This inspection took place on 13 and 14 November 2018. The first day was unannounced; the provider knew we were returning on the second day.

Rastrick Hall and Grange 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 home provides nursing and personal care for up to 79 older people, some of whom may be living with dementia. Accommodation is provided in two adjoining buildings Rastrick Hall and Rastrick Grange. Each building has three floors with passenger lift access between floors. All bedrooms are single rooms with ensuite facilities. There are communal areas on each floor, including a lounge and dining room. There were 72 people in the home when we inspected.

At our last inspection on 10 May 2017 we rated the service as ‘Good’.

There was a registered manager in post. 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 to people were not properly assessed or managed well, putting people at risk of harm or injury, particularly where people displayed behaviour that challenged others. Accidents and incidents were recorded, however, the analysis of these was poor with little evidence to show lessons had been learnt or actions taken to improve safety.

Some aspects of medicine management were safe. However, there were concerns about the storage of some medicines as fridge temperatures exceeded the recommended safety range and no action had been taken to resolve this.

We found there were not always enough staff to meet people’s needs and keep them safe.

Staff recruitment procedures ensured staff were suitable to work in the care service. Staff completed induction and were up to date with most of their training. However, they lacked the skills and knowledge in how to manage behaviour that challenged which put people who used the service and staff at risk of harm and injury. Staff said they felt supported and received supervision and appraisals.

Staff had received training in safeguarding and understood the reporting systems. Safeguarding incidents were recorded and reported to the local authority safeguarding team.

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 supported this practice.

People’s care records were not personalised and did not reflect people’s needs or preferences. There was not enough detail to guide staff about the care and support people required. People’s nutritional needs were met, although the monitoring of people’s fluid intake needed to improve. People had access to healthcare services and systems were in place to manage complaints.

People and relatives told us activities were limited which our observations confirmed. Relatives told us staff were kind and caring. We saw some caring interactions but also practices which showed a lack of respect for people and compromised their privacy and dignity.

The registered manager acknowledged they had struggled to complete management tasks due to staff turnover and absences. The provider had arranged additional support however staff had only just started in these posts when we inspected. The provider’s systems and processes did not enable them to effectively assess, monitor and improve the service. They did not monitor and mitigate risk effectively.

We found shortfalls in the care and service provided to people. We identified five breaches in regulations; staffing, safe care and treatment, dignity and respect, person-centred care and good gove

This inspection took place on 10 and 11 May 2017. The first day was unannounced, the second day the provider knew we were returning. The service was previous registered as two separate entities – Rastrick Hall and Rastrick Grange. In July 2016 the provider registered Rastrick Hall and Grange as one entity. This is the first inspection of the service since that registration.

Rastrick Hall and Grange provides accommodation and personal care for up to 79 older people, some of who may be living with dementia. There were 70 people using the service when we visited. Accommodation is provided over three floors with lift access to each level. All bedrooms are single occupancy with ensuite facilities. There are a variety of lounge and dining areas on each floor.

The home has 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. The registered manager was present on both days of this inspection.

Prior to the inspection we had received concerns about staffing levels, the food and the lack of supplies of personal protective equipment (PPE) such as gloves and aprons. We looked at all these areas during our inspection.

Although some staff were not happy with the staffing levels, people and relatives felt there were enough staff and this was confirmed in our observations. We saw staff were available and responded promptly to people. Staffing levels had increased on days and nights over the last 12 months and the use of agency staff had decreased which had resulted in a more stable staff team who knew people well and how to meet their needs.

Safe medicines management systems were in place and were being monitored through regular audits. This helped to ensure people received their medicines when they needed them. Robust recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the Commission. Risks to people were assessed and managed to ensure people’s safety and well-being.

People told us they enjoyed the food. We saw at lunch and breakfast people were offered choices and given the support they required from staff. A choice of meals, snacks and drinks were provided throughout the day. However, staff told us although people never went without food, the quantity and quality of food varied. They described times when they had run out of essentials such as bread and milk which meant the registered manager had to go and buy supplies from a local shop. They also said the quality of some of the foods had reduced for example people were now being given pollack instead of salmon which they did not like. We have made a recommendation about the food supplies. People's weights were monitored to ensure they received enough to eat and drink.

