This unannounced inspection took place on 25 June 2018.

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 p

This unannounced inspection was conducted on 13 November 2017.

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

This unannounced inspection was conducted on 8 May 2017.

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 p

Riverslie provides 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.

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.

Riverslie provides 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.

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 c

We carried out an unannounced comprehensive inspection of this service on 12 & 13 February 2015 when seven breaches of legal requirements were found. The breaches of regulations were because we had some concerns about the way medicines were managed and administered within the home, the effective recruitment of staff, the planning and review of care needs, the need to gain consent to care and treatment, the accuracy and fitness for purpose of peoples care records and the effectiveness of management systems to regularly assess and monitor the quality and safety of service that people received.

We asked the provider to take action to address these concerns.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 17 September 2015 to check that they had they now met legal requirements. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover four of the domains we normally inspect; 'Safe', ‘Effective’, ‘Responsive’ and ' Well led'. The domain ‘caring’ was 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.

Riverslie provides residential and nursing care for up to 26 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.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [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 current acting manager has applied for registration and the application is being processed by CQC.

At our last inspection in February 2015 we found when people received any care or treatment they were not always asked for their consent. Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements. We asked the provider to take action to address these concerns.

We looked to see if the service was working within the legal framework of the Mental Capacity Act (2005) [MCA]. This is legislation to protect and empower people who may not be able to make their own decisions. We looked at and reviewed the care of six people living at Riverslie. These people varied in their capacity to make decisions regarding their care. We found that there was a better understanding of good practice in this area of care but there needed to be ongoing consolidation of the improvements made. There still needed to more consistency of practice.

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

We found that action had been taken to improve the medication administration in the home. Medicines were administered safely. Medication administration records [MARs] were maintained in line with the home’s policies and good practice guidance. We made recommendations to further develop the home’s medication audit tool in line with best practice.

We found recruitment processes had improved and were much clearer. Staff had been checked when they were recruited to ensure they were suitable to work with vulnerable adults.

We found that action had been taken to improve the responsiveness of the home regarding the planning of the care. People’s care was now planned so that it was more personalised and reflected their current and on-going care needs. Care records had been reviewed and were up to date. There was evidence that the manager and staff team had included people in care planning and this needed to be further consolidated.

We found action had been taken to improve the management and governance of the home. We found the provider was supporting the acting manager and had developed clearer and more effective systems to monitor standards in the home including getting information from people so that the service could be developed with respect to their needs and wishes.

We found that there were more comprehensive systems in place to identify, assess and manage risks to the health, safety and welfare of people living in the home.

On our last inspection of Riverslie in November 2013 we found that there was a lack of evidence to show that before people received any care or treatment they were asked for their consent or that the provider acted in accordance with their wishes. On this inspection we checked to see if required improvements had been made.

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.

On the day of our visit we spoke with the manager, staff, relatives and residents. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Riverslie.

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.

People told us what it was like to live at this home and described how they were

treated by staff and their involvement in making choices about their care. They

also told us about the quality and choice of food and drink available. This was

because this inspection was part of a themed inspection programme to assess

whether older people living in care homes are treated with dignity and respect

and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector

joined by an Expert by Experience who has personal experience of using or

caring for someone who uses this type of service. At the time of our visit twenty two people lived in the home. We spoke with seven of these people and two visitors. We also spoke to the home manager, a nurse, one care assistant and the cook.

During our observations we saw staff were respectful and treated people as individuals when they provided care to them. For example, when supporting one person to eat their meal, staff were careful to feed at a gentle pace, asking the person if they were ready for another spoonful of food and using their name when talking to them. We heard staff talk to people in calm, supportive tones and not rushing people such as when supporting them to move around the home

The support provided also respected individual needs and pace. For example, at lunchtime some people were brought into the dining room in wheelchairs, one person was supported to walk in using a walking frame.

We observed lunchtime in the dining room. Nineteen people were present .Nobody required help with feeding and drinking but staff regularly spoke to everyone when serving their meals using their name.

Meals were eaten in a pleasant dining room, with condiments and napkins on the tables. We saw that food was served hot and presented well on the plate. The meal time was not rushed and people enjoyed conversations with one another on two of the tables in the room.

One person told us, “They ask us each morning what we want and we tell them.”

We saw that everyone looked clean and well cared for.

During our observations we saw there were enough staff to meet people’s observable care, support and nutritional needs.

One person told us, “Even when staff are busy they’ll spot someone who’s struggling to cut something or has dropped something. They’ll shoot over very quickly to help. They are always looking.”

Another told us,” When I had to ring the call bell, as my blanket had fallen off, someone came straight away.”

We observed that the interaction between people who lived at the home and the staff was relaxed and informal and the atmosphere was friendly and homely.

Riverslie provides residential and nursing care for up to 26 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.

This was an unannounced inspection which took place over two days on 12 and 13 February 2015. The inspection team consisted of an adult social care inspector.

The service did not have 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 told the acting manager to ensure an application for registration was received by CQC.

When we spoke with people living at Riverslie they told us they were settled and felt safe at the home. We were told: “It’s a lovely place. Staff are there when you need them.’’ “I don’t feel anything could happen here. There’s always staff around.” Visitors we spoke with commented: “It’s very good – my relative has done well here and feels at home’’ and ‘’There is always staff available when we visit and they seem very attentive. It seems a safe environment.’’ We saw from the duty rota that the staff ratio was consistent to provide necessary safe care.

We looked at how staff were recruited. We looked at staff files and asked the manager for copies of appropriate applications, references and necessary checks that had been carried out to ensure staff employed were ‘fit’ to work with vulnerable people. The manager could not provide evidence of the required checks necessary.

