This inspection took place on 12 and 19 December 2018 and was unannounced.

St Winifred’s Nursing Home 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. The home provides nursing and personal care for up to 38 older people, some of who may be living with dementia. Accommodation is provided on two floors with passenger lift access between floors. There are communal areas on the ground floor, including lounges and a dining room. There were 23 people in the home when we inspected.

At our three previous inspections we rated the service as ‘Inadequate’ and in ‘Special Measures’. At our last inspection on 18 and 20 June 2018 we identified five regulatory breaches which related to safe care and treatment, recruitment, dignity and respect, person-centred care and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found improvements had been made, although there remained in breach in Regulation 12 (safe care and treatment). This related to medicine management.

The manager who was in post at the last inspection in June 2018 left. A new manager was in post when we inspected and their registration with the Care Quality Commission was confirmed on the second day of this inspection. 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.

Minor improvements had been made in how medicines were managed, however shortfalls remained which meant people were not always receiving their medicines as prescribed. On the second day of the inspection the manager informed us these issues were being addressed.

People received personalised care although care plans were not always up to date or accurate. Risks to people were well managed by staff, although this was not always fully reflected in risk assessments. The manager told us all the care documentation was being reviewed and updated.

There were enough staff to meet people's needs. Staff worked well together as a team communicating and supporting each other. Staff recruitment processes had improved. Staff received the induction, training and support they needed to carry out their roles.

Accidents and incident were reported and a monthly analysis considered trends and themes and looked at any lessons learned. Staff had a good understanding of safeguarding and the reporting systems and incidents were recorded and reported appropriately.

The home was clean, well maintained and comfortably decorated and furnished. However, some areas required improvement to make them more dementia friendly so people living with dementia could find their way around more easily. We have made a recommendation about making the environment dementia-friendly.

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.

People were supported to have sufficient food and drink, although the monitoring and recording of food and fluid intake needed to improve. People had access to healthcare services and systems were in place to manage complaints.

Relatives and staff spoke positively about the new manager who, alongside the providers, had made improvements to the quality of the service. Quality audit systems had improved, although medicine audits needed to be more thorough as issues we found had not been identified or addressed by the p

St Winifred's Nursing Home 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 home provides nursing and personal care for up to 38 older people some whom may be living with dementia. Accommodation is provided on two floors with lift access between floors. There are communal areas on the ground floor, including lounges and a separate dining room. There were 22 people in the home when we inspected.

This inspection took place on 18 and 20 June 2018 and was unannounced.

At our previous two inspections we rated the service as ‘Inadequate’ and in ‘Special Measures’. At the last inspection on 30 October and 1 November 2017 we identified six regulatory breaches which related to staffing, safe care and treatment, premises and equipment, dignity and respect, person-centred care and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

The home does not have a registered manager. The previous registered manager left on 30 June 2017. The manager who was in post at the time of this inspection started at the service in February 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.

Although we found some improvements had been made at this inspection, concerns remained in several areas. We found continued regulatory breaches in relation to safe care and treatment, person-centred care, dignity and respect and good governance. We also identified a new breach in relation to staff recruitment.

We noted continued improvements to the premises and equipment. The home was clean, well maintained and many areas had benefitted from redecoration and refurbishment. We found environmental checks and audits were robust and effective.

Accidents and incident recording had improved and a monthly analysis considered trends and themes and looked at any lessons learned. Staff had a good understanding of safeguarding and the reporting systems and we saw incidents were recorded and reported appropriately.

Staff training and supervision had improved and a new induction programme had been introduced. We found there were enough staff to meet people’s needs although the rotas showed the staffing levels at times fell below the levels the manager had determined as safe. However, we found staff recruitment processes were not robust as thorough checks had not been completed for two recently recruited staff.

We found shortfalls in the care and treatment people received. Medicines management was not safe and people were not always receiving their medicines as prescribed. People’s care needs were not always being met as changes in individual needs were not reflected in care records or communicated to staff in handovers. Risks to people were not always recognised, assessed or managed.

