CQC report explained · a nursing home
What the CQC found at The Wingfield
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Staffing had improved overall, but there were not enough staff on the first inspection day. Recruitment checks were completed, although some employment details did not match references.
- Effective?
- Good
- This question was not separately rated in this inspection report. Inspectors found that risks were assessed and people were supported in line with the Mental Capacity Act, although some records were not up to date.
- Caring?
- Good
- This question was not separately rated in this inspection report. People and relatives were generally happy with the care, although one person's preference for care from staff of a particular gender was not always respected.
- Responsive?
- Good
- Care planning had improved and included people's needs and preferences. Activities had increased, but feedback about activities and stimulation was variable.
- Well-led?
- Good
- Management and quality checks had improved, with regular audits and stronger leadership. The registered manager left after the inspection, and the provider was to confirm the ongoing management arrangements.
What inspectors found, March 2023
Rated Good overall, but inspectors found staffing and recruitment needed improvement and the safe rating remained Requires Improvement.
Inspectors visited the home without notice on 17 and 24 January 2023. They spoke with people, relatives, staff and health and social care professionals. They also checked care plans, medicines records, staff recruitment files and quality checks.
The home had improved since the previous inspection. People generally felt safe and were happy with their care. The home was clean, medicines were administered as prescribed, care plans had improved, and management systems were stronger.
There were still safety concerns. Staffing was not sufficient on the first day, recruitment records had discrepancies, and some fluid and medicines records were incomplete. The overall rating improved from Requires Improvement to Good, but Safe remained Requires Improvement.
Clean home
Inspectors found bedrooms, bathrooms and shared areas clean. Infection control training, audits and supplies of protective equipment were in place.
“Areas including people's bedrooms, bathrooms and communal areas were clean with no malodours.” from the report
People felt safe
Staff had safeguarding training and knew how to report concerns. People told inspectors they felt safe and relatives reported no safety concerns.
“People told us they felt safe at the home and relatives had no concern about safety.” from the report
Improved medicines systems
Inspectors found that medicines were given as prescribed and stored safely. Weekly pharmacist visits supported the home.
“Improvements had been made to the administration of people's medicines, which meant safe systems were in place.” from the report
Better care planning
Care plans contained more detailed information about people's needs, preferences and distressed behaviour. Staff were knowledgeable about how to support people.
“Care plans provided detailed information for staff on how to meet people's needs.” from the report
Stronger management
The home had regular audits, daily checks and meetings between department leads. People, relatives and staff were encouraged to share their views.
“There were a range of audits, which the provider deemed mandatory, to ensure the quality and safety of the service.” from the report
Staffing levels
seriousThere were not enough staff on the first day of inspection, and inspectors saw people enter other people's rooms without staff knowing where they were. Call bells were not answered on two occasions.
“There were not enough staff on the first day of the inspection however overall, since the last inspection, staffing levels had improved.” from the report
Recruitment records
needs fixingSome employment dates and job information did not match between application forms and references. Inspectors recommended that recruitment practice be reviewed.
“Overall the provider's recruitment policy was followed, but more attention to detail was required in some areas.” from the report
Fluid monitoring
needs fixingSome records did not show people's fluid intake effectively. The records were fully completed on the second inspection day after the manager responded.
“People's food and fluid intake was being monitored, but records did not always demonstrate this effectively.” from the report
As-required medicines records
needs fixingStaff recorded why as-required medicines were given, but did not always record whether they worked. Guidance also did not explain other ways to reduce anxiety before using medicines.
“Staff had documented the reasons why 'as required' medicines were administered, but the effectiveness was not always recorded.” from the report
Care preferences
minorOne relative said their family member's preference for care from staff of a particular gender was not always respected. Feedback about afternoon activities was also mixed.
“One relative told us their family member's preference of receiving care from staff of a particular gender was not always respected.” from the report
- 01How many care staff and nurses will be on duty during mornings, evenings and nights, and how will you respond if staffing falls short?
- 02What checks are now made to ensure employment histories and references agree before new staff start?
- 03How do you make sure fluid charts are completed accurately and only used for people who need monitoring?
- 04How do you record whether as-required medicines have worked, and what other approaches are tried first for anxiety?
- 05Who is currently managing the home since the registered manager left, and how will the improvements be maintained?
This was an unannounced focused inspection prompted partly by concerns about care and call-bell response; Safe, Responsive and Well-led were rated, while Effective and Caring were not separately rated. This explanation was written from the published report of 25 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2022
Overall rated Requires Improvement; inspectors found the home was not safe, with Safe rated Inadequate in the detailed findings.
