The inspection was unannounced and took place on 21 & 22 November and 4 December 2018.

West Ridings 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. Accommodation is provided for up to 180 people, across six units, although one unit had not been in use since 2015. At the time of the inspection, there were 133 people living in the home.

At the time of the inspection West Ridings Care Home consisted of the units Swaledale (general nursing), Calderdale (dementia care nursing), Wensleydale (dementia care), Airedale (residential care) and Wharfedale (residential care).

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.

We identified four breaches in the regulations in relation to, safe care and treatment, staffing, fit and proper persons employed and good governance.

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.

We found weaknesses in how the service was run and managed. There was a lack of clinical oversight across the service. Some staff did not feel fully supported or clear in their roles and responsibilities. Audits of the quality of the provision were not robust and there were significant gaps in documentation.

Staffing levels on the whole were sufficient in number to meet people’s needs, although little consideration had been given to the skill mix of the team, particularly on the Calderdale unit.

Recruitment, induction and training was not robust and there was very little evidence staff were sufficiently vetted or had the right skills to support people safely. We found some concerns in the supervision and support of staff.

Management of medicines was not sufficiently safe. We found concerns around the supply of people’s medicines, stock balances and recording.

There were missed opportunities for lessons to be learned when accidents and incidents occurred.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice although staff understanding of the legislation around people's mental capacity was variable and decisions made in people’s best interests were not always clearly recorded.

People’s dietary needs were appropriately met, although people did not always have access to drinks in their rooms. There were effective links with other professionals to support people’s care and health needs.

Staff had a kind and caring approach and showed respect when interacting with people. There was appropriate regard for people's privacy and dignity.

Activities were variable; there were some meaningful opportunities in place and staff knew people as individuals, although not all people were happy with activity provision. People and relatives knew how to complain, although we found weaknesses in the recording of and response to complaints raised.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. T