Archived: Lakeside House

The service had not originally been developed and designed in line with the Registering the Right Support guidance. This was because there were five other registered care homes set in the grounds of Somerset Court in close proximity to Lakeside House. The Registering the Right Support Guidance was implemented in 2017 after the service had registered with us. The registered manager had since personalised the service to reflect the Registering the Right Support Guidance.

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

There were measures in place to minimise risks to people involving the risks relating to choking and individual health needs. Staff were aware of the control measures in place. Systems had been implemented to ensure all staff working in the service were aware of the risks and how to mitigate them. Risk assessments were reviewed and updated where required. We found one person’s risk assessment did not have one piece of accurate information relating to how staff should respond to their health need. The registered manager confirmed they would amend the assessment.

Rating at last inspection

The last rating for this service was good (published November 2017).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about a choking incident. A decision was made for us to inspect and examine those risks. The information the Care Quality Commission (CQC) received about the incident investigation indicated concerns about the management of choking. This inspection examined those risks and the management of health-related risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lakeside House 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.

Lakeside House provides accommodation for five people with autism and complex needs who ¿require personal care. Four people live in the main part of the home; one person lives in a self-¿contained flat. ¿

Lakeside House is part of a complex owned by the National Autistic Society, called Somerset Court. Within the complex there are other care homes and a day services facility which people can use.

The last inspection of this service was carried out in September 2016. At that inspection the service was rated Requires Improvement. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) ¿Regulations 2014. This was because people’s legal rights in relation to decision making were not ¿always upheld, people were not provided with a consistently homely and well maintained ¿environment, staff had not been supervised regularly and the quality assurance processes in ¿place to monitor care and safety and plan on-going improvements were not fully effective.

Following the inspection in September 2016 the provider sent us an action plan to state what changes they would make to ensure they were compliant with the regulations. At this inspection we found all the required improvements had been made and the home was fully compliant with regulation.

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Since the last inspection a new registered manager had been appointed. 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. Staff and relatives spoke highly of the current management at the home.

People lived in a home which was well led and there was a commitment to making on-going improvements to the service. Positive comments were received about the changes that had been made during the past year. One member of staff said, “I think the main thing is consistency. We all know what is expected and the people who live here are more settled because of it.” A relative told us “The management are definitely on the ball now.”

People were safe at the home and appeared relaxed and comfortable with the staff who supported them. There were adequate numbers of staff to keep people safe and to meet their needs. There were systems in place to make sure people received their medicines safely. One relative told us, “I have every confidence they are safe.”

People received effective care because staff were well supported and trained. Staff knew how to support people when they did not have the mental capacity to make a decision for themselves. Staff used pictures and symbols to promote choice for people. They also used easy read posters and information to make sure people had access to information about abuse and making a complaint.

Improvements to the environment meant people lived in a comfortable home which promoted their independence. People were involved in decisions about the décor and furnishings within the house.

People were supported by kind and caring staff who they had built trusting relationships with. When people returned to the house from their activities they looked genuinely happy to see staff and one person gave a number of staff a hug as a greeting. Staff supported people to keep in touch with people who were important to them.

People had their needs assessed and reviewed to make sure care provided met their up to date needs. People were able to set goals for the things they would like to achieve and staff helped people to achieve their goals.

People had access to a wide range of activities according to their abilities and interests. Some activities were provided on site and people also accessed facilities in the local community. One relative said, “There is so much going on. Lots of trips out and they regularly go down to the local pub.”

This inspection took place on 2 and 6 September 2016 and was unannounced.¿

There was currently no registered manager responsible for the home. The last registered manager ¿deregistered with us on 3 May 2016. 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. A ¿new manager had been recruited and was present at this inspection. They will start the ¿registration process with us shortly.¿

People had communication difficulties associated with their autism. We met four people who lived ¿at the home. We had very limited communication with two people. We also used our discussions ¿with people’s relatives and staff to help form our judgements. ¿

The home was a safe place for people. Staff understood people’s needs and provided the care ¿and support they needed. One relative said “We know [name] is happy and safe.”¿

People appeared happy with the care they received and interacted well with staff. Experienced ¿staff had built good relationships with people. Staff supported people’s independence and ¿involvement in the community. A lack of transport sometimes limited people’s ability to access the ¿community. ¿

People, and those close to them, were involved in planning and reviewing their care and support. ¿There was a close relationship and good communication with people’s relatives. Relatives felt ¿their views were listened to and acted on. One relative said, “We have agreed with and are happy ¿with the care plan.” ¿

