and the deployment of staff was suitable to meet people’s needs. People were protected by the registered provider’s arrangements for the prevention and control of infection.

People’s healthcare needs were met and they had access to a range of services and professionals as required. The dining experience for people was positive and their nutritional and hydration needs were adequately met. Staff had a good knowledge and understanding of people’s specific care and support needs and how they wished to be cared for and supported. Social activities were available for people to enjoy and experience. The service worked together with other organisations to ensure people received coordinated care and support. Suitable arrangements were in place to support people who required end of life and palliative care.

People confirmed they knew how to make a complaint or raise concerns. Records of compliments had been maintained to recognise the service’s achievements.

We have made some recommendations about medication practices and procedures, safe re

We inspected this service on 28 October 2015 and the inspection was unannounced. Bings Hall can provide accommodation and personal care for up to 17 older people, some living with dementia. At the time of our inspection there were 16 people living at the service.

There was 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.

There were enough staff to support people safely and they were clear about their roles. Recruitment practices were robust in contributing to protecting people from staff who were unsuitable to work in care in the home care section of the service.

Staff knew what to do if they suspected someone may be being abused or harmed and medicines were managed and stored properly and safely so that people received them as the prescriber intended.

Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Where people were not able to give informed consent, staff and the manager ensured their rights were protected.

People have enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled. Staff also made sure that people who became unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff showed commitment to understanding and responding to each person’s preferences and needs so that they could engage meaningfully with people on an individual basis. The service offered people a chance to take part in activities and pastimes that were tailored to their individual preferences and wishes. Outings and outside entertainment was offered to people, and staff offered people activities and supported them on a daily basis.

Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that they were confident that complaints they made would be addressed by the manager.

The service had consistent leadership of a high standard; the manager is well organised and committed to supporting an open and positive culture that is person centred. The staff told us that the manager was supportive and easy to talk to. The manager was responsible for monitoring the quality and safety of the service and asked people for their views so that improvements identified were made where possible.

We found that people were cared for a respectful and dignified way. One person told us "The staff here are marvellous, they look after us so well." Another person told us "I am very happy here, the staff are so kind." We saw people being offered choices and were encouraged to maintain their independence.

Care plans were in place and were comprehensive. Risk assessments had been cross referenced to care plans which ensured people's needs were met. We saw that people and their relatives had been involved in care planning.

The service was clean and well maintained. Staff had access to infection control training and they demonstrated a good technique in hand washing and the rationale for it.

There were enough suitably skilled and experienced staff to meet people's needs. We saw that people were attended to in a timely way and were unhurried when they needed assistance.

Records were up to date and fit for purpose.

We spoke with seven people who used the service. They told us that staff were kind and supportive. One person said, “The kindness of staff is tremendous.” Another person said, “It’s very homely here and you can please yourself.” We saw that the service had good equipment to support people with poor mobility.

We found that care planning was effectively managed so that care and treatment was provided according to people’s wishes and needs. There was effective management of medication. We saw that there were regular quality checks including gaining the views of people living in the service.

Staff were trained appropriately and supervised regularly to maintain competence. Staff told us they had training to provide safe care including to people living with dementia.