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.

People’s nutritional needs were met, although the completion and monitoring of food and fluid charts was poor. People had access to healthcare services and systems were in place to manage complaints.

People told us activities were limited which our observations confirmed. People and relatives told us staff were kind and caring. We saw some caring interactions but also practices which showed a lack of respect for people and compromised their dignity.

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The inspection took place on 30 October and 1 November 2017. St Winifred’s Nursing Home provides personal care and nursing care for up to 38 older people, some of whom are living with dementia. On the days we inspected there were 22 people living at the home.

The home did not have a registered manager in post at the time of inspection. 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 had previously inspected the home in April 2017 and rated the service as 'Inadequate' and in 'Special Measures'. At the inspection in April 2017, we found nine regulatory breaches which related to safe care and treatment, premises and equipment, staffing, safeguarding, consent, dignity and respect, person-centred care, complaints and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Overall we found some improvements had been made in the home since our last inspection, although there were still areas where further improvement was required. The provider remained in breach of six regulations. The provider was no longer in breach of regulations which related to safeguarding, consent and complaints.

Improvements had been made to assess and mitigate risks to people's health, safety and welfare. Unsafe equipment had been replaced. The provider had begun to replace the carpets and radiators. However some radiators remained hot to touch and the risk in relation to this had not been managed.

The systems and processes in place to manage medicines were not always safe or effective.

The provider had not assessed whether staffing levels were sufficient to meet people's needs in a timely manner. People told us they waited a long time for their call bell to be answered.

Staff recruitment checks were completed before new staff started work to ensure their suitability to work in the care service. Staff did not receive a robust induction.

The manager had begun to ensure staff received supervisions but had not begun to assess staff's competency.

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 interaction was positive and supportive with people on the whole, although staff were on occasion task focused. When staff assisted people, they were kind and patient. However some people’s continence needs were not always managed in a timely way. We observed people who needed support to mobilise sat in the residential unit lounge for long periods without moving.

All care records, except one, had been updated. We found care records were organised but were not always fully completed. Work had begun regarding the provider’s approach to managing behaviours that challenge.

The provider had an up to date complaints policy displayed within the home. We saw complaints were logged, investigated and the outcome communicated to the individual.

Day to day leadership and management of the service had improved since the last inspection. Staff now felt supported and positive. Staff told us the service had got better. The quality assurance systems for assessing, monitoring and improving the quality of the service had improved but were in their infancy and there was insufficient time for these systems to become embedded. However, the provider did not effectively monitor or assess the service.

The overall rating for this service is 'Inadequate' and the service therefore remains in 'Special measures'.

Services in special measures will be kept under review and, if we have not ta

This inspection took place on 25 and 27 April 2017 and was unannounced. At the last inspection on 24 May 2016 we rated the service as Requires Improvement. We found three regulatory breaches which related to person-centred care, consent and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

St Winifred’s Nursing Home provides personal and nursing care for up to 38 older people, some of who may be living with dementia. There were 32 people using the service when we visited. Accommodation is provided on two floors, there are single and shared rooms, some of which have en-suite facilities. There are a variety of lounge and dining areas throughout the home.

The home had a registered manager who commenced in post on 1 March 2016. 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. The registered manager was present on both days of this inspection.

We found there were not enough staff on duty to keep people safe and meet their needs. People told us when they pressed their buzzers it was often a long wait before staff attended and we observed this happening.

Risks to people were not well managed which placed people at risk of harm or injury. For example, where people had been involved in incidents relating to equipment such as bed rails there had been no investigation into the incident or review of the risks to establish if using bed rails was suitable or safe. We also found environmental checks in place to ensure the safety of the premises in relation to hot water, radiators and window openings were not effective or thorough as they had not identified or addressed concerns we found at the inspection.

Staff had received training in safeguarding and understood the reporting systems, however we found safeguarding incidents were not always recognised or reported to the local authority safeguarding team. For example, we found one person had an extensive area of unexplained bruising, yet this had not been referred to safeguarding and no action had been taken to investigate the possible cause.