People received good support from health and social care professionals. Staff were skilled at ¿communicating with people, especially if people were unable to communicate verbally.¿

People’s legal rights in relation to decision making were not always upheld. People were not ¿provided with a consistently homely and well maintained environment. ¿

Staff were well trained, but had not been well supported through a time of significant change. ¿Staff morale had been adversely affected. One staff member said, “There just hasn’t been the ¿support for us, even though we have been through a very difficult time.” Staff support and morale ¿had improved throughout this year. ¿

There had been a number of changes in the management team since our last inspection. This ¿had led to a period of instability and inconsistency. A new management team were now in place ¿and improvements in the service were being made. One relative said, “They don’t keep managers ¿long enough. This has an effect on the quality of care and things don’t get followed up.” ¿

The quality assurance processes in place to monitor care and safety and plan ongoing ¿improvements were not fully effective. There were systems in place to share information and seek ¿people’s views about the home. ¿

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) ¿Regulations 2014. This was because people’s legal rights in relation to decision making were not ¿always upheld, people were not provided with a consistently homely and well maintained ¿environment, staff had not been supervised regularly and the quality assurance processes in ¿place to monitor care and safety and plan ongoing improvements were not fully effective. You can ¿see what action we told the provider to take at the back of the full version of the report.¿

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at. Due to the nature of people's disabilities we were only able to gather limited comments with the support of staff.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The deputy manager informed us that a new manager had recently been appointed.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found the service was safe because medicines were stored securely with the administering of medicines handled and recorded appropriately. Each of the people living at Lakeside House had personal emergency evacuation plans. There was also a disaster recovery plan in place for dealing with foreseeable emergencies. A member of the Somerset Court management team was available on call in case of emergency.

Staff training records demonstrated that the staff had the skills and experience needed to support the people living at the home. Staff we spoke with told us they had been provided with relevant training.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager advised us that people were subject to Deprivation of Liberty Safeguard (DoLS). We saw documentation that showed the staff were following the correct procedure and policies and procedures were in place.

Is the service effective?

Speaking with staff it was evident that they understood individuals' care and support needs. We saw support plans were based on people's assessed needs and risk assessments had been completed and were regularly reviewed.

Is the service caring?

People living in the home had complex needs and some people were unable to fully express their views. During our visit we observed staff provided support and engaged with people positively. We observed people appeared relaxed and comfortable with staff and staff treated people in a sensitive, respectful and professional manner. In people's support plans there was detailed information about what care and support was required by staff to meet the individual's identified needs. We asked one person if they liked living in the home and they signed holding their thumb up to indicate yes.

Is the service responsive?

People met with staff on a one to one basis every week to discuss any issues and to plan what they wanted to do the following week. People were also involved in planning their regular person centred planning reviews and were able to invite their relatives or representative.

Is the service well-led?

The home had quality assurance systems in place to ensure that people remained safe. These included audits undertaken by the provider's representative and a monthly audit which covered all aspects of the home. Incidents were recorded and monitored which helped staff monitor patterns in people's behaviour's.

A wide range of health and social care professionals were involved in people's care. Regular care reviews were carried out. Any advice or guidance from professionals was acted upon and incorporated into care plans.

People were encouraged and supported by staff to make decisions about their day to day lives. Others close to them, such as their family members, were also involved in decisions about their care.

Some communal areas of the home had been redecorated and refurbished. This meant that people were provided with a safe and homely environment to live in.

There were safe and effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work which ensured people were protected from the risk of being cared for by unsuitable staff.

People were made aware of the complaints system. This was provided in a format that met their needs. People's complaints were fully investigated and resolved, where possible, to their satisfaction.

People who lived in the home were well cared for. We saw that people who were unable to express their views appeared relaxed and content. People appeared very comfortable and all were well dressed and clean which demonstrated that staff took time to assist people with their personal care needs.

None of the staff we spoke with had any concerns about any person being at risk and told us they felt the home was a "safe place" for people to live. Staff understood the various signs of abuse and knew what action they needed to take to ensure people were safe.

Some communal areas of the home needed redecoration or refurbishment. This meant that people were not provided with a consistently homely environment.

We saw that people were offered appropriate support by the staff team. We saw that staff were confident in their roles and understood the care people required. Staff were well trained and well supported in their roles.

Regular care and quality reviews were held so that people and those close to them, such as their parents, were involved in discussing and reviewing the care needed or provided. Changes or improvements were made where possible.