Archived: Riverslie

Riverslie is a care home providing accommodation, personal and nursing care for up to 30 people; some of whom lived with dementia and physical disabilities. At the time of our inspection 22 people were living at the service.

People’s experience of using this service and what we found

Risk to the health, safety and welfare of people and others had not been assessed, monitored and managed, placing them at serious risk of harm. We found a catalogue of serious concerns relating to the safety of both the inside and outside of the premises, utilities, equipment and preventing, detecting and controlling the spread of infections.

The systems and processes for assessing the quality and safety of the service failed to identify things that had gone wrong and bring about improvement and learning.

The provider and registered manager neglected the environment people lived in placing them at risk of abuse.

People were not protected from the risk of the spread of infection. Many parts of the service and equipment in use were unclean. The clinical waste bin stored outside the building was not secured posing a risk to the public. Items of used personal protective equipment was disposed of in the rear garden. The laundry was extremely dirty and laundering facilities were inadequate. Soil pipes at the rear of the building were missing resulting in waste from bathrooms being flushed onto a pavement.

Assessments were not carried out on staff to make sure they were competent to safely manage people’s medicines. The last medication audit was incomplete and previous audits could not be located; therefore, we could not be assured people’s medicines were safely managed. There were concerns in relation to the management of people’s medicines including the administration, recording and the use of ‘as required’ (PRN) medicines.

People and others were placed at serious risk of harm because the provider and registered manager lacked oversight and scrutiny of the service. They failed to operate an effective system and take responsibility for assessing, monitoring and improving the quality and safety of the service and for mitigating the serious risks found during this inspection.

Recent checks carried out on the environment were ineffective, they failed to identify any of the serious concerns we found, despite many of them being visible and longstanding.

There were sufficient staff on duty to provide care and support to people and safe recruitment process were followed.

The Care Quality Commission (CQC) took action to address the serious concerns found on the first day of inspection. The provider was invited to complete and send an urgent action plan, setting out how they were addressing the concerns identified during our inspection, and how they intend to address other serious concerns identified by inspectors immediately. We received an action plan from the provider within the agreed timescale, however it failed to adequately mitigate the risks.

During the first day of inspection CQC shared the concerns with the relevant local authority due to the significant risks identified by inspectors. The local authority took immediate steps to remove all 22 people from the service on the first day of inspection.

CQC used their urgent powers to ensure that people remained safe from potential harm.

Rating at last inspection

The last rating for this service was good (published 4 January 2021).

At this inspection we found breaches of regulation 12 (Safe care and treatment) and regulation 17 (Good governance).

You can read the report from our last inspection, by selecting the 'all reports' link for Riverslie on our website at www.cqc.org.uk.

Why we inspected

CQC received information of concern about people’s safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Please see full details in the individual sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurances that the service can respond to COVID-19 and other infection outbreaks effectively.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

Enforcement

We have identified serious breaches in relation to risk management, preventing and controlling infection and the governance and leadership of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The provider had safe arrangements for booking visitors to avoid the risk of infection transmission with other visitors. A monthly newsletter was sent to people’s relatives to keep them informed of visiting arrangements.

People at extreme risk and those that were isolating were supported in a manner to suit their needs. The registered manager had made changes to the deployment of staff to reduce their movement across the different areas of the home to promote better infection prevention and control.

The registered manager had appointed an infection prevention and control champion to complete regular checks on cleanliness and to ensure there were sufficient supplies of personal protective equipment (PPE) available to staff.

People and staff were tested regularly for COVID-19.

A dedicated social media channel was set up to support staff with queries relating to COVID-19.

The provider had systems in place to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19.

Riverslie is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

People’s experience of using the service and what we found

The service was following good practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control.

People's experience of using the service was positive. People received the care and support they needed when required. Most of the feedback we received showed staff were helpful and kind and treated people with dignity and respect. Positive relationships had been developed between staff and people they supported.

People felt safe living at Riverslie. We were told, “We are looked after well” and “I feel safe here.” One relative told us, “I can’t fault them. [Relative] is very settled and happy.”

