Lakeside House Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a positive culture for learning after things had gone wrong and they were open to improving. However, this was not embedded to promote good practice at all times for people receiving care and support.

Staff told us they took part in lessons learnt after accidents and incidents, but this was not always recorded. For example, staff told us the action they had taken after someone had fallen, which included increased monitoring and follow ups with their health professional, but this was not documented clearly. We identified while information was shared during handovers as this was not always recorded it meant the opportunity to identify trends and follow up risks was not being captured.

The provider told us that their care documentation was out of date but were taking steps to rectify this. Whilst no one was identified as being at immediate risk of harm, the practice of ensuring the records were regularly reviewed and monitored was not embedded within the service.

The provider did not always ensure and establish safe systems of care. They did not always manage or monitor people’s safety.

People had been living at the service for some time and their existing care records documented who was involved in their care. However, due to out-of-date risk assessments and care plans for some people living at the service, this meant safe pathways could not be established.

We identified concerns with the home environment which had not been identified by the provider or addressed until our site visit, this has been reported below in safe environments. We were not assured there were safe systems in place to routinely monitor and assess these issues as they arose.

Relatives told us they were involved in the referral process to ensure a smooth transition for their family member into the service and this included the local authority.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Records confirmed safeguarding was reported to relevant health professionals and the Care Quality Commission (CQC) when it was identified.

Staff were aware of the different types of abuse people could face and they knew how to raise concerns if someone they provided care to was at risk of abuse. A member of staff said, “We talk to them, we look for changes on their body or in their behaviour, are they scared. I’d report to the manager and they can check the cameras.”

Staff understood whistleblowing and the process to follow if they felt their concerns were not being taken seriously by management. Staff knew to raise concerns with the local authority, police or the CQC.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). Records confirmed appropriate legal authorisations were in place and were up to date when people had Deprivation of Liberty Safeguard (DoLs) in place.

Staff received training in the MCA and DoLS and showed their understanding of supporting people to make their own decisions and when they needed to seek support to make best interest decisions.

The provider did not always work well to record and manage risks for people using the service.

Staff told us records did not always reflect the current risks people faced.

People living at the service did not all have up to date care plans and risk assessments, nor could they be easily located. It was acknowledged by the director and acting home manager that the risk assessments and care records needed updating as they had not been updated by the previous acting manager. Records showed in some instances, it was the previous registered manager who had updated people’s care records in 2023.

The director and acting home manager informed us they were updating care records in their other home due to people’s higher needs, however, this meant that people were at risk at Lakeside Residential Care Home as they did not all have current risk assessments.

At the time of concluding the assessment the director and acting home manager were starting to update old risk assessments and make care records accessible for staff to view.

Staff told us about changes in people’s needs and how they were managing risk to reduce the risk of harm, however, this was not reflected in people’s risk assessments. For example, a member of staff told us how they supported someone in the community and the different types of words they used to help calm them down. We asked if this information was present in the risk assessment. The member of staff said, “I believe it is, but I have not read it in months.”

This information was not present in any behavioural plan and only known by a member of staff, which meant people were at risk of potential harm while out in the community.

Staff were knowledgeable about people’s risks through working with them. A member of staff said, “[Person] had a fall and we attended a meeting where we have to be more visible in communal areas. [Person] is now on 1-2-1.” Other staff we spoke with confirmed this was the case in terms of managing the risk, but it had not been recorded and staff confirmed this.

A shower chair which was used by a person no longer living at the service was being used by 3 people, staff confirmed this. The shower chair had not been assessed for their use, and the risk of harm was present. We were informed by the current acting manager they had contacted the occupational health for people to be assessed if they required a shower chair, the existing shower chair was also taken out of use.

We were sent updated risk assessments for the people who had out of date ones. Risk was clearly identified with measures explaining how to reduce the risk. For example, during personal care to reduce risk of falls, staff were to supervise the person while maintaining their privacy and dignity.

People were not restricted in the home and were able to access the community to support positive risk taking. Staff were available to ensure people safely enjoyed their local community.

The provider did not detect and control potential risks in the care environment. They did not always make sure equipment supported the delivery of safe care.

There was no effective oversight of keeping the environment safe. We identified issues within the home where there were two damaged windows. We asked the acting home manager and they acknowledged that it had not been identified during their initial walk around the home. We also brought this to the attention of the director and nominated individual and the windows were replaced after our site visit.

People’s Personalised Emergency Evacuation Plans (PEEPs) were not up to date and had been updated when the last registered manager was in post in 2022. We were sent fire risk assessments after the site visit but these were not accurate as the same information had been copied across for another person using the service. This was a risk for people as there wasn’t up to date information to ensure they were evacuated out of the home in the safest way possible to meet their individual needs.

We also found an emergency cord was not accessible for people to use in the ground floor bathroom. We were informed it was placed out of reach due to the behaviour of 1 person who pulled it randomly. On our third visit to the home the cord was taped to the ceiling, this meant in the event of an emergency people or staff could not activate the call bell which posed a safety risk.

The provider had not identified these problems themselves through their quality monitoring systems.

Staff kept walkways clear to enable people to be able to move freely.

The provider made sure there were enough staff, who received training, support and supervision. Specialised training development was not provided for all staff to support people with a learning disability or autistic people.

Records showed that only 1 member of staff out of 25 had completed autism awareness and epilepsy training.

Staff confirmed they received training but expressed the desire to have specific training in caring for people with a learning disability and autistic people as this was the main client group of people they supported. Another member of staff requested training in epilepsy as they had people who experienced seizures. Staff knew how to respond but felt they would benefit from more specific training. This had the impact of people being at risk for example, no lead on epilepsy care to provide guidance to staff.

A person told us they could find a member of staff when they needed help and they thought there were enough staff to provide support. A relative told us there were enough staff present to meet their family member’s needs. A relative said, “Yes I do believe there is enough staff at the home on call.” Records confirmed this.

Staff were recruited to service safely and appropriate checks to confirm their suitability were in place. Staff confirmed they received supervision which provided an opportunity to discuss their role and the people they supported. A member of staff said, “Our boss, they are good people, listen and support you."

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and free of malodour and the provider was proactive in ensuring they responded to an outbreak of bed bugs. They adhered to regular fumigation of the home with professional pest control and relatives were informed of this.

Staff and relatives told us the fumigation caused disruption to people living at the home. A relative said, “I am also concerned that the house always needs fumigating because of bed bugs that's also a problem.”

Staff further expressed concerns around bed bugs and the impact it had on people living at the service due to their clothing being placed in an outside building and not being able to remain in their wardrobes. It was acknowledged this was done to protect their clothing against contamination, however, this was having an impact on people who regularly liked access to their clothes. A member of staff said, “I worry how it may be mentally effecting them.” Staff did take people to access their clothing to minimise the affect it was having on them.

Staff were responsible for cleaning the home and managed this well. Staff used personal protective equipment and disposed of it appropriately.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes

happened.

Medicines were stored safely overall. However, we noted the medication room contained a working fridge, but this was primarily used for staff food and not dedicated to medicines. On inspection we noted the fridge recorded a temperature of 12 degrees Celsius, outside the safe range for the storage of medicines. Whilst no medicines were currently being stored in the fridge, we recommend the provider review best practice for storing medicines.

We viewed a sample of medicine administration records and overall these had been completed correctly. Where these had not been completed a medicines audit had taken place with actions completed where errors were identified.

Staff received medicine administration training and received annual medicine competency checks, records confirmed this.