The environment was clean and well maintained. We saw plentiful supplies of PPE throughout the home, although staff told us there were times in recent months when supplies had run out. The registered manager confirmed this had happened however they assured us systems were now in place to make sure there were ample supplies of PPE at all times.

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 supported this practice.

People told us they liked their rooms. People and relatives praised the staff

We inspected Rastrick Hall on 26 January 2016 and the visit was unannounced. Our last inspection took place on 16 January 2014 and, at that time, we found the regulations we looked at were being met.

Rastrick Hall is a purpose built home. It offers residential care for 40 older people. The accommodation is arranged over three floors. All of the bedrooms are single and have en-suite toilets and showers. There are lounges and dining rooms on each floor. There is a garden area at the side of the building that can be used in fine weather and a car park to the front of the building.

At the time of this inspection there were 40 people using the service.

The service has a registered manager in post. 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.

There were not always enough staff on duty to care for people safely or to make sure their needs were met in a timely way. People told us they liked most the staff and found them kind and caring.

People told us they felt safe in the home. Staff had a good understanding of how to control risks to people’s health, safety and welfare.

People’s views about the meals were mixed. Some people thought they were good whilst others thought they could be improved. Staff told us they felt the quality and variety of meals could be improved.

The general poor condition of the communal areas, some bedrooms and furnishings showed a lack of regard for people using the service. Some people’s independence was restricted because the armchairs were too low for them.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s healthcare needs were met. Safe systems were in place to manage medicines; however, people did not always receive their medicines at the correct times.

We found the service was meeting the legal requirements relating to the Deprivation of Liberty Safeguards (DoLS).

People told us their visitors were made to feel welcome and if they had any concerns they would speak to the registered manager or another member of staff.

We found some of the audits which were in place were effective. However, there was a lack of environmental audits or use of a tool to calculate staffing levels. This meant the service was not monitoring its quality in these areas and responding where improvements were needed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and you can see what action we told the provider to take at the back of the full version of the report.

When we visited the home in September 2013 we found the home had monthly audit systems in place which were to be completed by the home manager. The audits were of people's medication, weights, pressure sores, infection, use of invasive devices, skin tears and falls. However, we found that some of the audits had not been completed on a monthly basis. In April, June and August 2013 we found a large number of audits which had not been completed.

We also found that the communal kitchenette areas of the home required improvements. We saw that cupboard doors were broken, the plinths around the bottom of the cupboards were split, grouting on tiled areas was discoloured, skirting boards around the areas looked dirty and wallpaper was coming off in places.

We said that improvements were needed.

We returned on this inspection to check whether improvements had been made.

We looked at the monthly audit system in place and found that these had been completed. We saw that audits of people's medication, weights, pressure sores, infection, use of invasive devices, skin tears and falls had been completed for October 2013, November 2013 and December 2013.

We saw the kitchenette areas of the home had not been updated. However, we saw that dates for the work were scheduled and due to be completed by the end of February 2014.

We spoke with two people who lived at the home and they both told us they were very happy with the care they received. One person told us they felt the staff had been very patient and caring during their recovery from an injury which occurred prior to them moving into the home. They also told us the were supported and encouraged by staff to be independent. We spoke with the relatives of another person who lived at the home and they told us they find the home welcoming and a very clean environment for people to live in. They were very reassured with how the staff had responded to and cared for their relative who had been ill recently.

We spoke with ten people who lived at the home. These are some of the things they told us:

“The home is kept clean and tidy and I have a nice bedroom.”

“The staff are very kind and caring.”

“I’ve got no complaints whatsoever.”

“Some of the meals aren’t to my liking, I’ve told the manager and I’m sure she will sort this out.”

“I get on well with most of the staff and find them helpful and caring.”