We carried out an unannounced inspection of the service on 27 November 2018 and returned, with the provider’s knowledge, on 3 December 2018. Church Farm at Rusticus Limited 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 service was formed in three parts. The first two provided permanent residential and/or nursing care for older people. The third part, referred to in this report as ‘Hawthorn House’, provides short term assessment beds. These are for people who have left hospital and have their longer-term health needs assessed to determine whether they should return home, or move to permanent residential care.

Church Farm at Rusticus accommodates up to 76 people in one building. At the time of our inspection there were 46 people living at the home. This is the service’s first inspection under its current registration since it commenced in September 2017.

A registered manager was in place but not present during 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. The registered manager was on long-term leave and the home was managed by an interim manager until their return.

People received their medicines safely; however, medicines were not always stored appropriately. Records used to record how medicines were stored were not always fully completed. There were enough staff to support people; however, we did note an occasion when staff were slow to respond to an alarm that was activated in a person’s bedroom. Nursing staff at Hawthorn House required more staff to support them; recruitment for this was in process. Some relatives raised concerns about the variable quality of the agency staff. Risk assessments were in place to reduce the risk people’s safety. Checks of pressure relieving equipment had not always been carried out. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection. Accidents and incidents were regularly reviewed, assessed and investigated by the interim manager and reviewed with the Head of Operations.

People’s physical and mental health and social needs were assessed and met in line with current legislation and best practice guidelines. Staff were well trained and felt supported to carry out their role effectively. People were supported to follow a healthy and balanced diet. Referrals to dieticians had been made when weight loss was identified; however, for one person more action was needed to address these concerns. People had access to external health and social care agencies. The home environment was well maintained and was undergoing extensive renovation work to ensure it offered all people with a physical disability or living with dementia the best possible life. 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 support this practice.

People found staff to be kind and caring and felt they were treated with respect and dignity. People’s privacy was respected and people were involved with making decisions about their care. People’s cultural and religious needs had been discussed with them and acted on where needed. Advocacy services were made available for people if they required them. Supporting people living with dementia was a key aim of the provider. They had taken steps to provide people, the local community and relatives with information about dementia to enable them to understand the disease. People’s records were handled in l