Lake View

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People felt safe and protected from the risk of harm and abuse. Staff knew people well and were able to notice any changes. Systems were in place to keep people safe. Records showed staff had been trained in safeguarding and told us how they would report any concerns, they were confident these would be dealt with appropriately. Care plans and risk assessments were clear and gave good instructions to staff about how to keep people safe whilst minimising restrictions. Recent risk assessment reviews ensured staff were appropriately deployed. There were enough staff to meet peoples’ needs and staff had been recruited safely. Systems were in place to support staff and make sure they had opportunities to develop their skills and knowledge. Records showed a wide range of training had been completed. Individual accidents and incidents were reviewed and monitored to identify any developing trends that might indicate any changes in support. People’s medicines were looked after and administered safely, and they received them in the way prescribed. Medicines were generally well managed. The registered manager and provider had identified areas for improvement in relation to medicines management. The environment was comfortable and homely. People’s bedrooms were personalised and reflected their preferences. We fed back some issues relating to attention to detail which the registered manager acted on. The provider had a service improvement plan which included refurbishment and decoration.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People gave positive feedback overall about their experience of the service and told us they felt safe. They were confident that any concerns or complaints they may have would be listened to and address by the registered manager. People were able to identify the registered manager and felt they could raise any issues with staff who knew them well. No complaints were raised with us during this inspection. A relative explained when they raised a concern with the registered manager, this was addressed and resolved.

The registered provider had a service improvement plan in place to drive further improvements at the service. For example, a refurbishment and redecoration plan. Staff felt well trained and able to carry out their roles effectively. Staff said, “I know who to approach when we have concerns and I am supported” and “We have good quality training, online and physical. The manager allows us to undertake appropriate training, and we have to study and understand the care plan.”

Individual care plans and risk assessments were in place, including plans about specific issues such as pressure area care, prevention of falls, and catheter care. Risk assessments and care plans were generally reviewed regularly. We found two care plans were overdue a review. The nominated individual and registered manager were aware, and some additional support was being organised to help the registered manager complete the outstanding reviews. The provider had a complaints process in place and people confirmed they would be confident to raise any concerns.

People said staff understood their needs and helped them if they needed healthcare. Relatives said, “Definitely, the necessary people have been contacted when Dad needed support, the GP has visited regularly, Lake View welcomed him with open arms and give him excellent care.” People we spoke with said they would recommend the service to other people. One person said, “They look after me nicely. They have nice people [staff] here. The nurse is coming to see me and I have had painkillers.”

Staff felt care and support was well co-ordinated. They were able to tell us about one person who they had identified as having a health issue and the GP was seeing them that day. Staff knew peoples’ histories and why they required support so they could monitor any changes.

Health professionals we spoke to during our visit had no concerns and felt the service referred appropriately so people had prompt assessment and treatment.

There was a full and comprehensive assessment process in place, prompted by the electronic (PCS) system. The registered provider had a process for referrals and admissions to the service. The provider and registered manager worked with the local authority and health care professionals to ensure there was a smooth transition for people moving between services. We saw people were supported with their families to access health care. Staff knew when peoples’ needs had changed and acted appropriately. The GP was visiting during our visit, and we saw issues were raised in detail and treatment plans arranged. People had clear Treatment Escalation Plans (TEP) that had been discussed with them and their GP.

People spoke highly of the staff working at the service. They told us staff were kind and friendly and understood their needs. We observed people were happy, comfortable and confident with the staff team who were supporting them. However, two people said new staff or agency staff were not so knowledgeable about their needs and they did not have full confidence in these staff. The service had been using a high number of agency staff, however the nominated individual and registered manager confirmed this had reduced significantly over the past few weeks and a more stable and permanent team were in place. A summary of peoples’ needs was being devised so agency staff had a quick aide memoire when working. Agency staff were always supported by more experienced staff.

Staff told us they knew how to report potential abuse and knew people well. They had received safeguarding training and were confident that managers would ensure the right action was taken.

People were relaxed and comfortable with the staff team. Staff responded to people’s requests in a timely way and showed patience and understanding when some people repeated questions several times.

Staff used the new electronic care planning system to report concerns, accidents and incidents. This enabled the management team to have oversight at any time. Actions were taken to ensure people were safe. Safeguarding policy and processes ensured safeguarding referrals were made to the local authority as necessary. Records showed staff had all completed safeguarding training.

People felt supported by staff with their individual needs and were able to summon assistance should they need to. One relative said, “Lake View has provided Dad with a safe and warm environment when it was needed the most.” Care and treatment were planned and delivered in a way which was intended to ensure people's safety and welfare. People said they felt safe at the service. Comments included, “Yes, I feel safe. There's always someone here to help me”, “Complaints? No, none but I would speak to the staff” and “Yes. I had a fall today and they helped me; they got the ambulance. That makes me feel safe”.

Staff had access to care plans and risk assessments via handheld devices. A senior member of staff commented on how easy it was to record the daily delivery of care.

Staff were observant and vigilant when supporting people. Where people were at risk of pressure damage, pressure relieving equipment was available such as mattresses and seat cushions. Pressure relieving mattresses were set appropriately.