Medicines management was not always safe which meant people were at risk of not receiving their medicines when they needed them.

Safe recruitment processes were in place and staff received induction and ongoing training. Systems were in place for staff appraisals however there were no systems in place to ensure staff received regular and meaningful supervision.

Staff lacked understanding of the legislative requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s care records were not accurate or up-to-date and did not reflect people’s needs or preferences. Complaints were not investigated in accordance with the provider’s own complaints procedure.

An activity coordinator worked 20 hours a week and we saw some people enjoyed a singalong with a visiting entertainer. However, people told us they felt more could be done to fill their days and also wanted opportunities to go out.

People told us they enjoyed the food and we saw people were supplied with drinks and snacks between meals. People had access to healthcare services such as GPs and other specialists.

People praised the staff and we observed some kind and caring interactions between staff and people who used the service. However, we also saw occasions where staff did not respond in a compassionate way when a person needed assistance.

We found there was a lack of consistent and effective management and leadership which coupled with ineffective quality assurance systems meant issues were not i

The inspection took place on 24 May 2016 and was unannounced.

St Winifred’s Nursing Home provides accommodation for people who require nursing or personal care situated in Rastrick a suburb between Huddersfield and Halifax. There are single and double bedrooms available many of which have en suite facilities. Of the twenty seven people using the service on the day of inspection ten required residential care and seventeen required nursing care.

The last inspection was in August 2015. At that time we found the provider was in breach of a number of regulations and the home was placed in special measures. The breaches of regulation were in regard to safe care and treatment, staffing, meeting nutritional and hydration needs, safeguarding people from abuse and improper treatment and good governance. At this inspection we found the provider had made sufficient improvement to take the home out of special measures.

The home did not have a registered manager in post at the time of the inspection. However, a new manager had taken up post on 01 March 2016 and had applied to be registered with the Commission. 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 this inspection we found the staffing levels on night duty had been increased in line with the dependency levels of people who lived at the home and the layout of the building. In addition, a staff training audit had been carried out and a training and supervision plan for 2016 had been put in place to ensure staff received the training and support they needed to carry out their roles effectively.

At the last inspection we found people were not consistently receiving appropriate support to meet their nutrition and hydration needs. At this inspection we found people’s nutritional status was assessed to determine the risk of malnutrition and people’s weights were being monitored. However, we found staff were not always accurately recording the amount of fluid people were taking and although the audit systems in place had identified this issue no action had been taken to address the matter.

We saw the manager was in the process of implementing a new care planning system which would ensure the care plans were more person centred and people had access to the full range of NHS services. We observed people were well cared for by staff that had a good understanding of their needs and preferences.

The home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and kept them as safe as possible. People told us they felt safe because the staff were caring and because the manager listened to them and acted if they raised concerns. However, although we found improvements had been made in the way money held in safekeeping for people was managed; staff were not always following to the policies and procedures in place.

We found although the service was working in accordance with some requirements of the Mental Capacity Act 2005 (MCA) where people had their liberty restricted in order to keep them safe conditions had not always been met.

We saw the complaints policy was available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

We found although some improvements had been made to the quality assurance monitoring systems further improvements were required. The audit systems were not robust and had not identified some of the shortfalls in the service highlighted above and in the body of this report.

We identified three breaches of the Health and So

This inspection was carried out to assess whether the service had taken action to make sure that the systems for managing medicines in the home were safe. We had told the provider during our inspection in June 2013 that this must be done.

We found that action had been taken and the systems were safe.

Due to the focussed nature of this visit, we did not speak with any of the people who lived at the home on this occasion.

During our visit to the service we spoke with seven people who lived at the home. Not all of the people we spoke with gave us their opinions about the care and support they received but these are some of the things people did say :

"The staff are fantastic but they are busy. Sometimes I have to wait too long, especially when I need the toilet."

