The inspection took place on 30 October 2018 and was unannounced. The provider registered with the Care Quality Commission (CQC) in February 2018. This was the first inspection under a new registration.

Cantley Grange is a care home. People living 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.

Cantley Grange can accommodate up to 40 people. At the time of our inspection 34 people were using the service.

At the time of our inspection the service 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.

Risks associated with people’s care and treatment were not always identified or managed safely. This put people at risk of not receiving the right support to meet their needs.

We completed a tour of the home with the registered manager and found that some environmental risks which had not been identified prior to our inspection.

Accident and incident analysis was not taking place effectively and there was no evidence that trends or patterns were being identified, or that actions had been taken to reduce hazards in relation to people's care.

The provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in this subject. Staff we spoke with were not always confident that appropriate actions were taken when safeguarding concerns were raised with the registered manager. During this inspection we identified one safeguarding concerns which was reported to the safeguarding authority. This concern has since been looked in to and no further action was required.

The provider had safe arrangements in place for managing people’s medicines. However, we found some people were prescribed medication to be taken on an ‘as and when’ required basis known as PRN (as required) medicine. We found that PRN protocols were not in place. PRN protocols are used to guide staff in how these should be administered.

On the day of our inspection we observed people having to wait to be assisted with personal care. Staff told us that there had been a high level of agency staff used and they felt this had impacted on people who used the service.

The provider ensured that staff received training and support to carry out their role. Staff told us they received one to one supervision sessions with their manager, to discuss work related issues.

People’s needs and choices were assessed but care and treatment was not always delivered in line with current legislation and standards. Care records did not clearly evidence if people’s needs were being met. People mainly had access to healthcare professionals, however there were occasions where this was delayed or did not happen.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service were designed to offer people maximum choice.

People received support to maintain a balanced diet. Meals provided were nutritious and looked appetising.

We spent time observing staff interacting with people and found they were kind and caring in nature. However, staff did not always recognise when people needed support.

We found people did not always receive care that was responsive to their needs. Care plans we looked at were not always followed in line with people's current needs. People’s choices for their end of life care had been considered and staff were able to describe how they met people’s needs at this stage of their life.

The provider had a complaints procedure which was d