About the service: The Wingfield is a ‘care home’ with nursing. It comprises of two separate sites, The Lodge and Memory Lane. There were 74 people living in the home at the time of the inspection.

People’s experience of using this service:

There was evidence in care records to suggest that people did not always receive consistent personalised care that was responsive to their needs. Some care records showed where recommendations and methods of support were being followed accurately, others did not. This meant some people may not have received appropriate support. The management team were made aware of this shortfall at the time of the inspection and took immediate action to rectify it.

The service had improved from requires improvement to good, in the domains of safe and well led and received a good rating overall.

The registered manager had made steady progress with improvements to safety and the overall running of the service. They had a continued action plan to make further ongoing improvements.

The service had safe recruitment processes in place and staffing levels were improving, but relatives still had some concerns about the use of agency staff. However new staff were being recruited.

People told us they felt safe and staff were trained and knowledgeable about safeguarding people from the risk of abuse.

People’s needs were assessed by a multi-disciplinary team and care plans were reviewed and updated regularly.

People received kind, dignified and respectful care and support from a team of committed staff. People and relatives were complimentary about the quality of care and told us they were happy with the support they received.

The service was well-led by a dedicated management team who provided good support for staff to be able to do their job effectively.

Rating at last inspection: Requires improvement (report published 14 March 2018).

Why we inspected: This was a planned inspection base on the rating at the last inspection.

Follow up: We will monitor all intelligence received about the service to inform when the next inspection should take place.

This inspection took place on 24, 25, 29 January 2018 and was unannounced. At the last inspection, we found the service was in breach of regulations. We found the service was not meeting the regulations to provide person centred care plans and not investigating and responding to complaints in a timely way. We also issued warning notices for the lack of sufficient staff and mealtime provision. 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 Safe, Effective, Caring, Responsive and Well-led to at least good. This inspection was undertaken in order to check how the provider had met its action plan. We had also received information of concern from an external source prior to this inspection and these concerns were looked into as part of the inspection. This is the fourth time this service has been inspected and rated as requires improvement.

The 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 Wingfield is a care home with nursing registered to provide personal and nursing care for up to 89 older people. The Wingfield is part of Barchester Healthcare Homes Limited. The service is housed in two separate buildings a short walk from each other on a site that is shared with a GP surgery and pharmacy. The smaller building, The Lodge has accommodation for up to 32 people on three floors. The second building, Memory Lane has accommodation on two floors for up to 57 people, and specialises in providing care to people living with dementia. At the time of our inspection, there were 19 people living at The Lodge and 41 people living in Memory Lane.

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.

Staff were not recruited safely, references from previous employers were not always verified and checked and where issues were identified, the service had not followed up to check discrepancies. Where potential issues had been identified and disclosed by the applicant risk assessments had not been put in place to make sure people were being supported by suitable workers.

Safeguarding concerns had been raised about four members of staff. The provider had taken the decision not to suspend all of them pending an investigation. Where this decision had been made there were no risk assessments in place to safeguard people whilst an investigation took place.

There were areas in the service, which due to their poor condition could not be cleaned effectively. The areas we highlighted as in need of maintenance are not part of the refurbishment programme.

People told us they felt safe and were cared for by staff who were kind and caring. We observed positive social interactions during our inspection, which demonstrated that staff knew the people they were supporting well.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Where people had their liberty restricted, the service had completed the related assessments and decisions had been properly taken. Staff had been trained and understood the general requirements of the Mental Capacity Act (2005).

People’s medicines were managed safely. We observed medicines were administered safely and in line with the provider’s policy. Safe storage and disposal arrangements were in place. Nurses administered medicines and had appropriate train

We carried out an unannounced comprehensive inspection of this service on 1 November and 2 November 2016. At the comprehensive inspection we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with six requirements stating they must take action.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook this focused inspection on the 6 and 7 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements. We had also received complaints about the service provided on five different occasions since the last inspection.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Wingfield’ on our website at www.cqc.org.uk’

The Wingfield had not had a stable management team since the registered manager left in 2015. A new manager had recently been appointed and had submitted an application to the Care Quality Commission (CQC) to become the 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.

At our focused inspection on the 6 and 7 June 2017, we found that the provider had not followed their plan which they told us would be completed by the 30th March 2017. This meant not all legal requirements had been met.

