About the service:

Wingham Court Care Home is a BUPA care home which provides long-term nursing care and short stay care for up to 73 younger people. The house offers specialist support for those who have experienced a brain injury or for those who have challenging behaviour. At the time of the inspection there were 69 people at the service.

People’s experience of using this service:

¿ There was a risk that people’s rights were not protected because staff did not always act in accordance with the Mental Capacity Act 2005 (MCA). Where people’s capacity was in question MCA assessments were not always taking place.

¿ Records at the service were not always robust and required improvements to ensure accurate information was available in relation to people’s care. More appropriate terms were needed to describe some aspects of the service.

¿ The deployment of staff required some improvement in two areas of the service to ensure that people received care when it was needed. We have made a recommendation around this.

¿ People told us that they felt safe. There were appropriate systems in place to ensure that any risks associated with people’s care was managed well by staff.

¿ The clinical care for people was effective. People were supported with their health needs where necessary.

¿ Staff were provided with training and supervision in their role and were encouraged and supported to progress.

¿ People told us that they enjoyed the food at the service. Where people were at risk of malnutrition and dehydration appropriate steps were taken to support them.

¿ The environment was adapted to suit the needs of people living there.

¿ People were treated in a caring and dignified way. They were involved in decisions about their care.

¿ Staff knew people well and provided care that was reflective of their needs. Care plans had detail about the best way to deliver their care.

¿ End of life care was discussed with people and recorded to reflect their wishes.

¿ There were sufficient activities for people around their interests and hobbies.

¿ Complaints were recorded, investigated and responded to appropriately.

¿ There were systems in place to review the quality of the care being provided that included audits, meetings and feedback questionnaires.

¿ People, relatives, health care professionals and staff were complimentary about the leadership of the service.

¿ Where appropriate notifications were sent to the CQC by the registered manager.

Rating at last inspection:

¿ At the last inspection the service was rated Good (the report was published on the 13 October 2016)

Why we inspected:

¿ This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

¿ We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Please see the ‘action we have told the provider to take’ section towards the end of the report.

This inspection was carried out on the 31 August 2016. Wingham Court Care Centre provides long-term nursing care and short stay care for up to 73 people. The service offers specialist support for those who have experienced a brain injury or for those who have challenging behaviour. At the time of our inspection 70 people were living at the service.

There was a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 sufficient numbers of care staff deployed at the service to meet people's needs. People told us they felt safe at the service. Staff had a good understanding about the signs of abuse. They were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from potential risks.

Recruitment practices were safe and relevant checks had been completed before staff started work.

Medicines were managed, stored and disposed of safely. Any changes to people's medicines were prescribed by the person's GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the service would function in the event of an emergency.

Staff had received appropriate supervision with their managers. We found the staff team were knowledgeable about people's care needs. People told us they felt supported and staff knew what they were doing.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken.

People's needs were assessed when they entered the service and on a continuous basis to reflect changings in their needs.

People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Concerns and complaints were used as an opportunity to learn and improve the service.

People had access to activities that were important and relevant to them. People were protected from social isolation through systems the service had in place. There were a range of activities available within the service and outside.

The provider had systems in place to regularly assess and monitor the quality of the care provided.

The provider actively sought, encouraged and supported people's involvement in the improvement of the service.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive and staff felt valued.

The registered manager had informed the CQC of

We carried out an unannounced comprehensive inspection of this service on 25 November 2014 and 10 February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to consent to care and treatment, the support of staff, the deployment of staff, cleanliness and infection control and the quality monitoring of the service.

We undertook this focused inspection on 20 April 2015 to check that the provider had followed their plan and to confirm they have now met legal requirements. 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 Wingham Court Care Centre on our website at www.cqc.org.uk.

There were enough staff deployed through the service to safely meet people’s needs. People said they received care in a timely way and we saw this on the day. Staff were not rushed and were able to spend time with people and get involved in activities more than before.

The service was now clean and there was a reduced risk of infection spreading. Staff had a better knowledge of infection control measures which included hand washing and removal of clinical waste. People and relatives said the service was cleaner.

Staff were not up to date with all of the service mandatory training but there was an action plan in place to address this. The gaps included fire safety training and health and safety. All other areas were up to date which included infection control and safeguarding people. This meant that staff were provided with the most up to date guidance in relation to their role.

Group supervisions had taken place with staff as well as one to one supervisions. There was a schedule of ones to ones due to take place with all staff with their manager. Staff said they felt supported in their role by the management team and could go to them whenever they needed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. Staff did not have the correct knowledge of the Mental Capacity Act 2005 and mental capacity assessments had not taken place for all people where needed. The regional manager said they knew this was a concern and were addressing this as soon as practicable.

People and staff felt the service was well managed. Audits that took place were effective and improvements had been made as a result of the audits. For example, in relation to cleanliness and the environment.

We found one breach 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 the report.

We carried out an unannounced comprehensive inspection of this service on 25 November 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to staffing and cleanliness and infection control.

We undertook this focused inspection on the 10 February 2015 to check that they had followed their plan and to confirm they have now met legal requirements. 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 Wingham Court Care Centre on our website at www.cqc.org.uk.

There were not always enough staff to meet people’s needs. This meant that sometimes staff did not spend time with people other than to provide personal care. People did not always receive personal care in a timely way. One person told us, “Last week I missed an appointment because they didn’t get me up in time.”