People reported good support regarding the management of their medicines and told us they got their medicines on time. The medications records supported best practice although we fed back some minor anomalies to make records clearer. Nursing staff who administered medicines were suitably trained and competent.

Risks associated with people’s care were identified and managed to minimise harm. Supporting care records mostly identified risks clearly and there were plans in place to help keep people safe.

Since the last inspection there had been changes of management. The current manager was providing effective leadership and was supported by a senior manager and deputy manager. The provider’s governance systems and organisational structure provided monitoring and support for the service.

Rating at last inspection and update

At the last inspection the service was rated Good (report published 27 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about aspects of the overall management of the home including the internal environmental standards and people not receiving timely personal care. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverslie on our website at www.cqc.org.uk.

Follow up

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

Riverslie is registered to provide nursing and residential care for up to 30 people. Accommodation is provided over three floors, with the dining room, lounge, manager’s office and some bedrooms on the ground floor. A lift and ramps allows access to all parts of the home. There was a large enclosed garden to the rear. At the time of the inspection 19 people were living at the home.

Riverslie is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

A registered manager was in post. 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.

At our last inspection in November 2017, we identified breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the registered provider to submit a plan detailing what action they were going to take to address the breaches. The registered provider submitted a plan and as part of this inspection we checked to see what action had been taken by the registered provider. During this inspection we checked to see if sufficient improvements had been made and we found that they had.

At our last inspection, the environment was not always safe. This was because some of the fire doors did not close properly and the emergency lighting did not work; some windows on the upper floors of the home did not have window restrictors and the temperature of hot water to sinks in people’s bedrooms was too high.

As part of this inspection we looked at the environment and saw that fire doors to people’s bedrooms closed fully and that the emergency lighting had been replaced. Window restrictors had been fitted to people’s bedroom windows. A temperature control mechanism had been installed which meant that the hot water temperature to the sinks in people’s bedrooms was at a safe level.

During the last inspection, we noted that sluice doors did not have secure locks. Cleaning chemicals were kept in the sluice rooms which meant that people could access them. We made a recommendation regarding this. During this inspection we saw that sluice doors had been fitted with secure locks and cleaning chemicals were kept securely in a locked cupboard.

At our last inspection the audit processes in relation to maintaining a safe environment were not always effective; this was because identified risks in the environment had not been recorded. At this inspection we looked at audits for safety and monitoring of the home and found that they were completed appropriately and identified areas of concern.

Each of the people we spoke with told us they felt safe living at Riverslie. Staff we spoke to understood their responsibilities in relation to safeguarding people from abuse and mistreatment and were able to explain how they would report any concerns.

We found that medicines were managed safely. Medicines were stored correctly and were administered by staff who were trained to do so.

We looked at how accidents and incidents were reported in the home and found they were managed appropriately.

We looked at the recruitment records for three members of staff. We saw that each staff member’s suitability to work at the home had been checked prior to employment to ensure that staff were suitable to work with vulnerable people.

We looked at care records belonging to four people. We saw that people’s care requirements were appropriately identified and recorded. We also saw that people were appropriately referred to external health professionals when required. This helped to maintain people’s health and well-being.

People and their relatives were involved in the formulation of their care plans. We saw that people’s preferences were taken into account. Staff supported people in a person-centred way and treated them with respect. Staff were familiar with people’s needs and requirements.

Staff sought consent from people before providing support. Staff we spoke with understood the principles of the Mental Capacity Act 2005 (MCA) in order to ensure people consented to the care they received. The MCA is legislation which protects the powers of the people to make their own decisions.

Staff we spoke with told us that they enjoyed their jobs and considered Riverslie as a homely environment for the people living there.

We found that there were enough staff on duty to meet people’s needs. Interactions we observed between staff and people living in the home were warm and caring. Staff treated people with respect and took care to maintain people’s dignity.

Both staff and people told us there was no set routine, people confirmed they had a choice regarding their daily routine and how they wished to spend their time.

