Lakeside Residential Home

Lakeside Residential Home is a care home without nursing providing care and support to up to 72 older people. The service provides support to older people and people living with dementia, physical disabilities and sensory impairments. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 61 people using the service.

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

Staff training and appraisals were not up to date. The mealtime experience for people was poor. The provider had not ensured effective systems were in place to ensure compliance with the fundamental standards. This meant people were not always protected from the risk of harm.

We made a recommendation in relation to the storage of prescribed thickeners and staff deployment.

Care plans reflected people's needs and preferences, and people felt involved in their care planning. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. People were supported to have access to a range of health and social care professionals.

People and relatives told us they felt staff were caring. The service supported people to be as independent as possible and people's confidential information was protected. People's communication needs were assessed, and staff supported people with their communication needs. The home supported people to maintain relationships to avoid social isolation and relatives told us they felt welcome in the home.

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

Rating at last inspection and update

The last rating for this service was good, published 31 March 2020. At this inspection, we found the overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about medicines management and governance. A decision was made for us to inspect and examine those risks. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, person centred care and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lakeside Residential Home is a care home without nursing providing care and support to up to 72 older people, some of whom may be living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 66 people using the service.

People’s experience of using this service

People were protected from the risks of abuse and said they felt safe with the staff providing their support and care. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. Staff recruitment and staffing levels supported people to stay safe and medicines were handled correctly and safely.

People received effective health care and support. People's rights to make their own decisions were protected. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received care and support from staff who knew them well and were well trained.

People were treated with care and kindness. They were consulted about their care and support and could change how things were done if they wanted to. People were treated with respect and their dignity was upheld. This was confirmed by people and relatives who provided feedback. People's diverse needs were identified and met and their right to confidentiality was protected.

People received support that was individualised to their personal preferences and needs. They were able to enjoy a number of activities, based on their likes and preferences. People said staff and management responded well to any concerns they raised.

People benefitted from staff who were happy in their work and felt well managed and supported. The service had an open and inclusive culture and encouraged suggestions and ideas for improvement from people who use the service, their relatives and staff. The quality assurance systems were successful in ensuring the quality of the service was maintained.

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

Rating at last inspection and update

The last rating for this service was requires improvement (report published 17 April 2019). There were breaches of three regulations relating to mitigating risks, staff ongoing training and the provider's system to ensure compliance with the fundamental standards. At this inspection we found the registered person had made improvements and the provider was no longer in breach of any regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Lakeside Residential Home is a care home without nursing providing care and support to up to 72 older people, some of whom may be living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 68 people using the service.

People’s experience of using this service:

¿ Measures were in place which were designed to ensure people were safe. However, these

measures were not always followed. For example, the annual safety checks of thermostatic

mixing valves, due in January 2019, had not been carried out.

¿ People felt safe and the service assessed risks to the health and wellbeing of people who use

the service and staff. However, where risks were identified action was not always taken to

reduce the risks where possible. For example, annual legionella risk mitigation measures, due in

January 2019, had not been completed. Actions set by staff to help reduce an individual's risk

of falls were not always realistic.

¿ Staff refresher training, identified as mandatory by the provider, was not up to date for all staff.

¿ Systems in place to oversee the service and ensure compliance with the fundamental standards

were not always effective in identifying when the fundamental standards were not met.

¿ Since the last inspection in January 2018, the service had experienced a large turnover of staff.

In addition to the registered manager leaving in October 2018, 33 other staff members left during

the year and the service recruited and inducted 37 new staff. The new manager and the

management team, with the support of the provider's regional and head office team, had

worked hard to re-introduce consistency and the smooth running of the service. At the time of

this inspection their efforts were starting to pay off and people, their relatives and staff were

complimentary about the improvements and the changes at the home.

¿ The provider and staff had worked extremely hard to make improvements to the environment to

ensure it was more dementia friendly. The changes made on the two floors where people lived

with dementia were of a high standard and reflected current thinking and best practice.

¿ Recruitment processes were in place to make sure, as far as possible, that people were

protected from staff being employed who were not suitable.

¿ Medicines were handled safely by staff who had been assessed as competent to do so.

¿ People felt the service they received helped them to maintain their independence where

possible.

¿ People and their relatives said staff were caring and respected their privacy and dignity.

¿ People received care that was designed to meet their individual needs and preferences.