The service used a DICE tool (a dependency assessment tool) to work out staffing levels. All staff we spoke with told us the tool did not reflect the needs of people living with dementia. We observed many people in Memory Lane stayed in bed and staff told us they were not able to get people up due to staffing levels. Relatives told us they had also raised concerns about staffing levels.

The service was not consistently meeting the requirements of the Mental Capacity Act 2005 (MCA). The service had liaised with Wiltshire Deprivation of Liberty safeguards team and had received advice on the implementation of the MCA. We saw evidence that mental capacity assessments had been completed for some people who lacked capacity to consent to care and treatment at The Wingfield. However, we found many people still did not have a capacity assessment in place. Staff showed a good understanding of the MCA and we saw staff giving people choice and asking for permission before providing support.

People were given a visual choice of two meals and if they didn’t like what was on offer, they could ask for an alternative. Pureed food was presented well and appeared appetising. We found though that people were not always encouraged to eat and drink sufficiently. We observed food taken away from people without staff encouraging them to eat. We observed people with prescribed build up drinks next to them, untouched. Where people were prescribed thickeners we found an increased risk to people due to conflicting information available and the knowledge of the staff.

We found the service had started to implement a system of reviewing and updating all care plans. However care plans we looked at, were not person centred and information within the plans was contradictory. People were not supported to follow their interests and take part in social activities.

Complaints received had not been investigated and responded to in a timely way.

Staff told us they did not always feel supported by management, but were hoping the new manager would make positive changes to the service.

Staff had received additional training in dignity and respect since our last inspection. The service no longer used agency staff to provide c

The Wingfield is a care home with nursing service, registered to provide personal and nursing care for up to 89 older people. The Wingfield is part of Barchester Healthcare Homes Limited; a large provider organisation. The service is housed in two separate buildings a short walk from each other on a site that is also shared with a GP surgery and pharmacy. The smaller building; The Lodge, has accommodation over three floors for up to 32 people. The second building; Memory Lane, has accommodation on two floors for up to 57 people, and specialises in providing care to people living with dementia. At the time of our inspection 23 people were living at The Lodge and 48 people at Memory Lane.

The inspection took place on the 1 and 2 November 2016. The first day of the inspection was unannounced.

The service did not have 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 was a deputy manager and two operations managers who were responsible for the day to day running of the service. One of the operations managers was in the process of applying to be the registered manager.

At the last comprehensive inspection in August 2015 we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because insufficient care staff were deployed which meant care was not consistently provided in a timely way, the service did not effectively assess and promote infection control, the service did not always follow the requirements of the Mental Capacity Act 2005 when people did not have capacity to consent to care and treatment. In addition, the service did not have effective quality and safety assurance information gathering systems in place.

At this inspection we found that the provider had taken action to address some of the issues highlighted in the action plan, however some issues remained and still needed improvement. The service was managing risks of infection effectively. We found bedrooms and communal areas were clean and tidy. The service had adequate stocks of personal protective equipment such as gloves and aprons for staff to use to prevent the spread of infection.

Staffing levels had improved, however staff were more effectively deployed in the Lodge, than they were on Memory Lane. The majority of people living in Memory Lane stayed in their bedrooms and did not see staff other than when care tasks were completed, which meant people could be at risk of social isolation.

The requirements set out in the Mental Capacity Act 2005 (MCA) were not always followed when people lacked the capacity to give consent to living and receiving care at the home. People living with dementia were not always supported to make choices. At The Lodge staff said they had received training on this topic and understood the importance of encouraging and enabling people to make informed choices about their daily lives. On Memory Lane permission was not always sought from people prior to tasks being undertaken.

People told us they enjoyed the food and there was a good choice of meals. The chef knew people’s likes and dislikes as well as nutritional requirements. At The Lodge, people had access to food and drinks throughout our inspection. At Memory Lane people were not always supported to eat sufficient food and records did not accurately reflect what people had or had not eaten.

People’s privacy and dignity was not always respected. On Memory Lane we observed staff consistently entering people’s rooms without knocking or seeking permission to enter. There was a pleasant and friendly atmosphere throughout The Lodge.

Care plans were regularly review

There were 83 people living in the two units. We spoke with eight people who used the service and seven staff. Some people using the service had complex needs so we used various methods to collect their experiences.

People who used the service told us they were satisfied with the service they received. People felt the staff supported them and met their needs. One person who used the service said "I feel that I can do what I want."