"The staff are really good, sometimes they take longer than I would like to come to me but that is because they are busy. The girls are lovely, I speak to the manager when she comes round every week, the cleaners are good and the receptionist comes round for a chat. The food is fantastic"

Two people told us that some staff are better than others.

We spoke with three visiting relatives who told us they were more than satisfied with the care provided. One person who lived at the home and the visiting relatives told us that they are involved in the care planning and review process.

We found that the home was clean and tidy and had benefited from some recent redecoration.

Staff told us that they enjoyed working at the home. They said they were busy but felt there were enough of them to meet people's needs.

This inspection was carried out to see what actions had been taken to achieve compliance with regulation 20 of the Health and Social Care Act of which breaches had been identified on our last two inspections of the service. These were particularly in relation to care plans.

We found that appropriate actions had been taken to achieve full compliance.

Due to the the focussed nature of this inspection, we did not speak with people who lived at the home on this occasion.

This was a follow up inspection to check compliance with a warning notice relating to outcome 7 (safeguarding) and a compliance action relating to outcome 21 (record keeping) which were issued following our inspection in September 2012.

Due to the focussed nature of this inspection we did not, on this occasion, seek the views of people who use the service.

We found that actions had been taken to achieve compliance with outcome 7 but we found continued non-compliance with outcome 21.

People said that staff supported them in meeting their needs and that they were respectful of their privacy and dignity needs.

People who live at the home said:

"I'm very contented here, no complaints at all"

"I don't like it here because I have no-one to talk to. Staff are nice but are too busy to chat"

"The staff are nice, I have a nice room"

" I don't like it here because staff don't give me the help I need when I need it"

Staff said that they liked worked at the home

We inspected St Winifred’s Nursing Home on 11 and 12 August 2015 and the first day of inspection was unannounced. Our previous inspection took place in June 2013 and at that time we found the service was not meeting one regulation we looked at relating to medicines. We returned to the service in September 2013 and found improvements had been made and the service was compliant with this regulation.

St Winifred’s Nursing Home provides accommodation for people who require nursing or personal care situated in Rastrick a suburb between Huddersfield and Halifax. There is a car park to the front of the building and a courtyard in the middle of the building where people can sit in the nice weather. There are single and double bedrooms available many of which have en suite facilities. Of the thirty three people using the service on the day of inspection seventeen required residential care and sixteen required nursing care.

The home had a registered manager. 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.

The home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and kept them as safe as possible. However, we found staff were not following the procedures in place for safeguarding people’s money held in safekeeping, which might lead to mistakes being made.

We were concerned that there was not always sufficient staff on duty to meet people’s needs and that staff did not always receive the training and support they required to carry out their roles effectively.

There were procedures in place and guidance was clear in relation to Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) that included steps that staff should take to comply with legal requirements. However, the staff we spoke with did not have a clear understanding of the MCA or DolS or when Best Interest Decisions needed to be made to safeguard people. This legislation is used to protect people who might not be able to make informed decisions on their own.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists. However, we found the guidance and advice provided by other healthcare professionals was not always followed and people were not consistently receiving appropriate support to meet their nutritional and hydration needs.

We also found that although medication policies and procedures were in place medicines were not always administered as prescribed.

People told us they found the staff caring, and said they liked living at the home. Relatives gave us positive feedback about the care and support their family members received. Throughout the inspection we saw staff were kind, caring and patient in their approach and had a good rapport with people.

Staff were careful to protect people’s privacy and dignity and people told us they were treated with dignity and respect. We saw information relating to people’s care and treatment was treated confidentially and personal records were stored securely.

We saw the complaints policy had been available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

Staff told us communication within the home was good and staff meetings and daily handovers were held to keep them up to date with any changes in policies and procedures or anything that might affect people’s care and treatment. Staff were confident senior management would deal with any concerns relating to poor practice or safeguarding issues appropriately.

However, we found the quality assurance monitoring systems in place were not robust and therefore we could not be sure the service was managed effectively and in people’s best interest.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.