¿ People were supported to have maximum choice and control of their lives and staff supported

them in the least restrictive way possible; the policies and systems in the service supported

this practice.

¿ People knew how to complain and knew the process to follow if they had concerns.

¿ People's right to confidentiality was protected and their diversity needs were identified and

incorporated into their care plans where applicable.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement. This was because the environment was not as dementia friendly as it could be for those living with dementia at the home. At this inspection we found the provider had carried out extensive work, in line with best practice, to make the environment dementia friendly.

Why we inspected:

This was a planned comprehensive inspection carried out in line with our aim to re-inspect a service within 12 months of being given a rating of Requires Improvement.

Enforcement:

We found breaches of three regulations relating to mitigating risks, staff ongoing training and the provider's system to ensure compliance with the fundamental standards.

Follow up:

¿ We have asked the provider to send us a report that says what action they are going to take.

¿ We will check that the action is taken.

¿ We will continue to monitor all information we receive about this service.

¿ We will carry out a comprehensive inspection within one year of the publication of this report in

line with our methodology for services rated as requires improvement.

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

Lakeside Residential Home is a care home without nursing that provides a service for up to 72 older people, some of whom may be living with dementia. People receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is arranged over four floors. The ground floor has 20 rooms, the first and second floors have 22 rooms each and the third floor has eight rooms. People who are living with dementia are accommodated on the ground floor and the first floor. At the time of our inspection there were 67 people living at the service.

The service had a registered manager as required. 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.

Since the last inspection there have been two changes to the service's registration. Eight bedrooms were added to the service on the fourth floor. This increased the overall bedrooms from 64 to 72. The second change was that the previous registered manager moved to another of the provider's care homes and a new manager started working at the service 10 weeks before our inspection. Her registration as manager was approved by the Care Quality Commission on the second day of our inspection. The new registered manager was present and assisted us during this inspection.

At our last inspection we identified that the environment on the ground and first floors was not very 'dementia friendly'. The previous registered manager told us they planned to review and assess the environment on those two floors where people with dementia lived. However, we found little change at this inspection. While some actions had been taken to make the environment more 'dementia friendly', overall the measures taken did not help people to compensate for sensory loss and cognitive impairment as much as they could and did not contribute to supporting their independence. You can see what action we have asked the provider to take in the full version of this report.

In 2017 the local authority raised some concerns with the service that their staff training had fallen behind with their expected refresher training. Action was taken and people now benefitted from a staff team that was well trained and supervised. Where staff training refreshers were due, places had been booked on upcoming training dates. We have made a recommendation that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.

Staff had a good understanding of how to keep people safe and protect them from abuse. Personal and environmental risks to the safety of people, staff and visitors had been assessed and actions had been taken to minimise those risks. Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

The staff team were caring and respectful and provided support in the way people preferred. Their right to confidentiality was protected and their dignity and privacy were respected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. People were supported to eat and drink enough and their health and social care needs were met.

People received care and support that was personalised to meet their individual needs. People were supported to maintain relationships with those important to them. The service provided access to local events in order to enhance social activities for people. They took into account their individual interests and links with different communities. There were sufficient numbers of staff to meet people's care needs and medicines were stored and handled correctly.

People were relaxed and there was an open and inclusive atmosphere at the service. Staff were happy in their jobs and there was a good team spirit. They felt supported by the new management and said the training they received enabled them to meet people's needs, choices and preferences. Quality assurance systems were in place to monitor the quality of service being delivered and the running of the service.

Lakeside Residential Home is a care home without nursing that provides a service for up to 64 older people, some of whom may be living with dementia. The accommodation is arranged over three floors. The ground floor has 20 rooms and the first and second floors have 22 rooms each. People who are living with dementia are accommodated on the ground floor and the first floor. At the time of our inspection there were 57 people living at the service.

The service had a registered manager as required. A registered manager is a person who has registered with the 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 registered manager was present and assisted us during this inspection.

People felt safe living at the service and were protected from abuse and risks relating to their care and welfare. They were protected against environmental risks to their safety and furniture and fixtures were of good quality and well maintained. The registered manager planned to review and assess the environment on the two floors where people were living with dementia. This was to ensure the environment was as dementia friendly as possible and helped to encourage and promote people's independence and sense of wellbeing.

People received effective care and support from staff who knew them well and were well supervised. Staff training was not all up to date but, where there were deficits, training had been booked to bring staff up to date within the next four months. People received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans formally reviewed six monthly or as changes occurred.