There was an open visiting policy for friends and family. This helped people feel supported. For people who had no one to represent them, the service would support them in finding an advocate to ensure that their views and wishes were considered.

The home employed an activities co-ordinator who facilitated varied social activities and people told us they were able to have a say in what activities they would like to do.

We asked people what they thought about mealtimes and feedback was positive. People told us they had a choice of main meal and had devised a two-week rolling menu to suit their likes. We spoke to staff who were knowledgeable about people’s preferences and dietary requirements.

The home had a complaints procedure in place and both the staff and people we spoke to told us they would feel comfortable in raising any concerns they had with the manager.

Riverslie is registered to provide residential and nursing care for up to 30 people. Accommodation is provided over three floors, with a dining room, lounge and bedrooms on the ground floor. A passenger lift and ramps allow access to all parts of the home and the large enclosed garden. At the time of the inspection 23 people were living at Riverslie.

A registered manager was 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.

At the inspection in May 2017 we found that the provider was in breach of regulations relating to safeguarding service users from abuse and improper treatment. This was because the provider had not notified the local authority of a serious incident as required. We also found that improvements were required to ensure that medicines were safely administered and audit processes were robust. As part of this inspection we checked to see if the necessary improvements had been made and sustained.

This inspection was focussed and only covers our findings in relation to whether the service was Safe and Well led. The domains Effective, Caring and Responsive were not assessed at this inspection.

Since the last inspection the service had been working with representatives of the local authority to improve practice in a number of areas including safeguarding. They had also developed a safeguarding log. The service was no longer in breach of regulation regarding safeguarding.

During the inspection we found that a number of fire doors did not close fully. This meant that they would be ineffective in the event of a fire and placed people at risk. We also identified concerns relating to; emergency lighting, window restrictors, access to hot water and infection control.

You can see what action we told the provider to take at the back of the full version of this report.

At the inspection in May 2017 we identified concerns relating to the effectiveness of audit processes. We made a recommendation to improve practice. As part of this inspection we checked to see if the necessary improvements had been made and sustained.

We saw that the service completed a wide range of safety and quality audits including; medicines, care plans and health and safety. However, these processes had not been completed in accordance with the provider’s schedule and significant risk relating to the physical environment had not been identified and/or actioned.

You can see what action we told the provider to take at the back of the full version of this report.

During the last inspection we found that medicines were not always safely administered. We made a recommendation to improve practice. As part of this inspection we checked to see if the necessary improvements had been made and sustained. We saw that medicines were managed safely and audit processes were effective in identifying concerns.

Incidents and accidents were recorded and managed appropriately and showed evidence of being analysed to look for patterns or trends. We saw that the information had been used to improve people’s safety.

Staff were not always recruited safely. One staff record had noticeable gaps in the employment history which were not accounted for and two records had start dates before people’s references had been received. We made a recommendation regarding this.

Individual risk was appropriately assessed and recorded in care files. The care records that we saw demonstrated that risk was reviewed monthly in accordance with the relevant plan of care. Where risk had changed or concerns had been identified, we saw that appropriate action had been taken.

The registered manager supported senior staff with the day to day management of Riverslie. They were in turn supported by an operations manager. The registered manager told us that they understood their responsibilities in relation to their registration with the Care Quality Commission.

Staff understood what was expected of them and told us that they had an open and professional relationship with senior staff and the registered manager. They told us that they enjoyed their jobs and were motivated to provide good quality care.

The service had an extensive set of policies and procedures to guide and inform staff practice. However, policies had not been consistently reviewed to ensure that the printed copies remained current.

The ratings from the previous inspection were displayed prominently as required.

Riverslie is registered to provide residential and nursing care for up to 30 people. Accommodation is provided over three floors, with a dining room, lounge and bedrooms on the ground floor. A passenger lift and ramps allow access to all parts of the home and the large enclosed garden. At the time of the inspection 23 people were living at Riverslie.

A registered manager was 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.

