We carried out a review of the data available to us about The Lakes on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Lakes, you can give feedback on this service.
The Lakes is a care home providing residential care for up to 47 younger and older people, including people living with dementia in one building. There were 44 people receiving care at the time of the inspection
People’s experience of using this service and what we found
People were supported by staff who had been safely recruited and who had received sufficient training to understand their roles and responsibilities and to meet people’s individual needs.
People were protected from potential abuse. Staff understood the policies and procedures for reporting any concerns. Risks to people were safely managed. Risk assessments were in place and contained relevant strategies to mitigate known risks.
People received their medicines as prescribed. Records were kept up to date and evidenced medicines were given on time. People were informed of what medicines they were taking.
Care plans were detailed and person centred. Information on people’s communication, wants and needs, skills and significant relationships was recorded. People’s needs in relation to protected characteristics was recorded and staff understood how to support people to meet these needs.
The registered manager had a good oversight of the service. Regular audits and reviews were completed on records and staff received spot checks to observe their interactions with people to ensure good quality care was delivered.
People, relatives and staff were asked to feedback on the service to support improvements. Action plans were implemented when any issues were raised or found. Staff felt supported within their roles.
People told us they felt safe at The lakes and the staff were kind and caring. Visitors were welcomed into the home. People’s healthcare needs were met, staff referred people to external professionals as needed.
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
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 inspected but not rated (published 15 February 2022) as this inspection was completed to look at infection prevention control only.
The inspection before this was rated requires improvement (published 2 June 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
The Lakes appeared clean and had no odours. Cleaning schedules were in place, equipment and high touch areas were cleaned regularly. The registered manager completed monthly infection, prevention and control (IPC) audits to ensure oversight and compliance with good practice and government guidance.
Staff wore appropriate personal protective equipment (PPE). Staff changed their uniform before and after their shift. There were designated rooms available for staff to store their clothes and take a shower. All staff received IPC training including how to take their PPE on and off. Staff had regular ‘hand hygiene’ checks to support effective hand washing techniques were being completed.
The registered manager maintained contact with relatives and kept them updated on any changes. Essential care givers were supported, and people could also nominate three people to visit them regularly. Government guidance had been followed to safely
Risk assessments were in place for people and staff regarding individual risk factors of COVID-19. Staff and people were regularly tested and had received COVID-19 vaccinations.
The Lakes is a residential care home providing personal and nursing care for up to 47 younger and older people, including people living with dementia. At the time of the inspection, 34 people were receiving care at the service.
People’s experience of using this service and what we found
Staff received training on safeguarding and understood how to recognise and report abuse. Staff were recruited safely.
Bruises and injuries had not always been investigated or recorded on an incident or accident form to identify how they occurred.
Not all people diagnosed with diabetes received support from staff to maintain a healthy and balanced diet.
Staff supported people who were at risk of developing pressures sores to regularly reposition to relieve pressure on their skin.
Checks were in place to ensure the environment was safe.
Medicines were administered and stored safely.
People were protected against infection. Staff wore appropriate personal protective equipment (PPE) and the home was clean.
People and relatives spoke positively about the care provided.
Auditing processes required further development as some of the shortfalls found during the inspection had not been identified.
Staff told us they received support from the manager and attended regular supervision meetings.
Rating at last inspection
The last rating for this service was requires improvement (published 18 December 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
We received concerns in relation to pressure sore management and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvement.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lakes on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Lakes is a care home providing residential care for up to 47 younger and older people, including people living with dementia in one building. There were 30 people receiving care at the time of the inspection
People’s experience of using this service and what we found
Risk assessments were in place to protect people from harm; however, these were not consistently followed by staff.
People were not always safeguarded from the risk of abuse. Bruises and injuries had not always been investigated. Staff had a good understanding of safeguarding and how to raise any concerns they may have.
People were at risk of not receiving their medicines as prescribed. Protocols in place for ‘as required’ medicines did not always contain information regarding when the medicine should be administered. They also contained conflicting information regarding dosage.
Systems and processes to ensure good oversight of the service required some improvements. Audits had been completed but had not identified some of the concerns found on inspection.
People were protected against infection. Staff wore appropriate personal protective equipment [PPE] and the home appeared clean.
Staff were recruited safely with appropriate checks in place. People, staff and relatives felt there was enough staff to meet people’s needs.
The manager and staff knew people’s individual needs well. They supported people in their preferred method and were kind and caring.
Relatives were kept up to date with changes to their loved ones needs. The service had designed a space to allow contact between people and their relatives to use safely during the pandemic.
People, relatives and staff were all aware of the complaints process and felt comfortable to raise issues as needed. There were policies and procedures in place to explain these processes.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 18 February 2020). The service remains rated requires improvement.
Why we inspected
We inspected due to concerns relating to the service not having a registered manager and the number of safeguarding alerts received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvements.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lakes on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Lakes provides residential care for up to 47 older people living with dementia. There were 33 people receiving care at the time of the inspection.
People’s experience of using this service and what we found
The management team monitored the quality of the service, identifying issues and making changes to improve the care. We found that new systems and processes were in place to ensure people received safe and person centred care. However, these required time to be embedded into the service to ensure they were sustained.
People received care from staff they knew. Staff had a good understanding of people's needs, choices and preferences. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. Staff gained people's consent before providing personal care.
People were supported to have 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.
People were involved in the planning of their care which was person centred. People were supported to express themselves, their views were acknowledged and acted upon. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.
Staff understood their roles and responsibilities to safeguard people from the risk of harm. People were supported to access relevant health and social care professionals.
People’s medicines were managed in a safe way. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care that mitigated these known risks.
Staff were recruited using safe recruitment practices. Staff received training to enable them to meet people’s needs and were supported to carry out their roles.