The service was not clean and there was a risk of cross infection. Some areas of the service had been re-decorated; however people’s bathrooms and the small kitchens used by people and staff that were on each floor were not clean. Some of the equipment in the bathrooms was rusty and dirty which was an infection control issue. We observed staff did not always wash their hands after cleaning the toilets. Staff had not undertaken recent refresher training in infection control.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

This was an unannounced inspection, which took place on the 25 November 2014. Wingham Court Care Centre is a BUPA care home which provides long-term nursing care and short stay care for up to 73 younger people. The service offers specialist support for those who have a brain injury or for those who have challenging behaviour. It is registered for up to 73 people. At the time of our inspection there were 71 people at the service.

The service is split into four areas on two floors. Rexley one and Rexley two are for people who have a physical disability and is on the ground floor. On the first floor is YPD one and YPD two which is for people living with a cognitive impairment or have an acquired brain injury.

At the time of inspection there was no 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 and associated Regulations about how the service is run.

People and their relatives told us that they felt they were safe. Not all staff had received updated safeguarding adults training but had knowledge of the safeguarding procedures and what to do if they suspected abuse. In addition not all staff had received up to date training in moving and handling and health and safety. This meant that staff may not have the most up to date guidance.

There were not always enough staff to safely meet people’s needs. This meant that sometimes people did not receive personal care in a timely way or at all. People did not always have their medicine on time and were sometimes woken late at night to have their medicine.

There were processes in place in relation to the correct storage and audit of people’s medicines. All of the medication was administered and disposed of in a safe way. Although there was a risk, due to lack of staff, that people may not get their medication in a timely way.

Pre-employment checks for staff were completed. For example in relation to their full employment history and reasons why they had left previous employment. This meant that only suitable staff worked there.

There was a risk of cross infection. Some areas of the service were clean. However there were certain aspects to the infection control that needed improvement. People’s rooms, the corridors and some of the living areas were not clean. Staff were not always using the correct procedures where bedpans were cleaned and sterilised.

Some people thought the food was good and felt that their needs were catered for. People were encouraged to make their own decision about the food they wanted. Other people felt that the food was not good and that they didn’t always get what they had asked for. We saw that there was a wide variety of fresh food and drinks available for people.

Some staff knew about the Mental Capacity Act 2005. However we saw that mental capacity assessments had not taken place in relation to one of the units. The unit had a key pad lock in place that some people were unable to access.

People thought that the staff were caring and that they were treated with dignity and respect. They also felt that if they needed privacy then this would be given. Staff communicated with people in a meaningful way however there were times where people were left for long periods of time without any interaction with staff.

People did not always feel that staff understood their care needs. One person said that they felt that staff did not understand their specific health needs. People had access to other health care professionals as and when they required it.

Some activities were available. We saw that some people enjoyed an activity on the day of the inspection. However there were not enough activities provided for people specific to their needs.

People did not always understand how to make a complaint and did not always feel comfortable to do so. There was a copy of the complaints procedure for everyone to see in the reception area. All of the complaints were logged and an action plan was written to resolve the complaint where possible.

People, relatives and staff were asked for their opinion and feedback on what they thought of the service. However these comments were not always used to make improvements. For example in relation to improving the environment.

People and staff did not feel that there was the management support in place in the service. The audits that took place were not effective and improvements had not been made as a result of the audits. For example in relation to the cleanliness and care plans. People were regularly asked for their feedback on the service through meetings and surveys. Information from these were used to make improvements.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

We carried out an inspection at Wingham Court to look at the care and welfare of the people who lived in the house.

As part of our inspection we spoke to nine people who used the service, nine members of staff, the manager and five relatives. People who used the service told us that they were happy living at the house. We were told “It’s nice here” and “Best place I’ve ever been to.” They said that staff were very kind, caring and treated them with respect. We observed this during our visit.

We saw that people chose how they spent their time and that they had opportunities to take part in a wide range of activities. One person told us “They keep us busy.” Staff respected people’s choices and provided a flexible service according to their individual needs. People were involved in their local community and were supported to maintain their independence.

When we asked people’s opinions on the quality of the food we were told “We get lots of vegetables” and “The fruit is good in the afternoon.” We asked people if they received the help they needed in a timely way and we were told that “generally” they did. Although we were told on the odd occasion they had to wait if several people wanted help at the same time.

All of those we spoke with said they could approach the staff if they wanted to make a complaint and we were told the manager would "Deal with things immediately."

We spoke to seven people. One person told us she was "very glad to be here and could not imagine being any better anywhere else.” Another person told us they “liked being here.” One person told us he had previously lived independently but was lonely, adding, “Wingham Court is the best place I have ever been.”

People all made positive comments about the staff. One person said “they are all considerate, no faults to be found.” Two people told us “the staff are good.” One person said the staff were “very good and caring” and another said they were “nice people.”

People told us about activities they enjoyed. These included Boccia (a sport similar to bowls), reading, pub lunches and using the gym.

We observed that staff respected and involved people, and that people received the care and support that met their needs. The people we spoke to confirmed they felt safe in the hands of the care workers. People were protected from abuse, as staff had information in the form of guidance and training to support them in keeping people safe.

We saw that staff were properly trained and adequately supported. We saw that measures to assess and monitor the service were in place.

Most people using the service told us that they were happy with the care and support that they receive. With comments such as ‘I can’t fault the staff’,' the staff are respectful and kind’. ‘the staff treat with me with respect’ and ' it’s a ‘good home to live in’.

Most people were consulted about their plan of care but this was not always the case.

All people we spoke with said that the staff are kind, caring and respectful.

People told us that they enjoyed their meals and that they are able to make choices.