People received effective health care and support. People saw their GP and other health professionals when needed. Medicines were stored and handled correctly and safely. Meals were nutritious and varied and people told us the food at the service was good.

People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure people's rights to make their own decisions were promoted.

People benefitted from living at a service that had an open and friendly culture. They were treated with care and kindness and their privacy and dignity was respected. During our visit there was a positive atmosphere as people and staff chatted and laughed with each other. People felt staff were happy working at the service and had a good relationship with each other and the management. They told us they felt the service was managed well and that they could approach management and staff with any concerns. Staff also stated that the management was open with them and communicated what was happening at the service and with the people living there.

The inspectors gathered evidence against the outcomes we reviewed to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary describes what people who use the service, relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

Possible risks to people had been identified in their care plans and the appropriate action taken to manage those risks. These included risk of developing pressure ulcers, falls and moving and handling.

The provider had taken appropriate action to ensure people's care records, staff records and other records relevant to the management of the services were accurate and fit for purpose. Records were also kept securely.

At this inspection we found the provider had taken appropriate action to address concerns identified with regard to infection prevention and control. We found people were being cared for in a clean hygienic environment.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager was aware of a recent Supreme Court judgement relating to 'deprivation of liberty' and had liaised effectively with the local authority DoLS team.

Is the service effective?

People's needs were assessed and care was planned and delivered in line with their individual care plan. We looked at six people's care records. The plans of care contained all the relevant information to enable staff to appropriately care for people.

At this inspection we found the provider had suitable arrangements in place in order to ensure that staff employed were appropriately supported in relation to their responsibilities. The provider had enabled them to deliver care and treatment to people who use the service safely and to an appropriate standard because they had provided appropriate training and induction.

Is the service caring?

During the inspection we observed care workers supporting people who use the service. Staff were respectful and caring. A relative told us: 'X is obviously well cared for' and 'as far as I'm concerned the home is great'.

Is the service responsive?

We saw care records and risk assessments had been recently reviewed and updated. If any changes to people's needs were identified these were made. Care plans were then updated and staff informed.

People were made aware of the complaints system. People had their comments and complaints listened to and acted on. People's complaints were fully investigated and resolved, where possible, to their satisfaction.

Is the service well led?

We found the provider had taken appropriate action to address all of the issues we identified at the last inspection on 3 & 4 February 2014.

People who use the service, their representatives were asked for their views about their care and treatment and they were acted on. The provider had made improvements to ensure there was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to medication administration and incidents.

The provider had put measures in place to ensure people's archived records could be located promptly when required. People's records and other records relevant to the management of the service were not always accurate and fit for purpose. People were not protected against the risk of unsafe or inappropriate care because of a lack of proper information about them. People's care records were not always stored securely.

We also looked at new concerns raised with the Care Quality Commission since our last inspection on 22 July 2013.These related to how the provider ensured people living in the home were being cared for in a clean and hygienic environment. Also, how the provider ensured there were enough qualified, skilled and experienced staff to meet people's needs.

People were not always protected from the risk of infection. Some protocols based on current Department of Health guidelines were not always followed by staff, such as the use of protective personal equipment and safe handling of soiled laundry.

We looked at staff rotas from November 2013 to January 2014 and observed people's lunchtime experience. We found there were sufficient qualified, skilled and experienced staff to meet people's needs.

People's needs were assessed, and care and treatment planned reflected the individual needs of people living in the home. A relative told us they were 'Very happy with the care received'. However, we found care was not always delivered in a way that was intended to ensure people's safety and welfare.

Care was planned with the involvement of the people who use the service and their relatives. People who use the service told us they were involved in discussions about any changes to their care. We found people were provided with appropriate care to meet their needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

A system of staff supervision and appraisal was in place to support workers. However, staff did not always receive appropriate training and professional development to enable them to deliver care and treatment to people safely and to an appropriate standard, particularly during the induction period.

Staff records and other records relevant to the management of the service were not accurate or fit for purpose. People were not protected against the risk of unsafe or inappropriate care because of a lack of proper information about them. We found that records were not kept securely.

We spoke with the person managing the service on the day of our inspection. The location did not have a registered manager at the time of our inspection.

People using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us that they felt safe at Lakeside. One person who uses the service commenting on her care in the home said 'You couldn't get better.' Another person said' Simply a wonderful place.'