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

We spoke with a visiting family member who said they found the service to be good at managing any risks, so that their relative was as independent as possible. When we reviewed the care of some of the people living at the home we found that risks to people’s health such as monitoring of falls and risk of pressure sores were assessed and monitored.

We looked at how medicines were managed. We saw that medicines had been given and people told us their medicines were given on time. We found some anomalies with the medication administration records, however, which meant that they were not always clear. This meant there was a potential risk that some medicines may be missed or given in error. We found that overall people were still not fully protected against the risks associated with medicines because the provider’s arrangements to manage medicines were not consistently followed.

We also found that people had not been assessed and given the opportunity to manage all, or aspects of their medicines which would encourage their independence.

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

The staff we spoke with clearly 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 through any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, a health and safety ‘walk about’ was completed by the manager on a regular basis where obvious hazards were identified; we saw an example of this. Any repairs that were discovered were reported to the maintenance person and the area needing repair made as safe as possible.

We observed staff provide support to people and the interactions we saw showed how staff communicated and supported people as individuals. Staff were able to explain each person’s care needs and how they communicated these needs.

We reviewed three people who had varying levels of medical and nursing needs. We saw that there had been regular input from various health care professionals and the home had made appropriate referrals when needed. People we spoke with told us that staff were quick to arrange for medical referrals if needed. One person told us, ‘’If anybody is ill [staff] check them all the time. [Staff] arranged for me to attend a [medical] appointment recently.’’

We looked at the training and support in place for staff. Staff we spoke with said they felt the support by training provided and by the manager. Records we saw confirmed up to date training. Most staff had a qualification in care such as NVQ [National Vocational Qualification] or Diploma and this was confirmed by records we saw. This evidence a good knowledge base for staff to support them in carrying out their work.

We looked to see if the service was working within the legal framework of the Mental Capacity Act (2005) [MCA]. This is legislation to protect and empower people who may not be able to make their own decisions. People living at Riverslie varied in their capacity to make decisions regarding their care. We saw some good examples of people being assisted to make decisions regarding aspects of their care but this was inconsistent. Care being carried out with regard to the use of restrictive practice such as bedrails had not been adequately assessed in terms the person mental capacity and a ‘best interest’ decision. It was unclear who had been consulted as part of the decision. Similarly, there were decisions in place regarding the right to refuse specific medical treatment in case of a cardiac arrest [‘do not resuscitate’ (DNR) procedures]. Records and supporting care plans were unclear as to the decision making process.

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

We discussed with staff and the people living at the home how meals were organised. People told us the meals were good and well presented. We observed meals were served appropriately and the portion size was also appropriate. We saw that people who needed support to eat had sufficient staff time allocated and that staff took time to talk to and socialise with people.

People told us their privacy was maintained. One person commented, ‘’I spend most of my time in my room and this is respected.’’ Another person said, ‘’Staff help when they need to but are not invasive.’’ People told us they felt they were listened to and generally staff acted on their views and opinions. One person said; “They [staff] show concern and will always try and help.’’ A relative we spoke with and people visiting at the time of the inspection were pleased with how staff displayed a caring attitude. We asked if there were any restrictions and were told relatives and visitors are free to visit at any time. One relative said, ‘’The reason I chose this home for my [relative] was that the staff approach is so good. They were open and friendly from the start.’’

We asked people who lived at the home how staff involved them in planning their care. We were told that staff kept them up to date with any important changes and they felt reassured by this. We found, however, that people and/or their relatives were not routinely involved in reviews about the care or how care plans were drawn up. A relative said, ‘’Staff let me know what’s going on but I haven’t seen a care plan.’’

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

We looked at the care record files for three people who lived at the home. We found that care plans and records did not contain evidence to show they were individualised to people’s preferences and reflected their identified needs. Care plans lacked detail and some had not been updated, as the person care needs had changed. For example, one person had been reviewed in October 2014 by a health care professional and specific interventions prescribed and agreed to manage the person’s care. The care plan had not been updated accordingly. The lack of accuracy, update and detail in peoples planned care might lead to an inconsistent delivery of care or care may be missed.

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

We looked at the daily social activities that people engaged in. We asked people how they spent their day. Mostly, people were happy with the daily level of activity in the home. Over both days we inspected there was an active program which included group and individual activities. These activities were appreciated by people living at Riverslie and helped provide a positive feeling of wellbeing for many.

We observed a complaints procedure was in place and most people, including a relative, we spoke with were aware of this procedure. We saw that any concerns or complaints made had been addressed and a response made.

We spoke with a member of the contracts monitoring team at social services who had visited the home in January 2015 as part of a safeguarding investigation. They told us the key issue had been the lack of detail in care records and the recommendation would be that these should be improved. On this inspection we found we had similar concerns about care records for people.

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

From the interviews and feedback we received, the manager was seen as open and receptive. One staff member said, ‘’We have had staff meetings and we can have our say and the manager will listen. You can speak to the manager any time.’’

We enquired about other quality assurance systems in place to monitor performance and to drive continuous improvement. We found there was a lack of formal systems to gain feedback from people living at the home, and their relatives so the manager could not use people’s views to develop the way the service was being run.

Other auditing and checking by the manager was also not evident. For example we accidents and incidents were not analysed to inform any overall patterns or lessons that may need to learnt for the home. The home’s administrator showed us the system for managing people’s personal allowances but these were not audited by the manager or provider.

On this inspection we found there were breaches of regulations covering, requirements relating to staff employed at the home, medication management, care and welfare including people’s involvement in their care planning, maintenance of records and issues around consent to care and treatment. We were concerned that the home’s current auditing and monitoring processes had not effectively identified any shortfalls or improvements needed.

We found that issues requiring the home to notify the Care Quality Commission had not been made. These included notifications about a serious injury to a person living in the home [person with a pressure ulcer], a person who had died and a safeguarding investigation.

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