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 22 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since May 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 the last inspection the provider had failed to notify CQC without delay of people's deaths. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lakes on our website at www.cqc.org.uk.
People’s experience of using this service:
¿ The provider failed to have sufficient oversight of the home as there were failings in the quality and safety of people’s care.
¿ People were not protected from the risks of abuse as staff and the registered manager had failed to recognise or report allegations of abuse, unexplained injuries and poor moving and handling; they had not alerted the relevant authorities.
¿ Staff did not consistently ensure people were supported to eat their meals. People were at risk of losing weight and dehydration.
¿ The provider did not employ enough staff to meet peoples’ needs; they relied heavily on agency care staff. Recruitment of staff was on-going.
¿ People’s experience of care differed depending upon how many permanent staff were on duty. People living with dementia did not always respond well to agency staff as they did not know them well. Permanent staff showed kindness in the way they spoke and reacted to people’s anxiety.
¿ The provider failed to ensure agency staff had a suitable induction to the service, employment checks, training and competencies required to carry out their roles. Both agency and permanent staff had not always received the training and supervision they required to provide care that met people’s needs.
¿ Staff were not adequately deployed to meet people’s needs. People’s dignity was not always maintained as their personal care was not always carried out in a timely way.
¿ The provider was not working within the principles of the MCA. They had not identified people who required a Deprivation of Liberty Safeguards (DoLS) assessment or made the appropriate applications.
¿ Staff did not always have information about people’s needs as people’s risk assessments and care plans did not always reflected their current needs. The registered manager had started to update the care plans.
¿ People did not always receive their medicines in a safe way. Staff did not always follow the provider’s medicines policy.
¿ People living with dementia had access to substances that are hazardous to health as toiletries including denture cleaner was readily accessible in people’s rooms.
¿ People did not receive care that reflected their personal preferences such as diet, bedding and clothing. The registered manager recently introduced deployment of staff that reflected people’s preference for female care staff.
¿ People had not had the opportunity to express their preferences or wishes for their end of life care.
¿ People had not been supported to express their views about their care or be involved in creating their care plans. However, the registered manager had recently written to relatives to invite them to people’s reviews.
¿ People and their relatives had not been asked for their feedback. People did not have any involvement in the running of the home.
¿ People’s verbal complaints were not recorded or responded to. The registered manager did not always follow the provider’s complaints procedure.
¿ The provider did not have adequate systems to assess, monitor, evaluate and make changes to improve the service. The provider failed to have systems in place to evaluate the quality and effectiveness of deployment of staff.
¿ The home was purpose built to meet the needs of people living with dementia. However, not all areas of the home were adequately used for the purpose they were intended.
¿ People were supported to access planned healthcare. Staff were prompt in referring people to their GP when they showed signs of ill health. Staff followed infection control procedures.
Why we inspected: We brought forward a planned inspection as we had received information of concern from families, staff and the local authority.
Enforcement: The provider was in breach of 10 regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 and two regulations of Care Quality Commission (Registration) Regulations 2009.
Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals are added to reports after any concerns found in inspections and appeals have been concluded.
Follow up: We will continue to monitor the service and work with partner agencies. The provider will be instructed to provide action plans and reports.
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, 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 timeframe. If not enough improvement is made within this timeframe 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 their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.
Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
For more details, please see the full report which is on the CQC website at www.cqc.org.
The Lakes accommodates a maximum of 45 people in one adapted building. On the day of the inspection there were 30 people living at the home. The Lakes support older people and people living with dementia.
The Lakes had 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.
This was the home’s first inspection.
Improvements were required to ensure that people were given the opportunity to express their end of life wishes and that care planning supported people with this. Improvements were also required to ensure that the home was meeting the Accessible Information Standards to ensure that people’s preferred communication needs were planned for.
People were supported by staff that understood how they could people safe. Safeguarding procedures were in place to help protect people from harm and staff understood their responsibilities to do so and to report any concerns. All concerns were investigated and appropriate action was taken.
Infection control systems were in place to support people to receive their personal care appropriately. Staffing within the home was good and ensured people received their care in a timely way. Staff responded to people quickly and suitable recruitment systems were in place to recruit staff from appropriate backgrounds.
People’s medicines were administered safely and people were given the appropriate support they needed to take them safely. Medicines were stored securely and medicines records were completed appropriately. Accidents and incidents were investigated and if learning was identified this was shared across the staffing team.
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. The service worked within the principles of the Mental Capacity Act and the registered manager completed appropriate documentation to evidence this.
The registered manager completed an assessment of people’s needs before they moved into the home to ensure the care staff would be able to support people effectively. People’s healthcare needs were monitored and when people required external support from other services, for example, the mental health team, this was requested at appropriate intervals.
Staff had the skills and knowledge to provide people with safe and compassionate care. Staff were able to have regular supervision with a senior member of staff and feedback was given to staff to help improve their performance. People were supported to have a balanced diet and to have their nutritional needs met.
People were supported by staff that treated them well and were friendly and kind. Staff were attentive and encouraging and people’s independence was respected. People were encouraged to do what they could do for themselves and to make their own choices. The registered manager had a good understanding of advocacy services and details of this was available for people that may require independent support.
Care planning supported people’s diverse needs, and the service was able to support people with complex needs as a result. Staff had a good understanding of people’s preferences and supported people to participate in activities they enjoyed. The service had appropriate complaint procedures in place and complaints were investigated thoroughly.
The culture within the home was open and transparent and the provider made efforts to ensure that people who lived at the home received good quality care. People and their relatives were given opportunities to become involved in giving feedback about the home and this was acted on promptly wherever possible. The provider and registered manager were keen to learn and to make improvements within the home wherever necessary. Quality assurance systems were in place to review the quality of the service and these were effective at identifying and acting on improvements.