About the service: Hambleton Grange is a residential care home that was providing personal care for up to 50 people aged 65 and over including people living with dementia. At the time of the inspection there were 32 people living at the service.

People’s experience of using this service: The provider had worked to make significant improvements following the last inspection. There was a culture of continuous learning and improvement. The registered manager and provider completed quality and safety checks across the service. Improvements were being made to records and audit systems. These changes had not had time to be embedded.

The service was embedded in the local community and had built links with various organisations in the Thirsk area.

People felt safe living in the service and able to request help. Systems were in place to identify risks to people and support their safety. The provider was making improvements to medicines systems and embedding these.

People could move freely around the home and had access to quiet spaces and a secure outside area. People’s care was coordinated effectively amongst the staff team and other professionals, including health services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrict way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect. Staff supported their emotional needs. Care was provided at people’s pace. People were encouraged to be independent with aspects of their care.

The lifestyle manager gathered information about people’s life histories and interests to support the delivery of person-centred care.

People knew how to provide feedback on the service. Complaints were addressed appropriately by the registered manager.

The provider was working to improve end of life care planning. Relatives gave positive feedback on how they had been supported during this life stage of their family members.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: At the last inspection the service was rated requires improvement (published 02 March 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 4 and 18 December 2017. Day one was unannounced.

At our last inspection, the provider was found to be in breach of three regulations (12, 17 and 18) in relation to safe care and treatment, good governance and staffing. We imposed conditions on the provider’s registration in respect of employing a manager within a specific timeframe, improving staff supervisions, training and appraisals and developing the skills of the junior management team who were left in charge of the service when the senior management were not on site. Over the last six months the provider sent us a monthly action plan showing how they had progressed towards meeting the relevant legal requirements.

Following the last inspection the provider had enlisted various internal resources to support the service to improve systems and process. This had included regional quality support to assist the registered manager. The provider was still working when we inspected to embed improvements in some areas. The registered manager continued to work hard to recruit and support the current staff team whilst encouraging positive change and ensuring staff understood their responsibilities. The provider was committed to making further improvements and we were confident this would happen.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider demonstrated to us that improvements have been made and therefore the service is no longer rated as inadequate overall or in any of the key questions. The service is now out of Special Measures.

Hambleton Grange is a ‘care home’ without nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service provides support and care to a maximum of 50 older people and people living with dementia. On the dates of our inspection, there were 41 people using the service with varying degrees of need and dependency.

The service provided people with accommodation and communal spaces over three floors and each floor was staffed separately. On the ground floor were 12 bedrooms and on the first and second floors there were 19 bedrooms per floor. The ground floor was for people living with moderate onset dementia, the first floor was for people who were living with mild onset dementia and the second floor supported people with residential needs.

The provider is required to have a registered manager. A registered manager is a person who has registered with 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 manager had registered with CQC in October 2017.

The arrangements for ordering, storage, administration and recording of medicines were not carried out safely or effectively. Medicine management practices were being reviewed by the registered manager and action was needed to ensure medicines were given safely and as prescribed by people’s GPs.

People told us that care was sometimes rushed and not always person centred, but they also gave us positive feedback about the support they received. We observed that some care was task orientated. We have made a recommendation about this in the report.

People had access to a range of low key activities which, although people enjoyed, did not meet everyone's needs. People said they remained bored at times with nothing to do. We have made a recommendation in the report around this.

Improvements had been made to the quality of the care records, but further work was need

This inspection took place on 16 and 17 May 2017 and was unannounced.

Hambleton Grange is a care home service without nursing. The service provides accommodation and residential care to a maximum of 50 older people and people living with dementia. On the dates of our inspection there were 49 people who used the service.

The service re-registered with the Care Quality Commission (CQC) in August 2015, due to a change of legal entity. This was the first inspection of the service since it re-registered.

The registered provider is required to have a registered manager in post. At the time of our inspection the service had been without a registered manager since April 2016. We have written to the registered provider about this, separately to this report. 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 was an interim manager who had been in post for 12 weeks who assisted us with our inspection. Their role was to manage the home on a short-term basis until the registered provider recruited a new registered manager. However, they were leaving the service within the week and another interim manager was due to take over their role.

Insufficient staffing levels were impacting on all aspects of the service and the system used to define and deploy staff around the service was not robust. The regional director for the service did take action on the second day of our inspection by increasing the staffing levels on shift. However, we felt that this did not address all the concerns in this area.

Senior care staff and care deputies did not receive appropriate training to enable them to effectively and efficiently carry out their job roles and duties. Competency checks of staff performance were not being completed and meetings with staff to discuss their work performance (supervisions and appraisals) were not taking place. There was a lack of effective communication between the care staff, senior staff and management team. This meant people’s health and well-being was at potential risk of harm.

The assessment, monitoring and mitigation of risk towards people who used the service with regard to accidents/incidents, medicine management, hydration, bowel care, falls, pressure care and infection control practices was not robust. This meant people’s health and safety was at potential risk of harm.

The management structure within the service did not effectively support the quality assurance systems and management arrangements within the service. There was a lack of robust audits and little evidence of appropriate action being taken to improve the service. Audits completed by the registered provider and the interim manager showed there were a number of recognised concerns with regard to documentation and people’s health and well-being. However, insufficient action had been taken to mitigate these known risks.

We found that cleanliness and infection control practices within the service were not robust. We noted odours in one bedroom and saw dirty laundry in another. We spoke with relatives who had concerns about hygiene in the service.

There were systems in place to keep people safe and protect them from unlawful control or restraint. Some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty. We found that the interim manager had carried out an audit of people who had a standard authorisation for a deprivation of liberty safeguard in place and had determined which ones required renewing. The interim manager had begun to submit the relevant documentation to the supervisory body of the local authority, but this piece of work was not finished.

Care files were completed in an inco