This inspection took place on 31 July and 01 August 2018 and was unannounced. This is the first inspection we have carried out of this service under its’ current registration with the provider 3A Care (Altrincham). When we last inspected the service in October 2016, the service was being run by a different provider and was rated requires improvement overall. At this inspection we rated the home requires improvement overall, and identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to provision of safe care and treatment.

Oldfield Bank Residential Care Home (Oldfield Bank) 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.

Oldfield Bank provides accommodation and personal care for up to 28 older adults, including people living with dementia, in one adapted building. Accommodation is across four floors, with a lift available between floors. The home is located in a residential area of Altrincham, Greater Manchester.

There was a registered manager who had been in post since May 2018, and was registered with the CQC in July 2018. 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 staff had found the change in provider, and changes made to the management team by the new provider difficult to accept. This had resulted in some resistance to change amongst the staff team, although both staff and the registered manager felt this situation was improving.

The home provided accommodation to people staying on a permanent and temporary basis. We found people living at the home on a permanent basis had comprehensive care plans and risk assessments in place. However, we found this was not the case for one person staying on a temporary basis who did not have a complete care plan or risk assessments. We have recommended that the provider reviews how they manage and monitor temporary placements at the home.

There were sufficient numbers of staff to meet the needs of people living at the home. There were times when staff were particularly busy, and when communal areas were unsupervised for short periods of time. However, we did not observe any issues when these instances arose or any significant delays in people receiving the support they needed.

Staff took steps to help ensure risks to people’s health, safety and wellbeing were reduced. This included using sensor mats, providing support and supervision and ensuring people had mobility aids to hand. However, in one instance, a person had a bed sensor mat in place and informed us they had not consented to this. This demonstrated staff did not always balance risk management with people’s rights to make informed decisions effectively. This issue was addressed when we raised it with a manager.

We identified some shortfalls in the safe management of medicines. Medicines were not always stored securely or recorded accurately. For example, we found the door to the treatment room open on one occasion and the keys for the medicines trolley and controlled drugs cupboard were inside the treatment room. Night staff did not administer medicines, and had to contact the on-call staff to administer any ‘when required’ medicines such as pain relief. This could result in potential delays in people receiving their medicines.

The provider was in the process of fitting magnetic locks to stairwell doors at the time of the inspection to help reduce the risk of people injuring themselves who were not able to use the stairs safely without assistance. Required checks and