At the inspection in April 2016 we found that the provider was in breach of regulations relating to safe care and treatment and good governance. This was because staff had not consistently followed the provider’s guidance around the safe management of medicines and audit processes had not been effective in monitoring some key issues. We issued two warning notices to the provider and re-inspected the service in September 2016 to ensure that practice had improved and the breaches of regulation had been met. We found that the service had made sufficient improvement and was now meeting legal requirements. However, we did not change the rating at this inspection because it was too early to demonstrate that the improvements were sustainable.

During this inspection we found that medicines were stored and administered safely. However, some records had not been signed as required.

We saw that staff were vigilant in monitoring safety and acting to protect people from harm. The staff that we spoke with had completed training in adult safeguarding and knew what action to take if they suspected that a person was being abused or neglected. However, we saw that one incident had not been referred to the local authority’s safeguarding team as required.

During this inspection we looked at records of audits and saw that they had been completed regularly. However, audit processes had failed to identify issues relating to; missed signatures on MAR sheets, the failure to notify the local authority and CQC of a potential safeguarding matter and a failure to notify CQC when a DoLS application had been authorised. We made a recommendation regarding this.

We spoke with people living at Riverslie and their relatives and asked if they felt the service was safe. Everybody commented positively about how safe it was.

Staff were recruited safely and deployed in sufficient numbers to meet people’s needs. Each of the four staff records that we saw contained an application form, two references and a Disclosure and Barring Service (DBS) check. A DBS check is used to help establish if a person is suited to working with vulnerable adults.

Individual risk was appropriately assessed and recorded in care files. The care records that we saw demonstrated that risk was reviewed monthly in accordance with the relevant plan of care. Where risk had changed or concerns had been identified, we saw that referrals had been made.

Checks were completed on aspects of the service with regards to their safety. For example, electrical condition, gas safety, hoists, water temperatures and fire safety equipment. Each check had been conducted by an external professional and was supported by an appropriate certificate.

The records that we saw indicated that all training had been completed as required by the provider. Staff were trained in subjects which were appropriate to their roles including; adult safeguarding, moving and handling and infection control.

We saw that the service was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA) and that applications to deprive people of their liberty had been made to the local authority.

We sampled the food at lunchtime and spoke with people as they ate their meals. The serving of lunch was relaxed. The dining room was well presented, had ample room to move around and was brightly lit. Meals were served by staff who confirmed people’s preferences before plating their food. Each member of staff wore personal protective equipment (PPE) to support good food hygiene practice.

People and their relatives told us that they could access healthcare services whenever they were required and that this was often done in consultation with families who provided support with appointments.

The people that we spoke with were extremely positive about the caring approach of the staff. We saw that staff generally had time to speak with people as well as completing their care tasks.

People and their relatives had been involved in the planning and review of care. Care records contained person-centred information which helped staff get to know people and provide personalised care. We observed that care was not provided routinely or according to a strict timetable.

We saw people engaging in activities with the activities coordinator throughout the inspection. There were group activities and individual ones. It was clear that the activities coordinator knew people’s interests and preferences well and that people were fully engaged in the activities for the majority of the day.

A copy of the complaints procedure was made available and people told us that they knew who to complain to if they had any issues. Each of the relatives that we spoke with said that they could approach the registered manager with any concerns and had not felt the need to lodge any formal complaints.

The registered manager told us that the service had a culture which aspired to be, “Professional, friendly, warm and homely.” This view of Riverslie was endorsed by the staff team and our own observations of the delivery of care. The registered manager was aware of the day to day issues within the service and provided clear leadership as required.

The service had an extensive set of policies and procedures to guide and inform staff practice. However, policies had not been consistently reviewed to ensure that the printed copies remained current.

Staff understood what was expected of them and told us that they had an open and professional relationship with senior staff and the registered manager. They told us that they enjoyed their jobs and were motivated to provide good quality care.

You can see what action we told the provider to take at the back of the full version of this report.

This was an unannounced inspection. The service was last inspected in June 2016 and at that time was found in breach of two regulations: Regulation 12 and 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safe management of medicines and the governance arrangements in the home [how the home was being managed]. We served a warning notice regarding medicines management.