This was an unannounced inspection after concerns about care, staffing and management. Inspectors visited on 22 and 23 June 2022, spoke with people, relatives and staff, and checked care plans, medicines, recruitment records and management audits.
There were not enough staff to meet people's needs. People waited for help with the toilet, getting up and going to bed. Inspectors also found medicines supply problems, incomplete guidance and records, poor infection control practices, and areas that were not clean.
Care was not always personalised. Care plans and records did not consistently describe people's needs, preferences or distressed behaviours. Activities were limited, although two activity staff had recently been employed. Management had changed several times, and quality checks had missed important problems.
The overall rating remained Requires Improvement, as did Responsive and Well-led. In the detailed findings, Safe was rated Inadequate, meaning inspectors found people were not safe and were at risk of avoidable harm. The home had four regulatory breaches and was asked to provide an action plan.
Safeguarding systems
Staff had safeguarding training and knew how to recognise and report possible abuse. Records of accidents and incidents were maintained so senior managers could monitor action.
“Staff had received training in safeguarding, which was deemed mandatory by the provider.” from the report
Risk assessments
The home assessed risks such as falls, malnutrition, mobility and skin damage. Staff used equipment such as pressure mats and hoists to reduce risks.
“There were risk assessments for example, related to skin integrity, falling, malnutrition and mobility.” from the report
Access to visitors
People could receive regular visitors in their rooms and communal areas after pandemic restrictions were relaxed.
“People were able to receive regular visitors, both in their room and communal areas, following the relaxation of government guidance.” from the report
Some healthcare support
People were supported to attend healthcare appointments, and some care plans gave useful information about health conditions such as diabetes.
“People received appointments with health care professionals as required.” from the report
Improvement work beginning
A new manager was working on staffing, staff retention, activities and the culture of the home. Two activity staff had recently joined and were getting to know people's interests.
“Two activity staff had recently been employed.” from the report
Too few staff
seriousStaffing shortages meant people waited for help with the toilet, getting up and going to bed. Inspectors also saw people whose whereabouts were not always monitored.
“There were not enough staff to meet people's needs.” from the report
Medicines not always safe
seriousOne person missed two doses because the medicine was unavailable. Guidance for medicines given when needed was inconsistent, and records did not always show why pain relief was given or whether it worked.
“One person had not received two doses of their prescribed medication to manage their health condition, because there was not any available.” from the report
Infection control and cleanliness
seriousMasks were often worn below the nose, and some staff wore jewellery or nail varnish. Inspectors also found an unclean kitchenette, lift and bedroom areas.
“The kitchenette at The Lodge was not clean.” from the report
Personalised care and records
seriousCare plans did not always contain people's preferences or guidance for distressed behaviour. Monitoring records were delayed or unclear, and some daily records used disrespectful language.
“Care planning did not ensure people's needs and preferences were met effectively.” from the report
Limited activities
needs fixingPeople and relatives said there was not enough to do and that some activities shown on the notice board did not happen. New activity staff were only beginning to address this.
“People and their relatives told us there was not enough to do in the home.” from the report
Weak management oversight
seriousThree managers had changed in quick succession. Quality checks had missed problems with staffing, records, masks, jewellery and cleanliness.
“Failing to ensure effective quality monitoring systems were in place was a breach of Regulation 17” from the report
- 01How many care staff are now on each shift, and how do you make sure people are not left waiting for the toilet or personal care?
- 02What has changed to prevent missed medicines and to make sure 'as required' medicines are given and recorded correctly?
- 03How do you check that masks, jewellery, nail varnish, cleaning and shared clothing meet infection control standards?
- 04How are each person's routines, clothing preferences, communication needs and responses to distressed behaviour recorded and followed?
- 05What progress has been made against the action plan for the four breached regulations, and how is this checked?
This was an unannounced focused inspection prompted by concerns, with detailed findings for Safe, Responsive and Well-led; Effective and Caring were not separately rated in this report. This explanation was written from the published report of 31 August 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Wingfield
8 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- March 2023Goodcurrent ratingup from Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2022Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2021Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2020Inspected but not ratedSafe: Inspected but not ratedEffective: Inspected but not ratedWell-led: Inspected but not rated
- May 2019Goodup from Requires improvementSafe: GoodResponsive: Requires improvementWell-led: Good
- March 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 15 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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