People told us that staff treated them with dignity and respect. One person said “the staff are very good and take time to listen.” We saw staff speaking to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live on the units. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people. The service trained their staff and had the procedures which protected people from abuse. People told us they did not have any complaints but would speak to staff if they had concerns. One person said “I know that I can speak to the manager at any time.”

The service and the building were monitored and risk assessed to ensure they were suitable for the people who used them.

The evidence we collected showed us the service kept people safe and met their care needs.

People told us staff respected them and met their needs. One person said “I’m looked after very well”, and another “they treat me sensitively.” A relative told us “they can take care of them better than I could.” A person described how they liked to be assisted to get up, washed and dressed at a specific time, and was pleased staff respected this.

Staff supported people appropriately, including when they gave them their medication and meals. We saw one person did not sit down to eat but continued to walk about throughout the mealtime, eating as they went. We saw the home maintained full records of what the person ate, to ensure they received adequate nutrition. We observed a very frail person was being given regular mouth care, to keep their mouth clean and comfortable.

We saw medication was administered in a safe way. Medicines were stored securely. Full records of medications administered were maintained.

People spoke favourably about the staff. One person told us “they do care, it’s not just a job to them.” The provider had safe systems for recruiting new staff. Staff records were appropriately completed and stored securely.

People told us they were pleased with the care and support provided.

Members of staff engaged with people and listened to what they had to say. It was clear that good relationships had been established.

The Wingfield is a care home with nursing service, registered to provide personal and nursing care for up to 89 older people. The Wingfield is part of Barchester Healthcare Homes Limited; a large provider organisation. The service is housed in two separate buildings a short walk from each other on a site that is also shared with a GP surgery and pharmacy. The smaller building; The Lodge, has accommodation over three floors for up to 32 people. The second building; Memory Lane, has accommodation on two floors for up to 57 people, and specialises in providing care to people living with dementia.

The main kitchen and laundry and the administration offices for the service were located in the Memory Lane building. As well as care and nursing staff, hostesses were also employed by the service. Their duties included providing food and drink to people, greeting and helping visitors and to set and clear tables for meals.

The first day of the inspection was unannounced and the visit took place over three days between17 and 19 August 2015.

The service had a registered manager who was responsible for the day to day running of the home. 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.

Some stairwells and sluice areas in home were not cleaned to a sufficient standard, and other preventative steps had not been taken in relation to infection control such as using separate hoist slings for each individual, and disposing of incontinence waste products appropriately. This meant the home did not always manage the risk of infection.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the rights of people who lack mental capacity to make decisions are protected in relation to consent or refusal of care or treatment. CQC is required by law to monitor the application of the MCA and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find.

The service had systems in place to record whether people consented to their care and treatment at the home. However, the requirements set out in the Mental Capacity Act 2005 (MCA) were not always followed when people lacked the capacity to give consent to living and receiving care at the home.

People said they felt safe living at the home. Staff were aware of their safeguarding responsibilities and showed positive attitude to this, and also to whistleblowing. We found that the home's safeguarding systems were not operated as effectively as possible and have made a recommendation about this which can be seen in the full version of the report.

We found that sufficient numbers of staff were not deployed fully to meet people’s needs for person centred care.

The Wingfield did not operate complaints systems as effectively as possible because not all complaints and their outcomes were recorded. We have made a recommendation about this which can be found in the full report.

Checks of records indicated that reporting and recording of incidents and accidents took place. The premises and equipment were usually safe and adapted to meet people’s needs. Medicines were safely managed.

People were complimentary about the food provided at the home. One person said, “there’s a good choice and food is excellent.” People’s health needs were monitored and they were assisted to access healthcare services as necessary.

Staff acted in a caring manner; we observed they were warm towards people and spoke with respect. People who use the service were helped to make decisions about how their care was provided, and suggestions about how the home was run. However some of these suggestions had not resulted in improvements to the care they received. We have made a recommendation about this which can be found in the full report.

People spoke positively about the staff. One family member said, “They take every care… It’s just like coming to a family.’’

We observed that people were given choices and consulted about their care. People, those important to them and staff informed us they felt confident to raise issues or concerns.

Each person who uses the service had their own personalised care plan which promoted communication.

People were assisted to go out into the community and to participate in activities.The service had quality and safety assurance information gathering systems in place but these were not always fully effective.

We found 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.