Tthis inspection was ‘focussed’ in that we only looked at the two breaches of regulations to see if the home had improved and the breaches were now met. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover only two of the domains we normally inspect; whether the service is 'Safe' and ' Well led'. The domains ‘Effective’ ‘Caring’ and ‘Responsive’ were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Riverslie' on our website at www.cqc.org.uk.

On this inspection we found improvements had been made and medicines were now managed safely. Quality assurance systems in place to monitor and improve standards in the home had also been improved. Both breaches of regulations were now met.

There was no 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. The previous manager had resigned in June 2016 and the new acting manager was in the process of applying to us [The Care Quality Commission] for registration.

We reviewed the way people’s medication was managed. We saw there were some good systems in place to monitor medication so that people received their medicines safely. We discussed and made some comments for consideration for further development.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally by staff and externally by a visiting senior manager for the provider. We found these had steadily been developed to meet the needs of the service.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

While improvements had been made we have not revised the overall quality rating for the home. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review the quality rating at the next comprehensive inspection.

section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

This was an unannounced inspection which took place on 1, 4 and 6 April 2016. The service was last inspected in September 2015 and at that time was found in breach of Regulation 11 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 which covers consent to care and treatment.

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.

During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines and the home’s governance arrangements.

We reviewed the way people’s medication was managed. We saw there were some good systems in place to monitor medication so that people received their medicines safely. However, we found some storage was not being monitored, some people’s medicines had been missed, some medicines given ‘when required’ lacked supporting protocols and external medicines [creams] were not being recorded appropriately.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from a visiting senior manager for the provider. We found some of these were not currently developed to ensure the most effective monitoring and in some areas there needed to be developments to ensure standards were identified and continually maintained.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home. We discussed the fact that a notification had not been made following two recent safeguarding investigations.

We found the outstanding breach of regulation regarding gaining peoples consent to care was now met. Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The managers had made referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were not fully completed and were not being fully monitored by the manager.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed on a regular basis where obvious hazards were identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

We saw people’s dietary needs were managed with reference to individual preferences and choice.

People we spoke with said they were happy living at Riverslie. They spoke about the nursing and care staff positively. When we observed staff interacting with people living they showed a caring nature with appropriate interventions to support people. Staff had time to spend with people and engage with them.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

We discussed the use of advocacy for people. There was information available in the home regarding local advocacy services if people required these. We were able to get an example of the use of advocacy for one person.

We asked people how their care was managed to meet their personal preferences and needs. People were satisfied with living in the home and felt the care of offered met their care needs.

People we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of people’s input. This was not consistent however as we saw other care records and plans that displayed very little evidence of people’s input.

Activities were organised in the home and these were appreciated by the people living at Riverslie. We saw some activity organised on all of the days we visited. The staff member who organised activities person was motivated to provide meaningful activities.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We could not find any obvious display of the complaints procedure in the home and this was addressed during the inspection. We saw that a record was made of any complaints and these had been responded to.

You can see what action we told the provider to take at the back of the full version of the report.

We looked at two examples of people care files and saw evidence that people had been consulted regarding their care and their agreement recorded. We also saw individual risk assessments for people where any restrictive care practices were being used; for example the use of bedrails to ensure a person's safety. This was carefully assessed and there was clear evidence that the person concerned or their family members had been consulted.

We checked to see if standards of environmental cleanliness were being maintained. We toured parts of the home including a bedroom, toilet and day areas and found these were being maintained in a clean and hygienic state.

During the inspection we looked at care planning, the environment, complaint systems and how the home was being run. We also observed care practices during the day and talked with residents and relatives about the home. Comments were positive and included, 'Very pleased, mum loves it here'. Also, 'I have been here for a while now, I love it and the staff are very caring.'

People we spoke with who lived at the home told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved people to ensure they received the right care and support. One resident we spoke with said, 'I feel they involve me in everything.'

There were a range of audits and systems in place to monitor the quality of the service being provided.