Person Centred Software (PCS) care planning system was in place. Risks relating to people’s health and wellbeing had been assessed and considered areas such as falls, skin integrity, and nutrition.

Staff had a good understanding of risks to people’s health and wellbeing and how to manage them. This meant people could be assured that their health and wellbeing was a priority. People were supported in an appropriate way throughout the day. We observed safe practices. For example, when staff supported people to move around the service safely using equipment. Environmental risks to people were minimised. Windows were restricted to prevent falls; radiators were covered to reduce the risk of burns, and the water temperature was within the expected range to reduce the risk of scalds.

Staff felt people were safe saying, “The staff are attentive and take necessary precautions to ensure the well-being of residents”, and “We have experienced and trained staff to ensure the safety of residents, for example we use sensors where needed for prompt attention.” One person was reviewed to ensure they were safe in their room and that furniture was secure.

People were supported to transfer safely using equipment such as hoists. Staff used the equipment confidently and competently, and ensured people understood what was happening throughout the move. People were reassured by this and transferred safely. The lounge had been trialled as a dayroom but this was found to be too small to accommodate enough people and use a hoist safely. We were sent photographs of the newly configured day spaces following our inspection.

The equipment log was completed to ensure equipment was safe to use showing regular checks. Records were up to date for external professional reviews such as fire extinguishers and hoist slings. There were window restrictors present throughout the building. A fete was being organised for the weekend during our visit and the nominated individual assured us that the grounds had been risk assessed and actions taken to make the area safe for people and visitors.

People engaged positively with the staff team. Everyone appeared comfortable with staff, and we observed kind and considerate interactions. Although busy throughout the inspection, staff did not rush when assisting people. For example, at lunchtime, some people required assistance from staff. Staff sat with people, assisted at the person’s pace, and made the lunchtime a sociable occasion by chatting. People said staff generally responded to call bells quickly. Comments included, “The staff are especially lovely. They are very caring. They come quickly most of the time unless they're busy”, and “They (staff) usually come quickly when I call for them, it depends on how busy they are. But I don’t wait for long, no more than 5 or 10 minutes”.

Some staff said there were not always enough staff. The dependency tool showed adequate staff but there was a review held about two people supported in an external adjacent bungalow which had an effect on staff availability in the main house. The nominated individual was aware, and this was managed well immediately following our visit. Additional support for the registered manager had been sought and planned from head office. The cook was very committed and asked that their workload be reviewed. The nominated individual took this on board and was meeting with them for a review.

We saw that when people needed assistance staff responded to their needs promptly. A new call bell system was being installed and would allow for easier audits. We did not hear call bells ringing excessively and peoples’ needs were met. The pace was unrushed, and bells were answered promptly. People were assisted with meals in an unhurried way where required. Staff were able to take adequate breaks.

There was a clear staff dependency tool based on peoples’ needs. This was regularly reviewed, and changes made such as the change to the level of need which could be managed in the external bungalow. The registered manager also carried out call bell spot checks.

The home was clean; however, two bedrooms did have an unpleasant odour at the beginning of the inspection. Domestic staff ensured this had reduced significantly by the end of the inspection and the rest of the premises was odour free and pleasant. Staff wore personal protective clothing when needed, such as aprons and gloves. There were hand washing facilities available for people, staff and visitors. No negative comments about cleanliness were raised. One relative said cleaning was of a fair standard but the premises were ‘care worn’. The nominated individual discussed plans for investment and we saw the new lounge and new managers office following our visit. There were further plans to modernise and update other areas.

Staff felt the home was clean and safe. They said they had enough personal protective equipment (PPE).

The service was generally clean and during our visit we observed staff using PPE such as aprons and gloves. Malodours in two rooms were dealt with promptly. There were no restrictions on visiting, which was confirmed by visitors we met during the inspection. Some areas needed attention to detail such as watering plants consistently and ensuring door name plates were tidy and in place, but the registered manager had this on their improvement plan.

The cleaning schedule was all completed. Staff had received training in infection control. There were audits in place to monitor the cleanliness of the service.

People said they received their medicines as prescribed. Two people confirmed staff used their prescribed creams regularly although sometimes staff needed reminding. Records were fully completed as administered.

One person had not received their evening medication (anticoagulant) on several occasions. Staff had used codes to indicate the person had declined their medicine or were sleeping. We discussed if the GP had been informed and when staff would inform the GP that a medicine was not being regularly taken as prescribed. The medicines policy did not provide guidance to staff about when to inform a GP that prescribed medicines were not being administered as prescribed. The registered manager agreed to discuss with the GP as a matter of urgency and stated that the medicines audit would also pick up these issues and one was due. The registered manager and provider had identified areas for improvement in relation to medicines management. This included a review of the policy to guide staff when to contact the GP where a person has not taken their prescribed medicine. The registered manager had reminded staff to record the actual dose of medicine given where a variable dose had been prescribed.

There were policies and procedures in place to guide staff when managing medicines. Staff had received training to safely manage medicines, and their competencies had been assessed to ensure safe practice. Staff needed clearer guidance about when to inform a GP that a person is not taking their medicines as prescribed, which was being actioned. The registered manager reminded staff to record variable doses to be able to monitor the effectiveness of the medicine.