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Lake and Orchard Residential and Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 February 2019

This inspection took place on 10 and 13 December 2018 and was unannounced.

Lake and Orchard Residential and Nursing Home is registered to provide residential and nursing care for up to 99 older people who may be living with a physical disability or dementia. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided across two units ‘Lake’ and ‘Orchard’, both spread across two floors. Lake provides residential care, whilst Orchard provides nursing care. Both units support people who may also be living with dementia. At the time of our inspection, there were 61 people using the service; 30 people living on Lake and 31 people living on Orchard.

The registered manager had left the service shortly before our inspection. A new manager was in post who told us they were going to apply to become the registered manager. 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. A ‘peripatetic manager’ had also been working at Lake and Orchard Residential and Nursing Home since our last inspection and they were supporting the new manager during their induction period. The management team were also supported by a regional area manager and two deputy managers; one who worked on Lake, and one who worked on Orchard.

At the last inspection completed in April 2018, we rated the service requires improvement overall with inadequate in well-led. We identified three breaches of regulation relating to person-centred care, staffing and the governance of the service. Following the inspection, we met with the provider and asked them to take action to make improvements, and this action has been completed.

Work was ongoing to improve the service. Significant progress had been made since our last inspection, but further improvements were needed to achieve a good rating.

Sufficient staff were deployed, but improvements were needed to the way staff were organised, supervised and deployed at busy times and to support with meals on Orchard.

There remained some inconsistencies in staff’s approach. Some staff did not always offer people choices and worked in a more task orientated way. Greater supervision and leadership was needed to monitor and address these inconsistencies and to promote good person-centred care.

Areas of the service were tired, worn and in need of redecoration. There were other environmental and maintenance issues throughout the service that needed to be addressed. The manager and peripatetic manager were aware of these issues and outlined the plans in place to address this. Renovation work was taking place at the time of our inspection to improve the dementia nursing unit, but further improvements were needed.

The overall rating for this service is ‘requires improvement'. Whilst this is the sixth consecutive time the service has been rated inadequate or requires improvement overall, the continued improvements and trajectory showed positive leadership. The provider had made significant progress since the last inspection and was now compliant with the fundamental standards of quality and safety. This progress demonstrated an ability and ongoing commitment to improving the service. We will continue to work with the provider to monitor progress and support improvement to achieve at least a good rating overall.

We received positive feedback about the new manager and the positive impact and changes being made. The provider was embedding a more robust system of audits.

Staff were safely recruited. They were trained to recognise and r

Inspection areas

Safe

Requires improvement

Updated 8 February 2019

The service was not always safe.

Improvements were needed to the way staff were organised, supervised and deployed to complete tasks.

Work was ongoing to address issues with maintenance and the decoration of the service.

Staff were trained to identify and report safeguarding concerns. Staff told us the new manager listened to them and responded to their concerns.

Systems were in place to make sure people received their medicines safely.

Effective

Good

Updated 8 February 2019

This service was effective.

Staff completed regular training.

Work was ongoing to embed a system of regular supervision and appraisals.

Staff supported people to make sure they ate and drank enough.

People had consented to the care staff provided. Staff had taken appropriate action where people lacked mental capacity or were deprived of their liberty.

Caring

Good

Updated 8 February 2019

This service was caring.

Staff were more engaged and there were overall improvements in the quality of care provided.

People gave positive feedback about the caring staff.

Staff supported people to maintain their privacy and dignity.

Responsive

Good

Updated 8 February 2019

The service was responsive.

Care plans contained person-centred information to guide staff on how best to meet people’s needs.

There were more opportunities to take part in activities.

People told us they felt able to raise any issues or concerns. Action had been taken to respond to complaints about the service.

Well-led

Requires improvement

Updated 8 February 2019

The service was not always well-led.

Work was ongoing to improve the service. Significant progress had been made, but further improvements were needed to achieve a good rating.

At times staff lacked supervision, leadership and direction when completing tasks.

We received positive feedback about the new manager and recent changes made.