Archived: Lakeside Care Centre

Lakeside Care Centre is a nursing home registered to provide nursing care for up to 53 older people. At the time of the inspection 27 people were residing in the service. Lakeside Care Centre accommodates people in one adapted building over three floors.

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

During this inspection we found a continued breach of Regulation 12 of the Health and Social Care Act 2008. Although some improvements had been made we still had concerns. This was because the management of risks was not always documented clearly, and medicines were not always safely managed.

At the previous inspection records were not suitably maintained, up to date and accessible. At this inspection we found improvements had been made. However, this was work in progress and there were several areas where improvements were required to be made to records, in order to become compliant. The manager was aware of this shortfall and was working with the staff team to make further improvements. This was a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Improvements had been made to the training of staff and how staff responded to concerns of abuse. This meant the service was no longer in breach of Regulation 13 and 18 of the Health and Social Care Act 2008.

During our previous inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the service was not following the Mental Capacity Act 2005 (MCA) code of practice. During this inspection we found this had improved. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

At the previous inspection in February 2019 we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because person centred care was not promoted, and information was not accessible to people. During this inspection we found improvements had been made and the service was now compliant with the regulation.

During the previous inspection the registered provider had failed to comply with duty of candour Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. During this inspection we found both areas had improved, and they were now compliant.

At the previous inspection in February 2019 we found the care provided to people was not personalised and people’s needs were not always met. During this inspection we found improvements had been made. We made a recommendation about care plans and risk assessments being individualised to people’s needs.

At our previous inspection we found the environment was not always safe, due to corridors being blocked by equipment and fire doors being propped open. During this inspection improvements had been made.

Peoples’ privacy and dignity was respected by staff. People and their relatives spoke positively about the staff and the care they received. Comments included “Couldn’t ask for anything better. The [staff] are absolutely wonderful. Attitude of staff is brilliant.” Where possible people were involved in the review of their care. People had access to other health professionals such as the GP, speech and language therapist, community mental health and palliative care teams. People were supported to participate in activities and maintain interests and hobbies. This went some way towards protecting them from social isolation.

Other improvements implemented by the manager included audits in areas such as care plans, meal audits and medicines audits amongst others. Where improvements were required these were actioned. Staff spoke positively about the manager and the support they were receiving and the changes they had made to the service. Comments included “The manager is present for all of the meetings. They talk through and explain everything”, “Team meetings are more constructive, frequent and issues are addressed”. Staff told us the manager was open to ideas.

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 Inadequate (published 21 March 2019).

This service has been in Special Measures since 20 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

At this inspection enough, improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Enforcement

We have identified breaches in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.

We have issued requirement notices.

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 Care Centre is 'a care home'. 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.

The service provides nursing care for up to 53 older people. At the time of the inspection there were 45 people living at the service. The home is set in beautiful surroundings overlooking a lake. It is made up of three floors with six bedrooms and the communal lounge and dining room on the ground floor. The remaining bedrooms are situated on the first and second floor. The main kitchen, laundry room and offices are situated on the ground floor.

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.

At our previous comprehensive inspection in August 2015 the service was rated as good overall, with a requires improvement rating in the responsive domain. At this inspection we found multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Following this inspection, the service has been rated inadequate.

Some people and relatives were happy with the care provided. However, some people raised concerns about the skills of staff and some relatives and professionals were dissatisfied with the way the home was run and managed.

The delivery of high-quality care was not assured by the leadership, governance or culture in the service. People's records and other records such as staff files were not suitably maintained, accessible and accurate. The service was not effectively managed or audited. The service had systems in place to audit the service but the auditing failed to address the issues we found. There was no external auditing carried out which meant the service was not working to best practice in relation to the delivery of care.

Risks to people and people’s medicines were not appropriately managed. New staff were not inducted and staff were not suitably trained. Their competencies were not properly assessed for their role and tasks they performed. Most staff told us they felt supported but the records did not support that staff had the one to one supervisions recorded on the supervision matrix.

Systems were in place to safeguard people. However, we saw practices and concerns which should have been reported to the local authority safeguarding team to safeguard individuals had not been reported.

People were supported to make day to day choices and decisions. However, the service was not working to the Mental Capacity Act 2005 and procedures were carried out which were not agreed as part of a best interest decision.

Staffing levels varied and some people felt the staffing levels were sufficient. Whilst other people and their relatives told us staff were rushed, call bells were not answered in a timely manner and there was a delay in people being supported with their personal care needs such as toileting and meals.

People had care plans in place but they failed to provide the detail around how person centred care was to be delivered and how people’s communication needs were to be met in line with the Accessible Information Standard. .

Systems were not in place to comply with the Duty of Candour Regulation and the registered manager failed to notify the Commission of issues that they were required to.

People had access to other health professionals to meet their needs however, the service did not always act on health professional’s advice. We have made a recommendation to address this.

Staff were suitably recruited and during the inspection some positive engagements between staff and people were noted. Some people described staff as kind and caring whilst others found staff to be brisk and showed no time for them. We have made a recommendation to monitor staff practice and address.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, Lakeside Care Centre will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not, enough improvement is made within this time frame so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this 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. The Care Quality Commission is now considering the appropriate regulatory response to resolve the problems we found during our inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response to the concerns found during inspections is added to reports after any representations and appeals have been concluded.

We observed people throughout the home, in their own rooms and in the communal areas. People appeared well cared for and told us they were happy with the care they received. We spoke with people who lived in the home. One person told us they 'Would not change a thing.' Another person told us 'I feel safer here than I did at home.'

We read the staff rota for the two weeks prior to the inspection. We saw that there were sufficient numbers of staff with the right skills and knowledge to meet the needs of the people living in the home.

We read documentation related to staff training and support. Staff were offered core training and induction as new staff members along with a mentor to support them through the induction process. Further training was available to staff as part of their professional development. Staff told us they felt supported by the senior staff and were aware that their practice was observed and monitored. They told us they found the feedback useful to assist them to understand the expectations of their role and provide a good service to people.

People's privacy, dignity and independence were respected at the service. Care plans were person centred to reflect people's wishes and preferences. We saw risks were identified and measures put in place to reduce likelihood of injury or harm. People had access to healthcare professionals to help keep them healthy and well.

Equipment such as hoists and pressure relieving mattresses was provided at the service to meet people's needs. Equipment was serviced to make sure it was safe to use. Staff had been trained in moving and handling techniques to make sure they carried out manoeuvres safely.

We found the service was using robust recruitment processes for the safety and protection of people using the service. However, in one case there was no evidence on the file of the person's continuing entitlement to remain in the country, since they had been appointed.

There was a system in place to listen to any complaints people had. Records were kept of complaints received at the service and how they had been responded to. People we spoke with did not have any complaints about their care.