Archived: Lake View Nursing Home

Updated 30 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook a responsive, focused inspection to look at whether the service was safe, effective, caring and responsive on 9 and 14 January 2015. This was because we had received some concerning information that needed to be acted upon quickly. The inspection was an unannounced inspection which meant the provider and staff did not know we were coming.

The inspection was carried out by a lead inspector, five additional inspectors and an inspection manager. During our inspection we spoke with 13 staff members; these included, the registered nurses, care staff, activities coordinator, operations director, regional manager, and the home manager. We spoke with two registered agency nurses who were on duty in the home during our inspection. We also spoke with three people who used the service, two visiting family members and one professional.

We undertook two Short Observation Framework for Inspection (SOFI) observations. SOFI is a tool to help us assess the care of people who are unable to tell us verbally about the care they received.

We spent some time observing care and staff interactions with people who used the service in the communal areas. We looked at the care records for eight people who used the service and other documents which included, policies, accident reporting and duty rotas.

Updated 30 March 2015

We carried out an unannounced focused inspection on 9 and 14 January 2015. We did this in response to concerns received by the Commission in relation to care, moving and handling, records and nutrition. We carried out a focused inspection to look at whether the service was safe, effective, caring and responsive.

The service did not have a registered manager in post. The previous registered manager left their post in March 2014. The provider had recruited a new manager who told us they were commencing the process of registering with the Commission. 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 and associated Regulations about how the service is run.

Lake View Nursing Home is registered to provide care for up to 51 people. At the time of our inspection there were 31 people living in the home. The home was providing nursing and personal care for people, including those living with a dementia.

Prior to this inspection we had previously visited the home on 12 and 13 March 2014 and identified several breaches of regulations. We asked the provider to send us an action plan to tell us how and when they would ensure they met their regulatory requirements. We issued the provider with a warning notice for regulations 10 and 15 and told the provider by what date they needed to meet their regulatory requirements.

We also revisited the home on 6th June 2014 to check whether the provider had met the requirements of the warning notice. However we identified ongoing concerns with regulations 10 and 15 and identified further concerns in relation to regulation 18.

We also revisited home the home on 2 October 2014 to check the provider had met the regulatory requirements. However we identified ongoing concerns and breaches in relation to the regulations.

During this inspection we again found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

During our inspection staff told us the staffing numbers to cover night duty had changed the week of our inspection. The provider had sent us documentation prior to our inspection detailing the staffing numbers in place however we noted this had changed.

We looked at staff files for currently employed staff members and noted discrepancies that related to their application form and employees references.

We identified some concerns during our inspection that related to five staff members and discussed these with the management. The provider took immediate action in response to our concerns.

We asked staff about people’s choice in relation to waking time in the home. Staff told us people had a choice of when they wished to get up. However we noted one person whose care file noted the time they liked to get up was still in bed over one and half hours later than this. During a tour of one of the units in the home. We noted 11 people were still in their bedrooms at 11:55am.

There was evidence of Deprivation of Liberty Safeguard documentation in some people’s care files. We noted one of these documented that the person required constant supervision, however we noted in this person was left unsupervised during our inspection.

We looked at fluid monitoring for people who used the service. We noted some evidence of monitoring taking place however there were gaps in actions noted by staff. We observed the care of one person and saw a lack of fluid offered to this person.

During our inspection we observed the care of people who used the service. We saw the staff interactions with one person who used the service. There was evidence of some positive interactions when staff engaged in meaningful conversation. However we observed some episodes where staff offered little meaningful interaction and engaged in personal conversation between themselves. Some staff offered little reassurance when undertaking personal care and failed to respond when the person who used the service appeared upset or distressed.

We observed the lunchtime period in one of the units. Staff were seen to offer support to people engaging in meaningful conversation. People were offered meal choices and we observed snacks were offered to people who used the service in between meal times.

During this inspection we saw evidence the care plans followed a more consistent format making them easier to navigate. Reviews were seen in the care files that related to care plans and risk assessments for people, however some of these lacked consistency.

Two care files we looked at had details that related to bowels checks. There was evidence of some recording taking place, however we identified inconsistencies in the recording and a lack of actions noted where concerns had been identified.

We observed the care for another person who used the service where we saw they had not been moved on several occasions for several hours over a period of days. We checked this person’s record and saw staff had completed positional change records for these days over the time period where omissions of care relating to positional changes had occurred.