Lakeside Nursing & Residential Home

Lakeside nursing and residential home is a care home providing personal and nursing care to 41 people aged 65 and over at the time of the inspection. The home is set in extensive grounds and accommodates up

to 50 people in one adapted building over three floors.

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

People were protected from the risk of harm and people said they trusted staff to keep them safe. Staff received appropriate safeguarding training. Care plans were detailed and included risk assessments in relation to people’s specific care needs. Medicines were managed safely. People's pressure care was managed. We saw moving and handling equipment being stored safely in the building.

We received mixed feedback from staff regarding staffing levels. Some staff felt they needed more staff during busy periods. We have made a recommendation about the provider reviewing their staffing structures.

Robust auditing systems were in place which comprised of various manager and provider level audits. Record keeping had improved. Staff felt supported by the registered manager and were recognised by the provider for their contributions through commendations. There was a good culture within the service which had a positive impact on people. The service worked in partnership with others such as commissioners, safeguarding teams and health and social care professionals.

The provider had two systems in place to record the administration of prescribed creams which was not best practice. We have made a recommend about the provider reviewing their documentation processes regarding prescribed creams.

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 requires improvement (published 12 December 2019). 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

We received concerns in relation to the management of people’s care needs and staff behaviour. 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.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lakeside nursing and residential home 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 nursing and residential home is a care home providing personal and nursing care to 43 people aged 65 and over at the time of the inspection. The home is set in extensive grounds and accommodates up to 50 people in one adapted building. It has three floors and there is a passenger lift to all levels. The majority of bedrooms are for single use and most rooms have an en-suite toilet. There are three large lounges, a dining room, in house salon and accessible gardens. The home was undergoing extensive refurbishment at the time of the inspection.

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

During the inspection we found care records stored in a cupboard in the communal dining room. The cupboard was unsecure which meant care records could be easily accessed by unauthorised people.

We reviewed a range of records and found improvement was required with record keeping. Topical treatments, such as creams, were applied by the carers and recorded on a chart. We found gaps in the signing of these charts.

During the inspection we saw moving and handling equipment being stored in communal bathrooms. We have made a recommendation about the provider following appropriate guidance in relation to these risks.

People’s pressure care was managed, and no-one had developed a pressure ulcer whilst living in the home. However, we have made a recommendation about the provider reviewing their documentation in relation to pressure care.

People’s outcomes were good, and people’s feedback confirmed this. One person told us, “I hated the thought of going to a nursing home, but it’s nice here.”

People told us they felt safe. One person said, “It is safe, very good, all the care is safe.” Staff had a good understanding of how to safeguard people from abuse.

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.

People told us staff were kind, courteous and sensitive. One person said, “The staff are kind, they are gentle with me and don’t make a fuss.”

The service received many compliments from people and their relatives. Written comments included, “This care home is absolutely fantastic. All the staff that work there are so so kind and respectful. My mum has been cared for in every way possible. I can highly recommend the food which is wholesome and nutritious. If I needed to go into care, then there would be no other place I would choose for myself.”

The registered manager had been managing the home for a short period and was committed to making positive changes to improve the standard of care.

Rating at last inspection

The last rating for this service was good (published 17 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person had systems or processes in place that were operating ineffectively as they failed to enable the registered person to ensure accurate, complete and contemporaneous records were being maintained securely.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was 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.

People we spoke with who lived at Lakeside Nursing and Residential Home told us they felt safe.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service.

We looked at five staff personnel files and there was evidence of robust recruitment procedures in place.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. Staff told us they had received safeguarding training and we saw training certificates that confirmed this. The home also had a whistleblowing policy in place.

We looked at how the service managed the administration of medicines. At the last inspection on 25 August 2015 there were no ‘when required’ (PRN) protocols in place and no information on medicines recorded in people’s care plans. At this inspection we found that the registered manager had introduced ‘when required’ protocols and detailed information on medicines was now in people’s care plans. We observed staff administering medicines and saw that people were given their medicines as required. Records of medicines administration had been completed consistently and accurately. We saw requirements relating to controlled drugs were being met. We saw medicines were stored safely in a locked medicines trolley in the treatment room which was very clean.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use. We saw that monthly infection control audits were in place and included areas such as beds and mattresses, furniture, bedrooms and the general environment and equipment. There was an up to date a fire policy and procedure. Fire safety and fire risk assessments were in place.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition. Accidents and incidents were recorded correctly and included a record of the accident or incident, a summary chart and action plan.

There was a staff supervision schedule in place, which identified meetings during the year and staff were subject to a formal induction process and probationary period. Comprehensive staff training records were in place and staff had completed training in a variety of other areas relative to their job role.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the authorisations. Staff had received training in the MCA and DoLS and most were able to explain the principles of this legislation to us. Staff were aware of how to seek consent from people before providing care or support.

Special diets were catered for, food allergies were recorded and people had nutrition and hydration care plans in place. People who used the service also commented positively about the food.

We saw staff showed patience and encouragement when supporting people.

People’s relatives told us they felt staff were caring when assisting their relative. Staff spoken to had a good understanding of how to ensure dignity and respect when providing care and support and people we spoke with confirmed that they felt staff respected their privacy and dignity and promoted their independence.

Staff interacted with people throughout the day and it was clear that they had a good understanding of the individual people who used the service.

Peoples’ spiritual needs were accommodated through the regular attendance at the home of different faith groups.

People’s care files contained end of life care plans, which documented people’s wishes at this stage of life where they had been open to discussing this.

We observed staff were patient, respectful and friendly towards the people who lived in the home.

Care files were well organised and contained care plans that covered a range of health and social care support needs. People’s needs for support were carefully described on their care plans so care staff knew exactly what tasks to undertake.

We saw people had a choice of activities to stimulate them and activities previously undertaken were recorded in people’s care files.

Residents and relatives meetings were held regularly. People’s care files identified that individuals and their relatives were involved in the planning of their care, and personal preferences were discussed.

There was a complaints policy and procedure in use and this was up to date.

People who used the service and their relatives spoke positively about the management team. Staff said they liked working at the home.

Staff supervisions were undertaken regularly and we saw that these were used to discuss issues on a one to one basis.

There was a business continuity management plan in place that identified actions to be taken in the event of an unforeseen event.

The service worked in partnership with a wide variety of organisations and professionals. There was a full range of policies and procedures in place which were available in paper copy format and electronically.

People's care records were kept securely and confidentially, and in accordance with legislative requirements.

There was a service user guide and statement of purpose in place.

There was an up to date certificate of registration with CQC and insurance certificates on display as required.

We spoke with four people who lived at the home and one visitor. They were full of praise for the staff. One person told us 'Nothing is too much trouble for the staff.' The comments we heard from other people included 'We are looked after very well here'; 'The food is very good. I always eat what I am given.'; 'I have no concerns about the staff or the way that I am treated here'; 'The staff are great' and 'There are no problems with my medicines'

Before our inspection there had been a safeguarding incident that was investigated by the local authority. We visited to check that actions had been taken to reduce the likelihood of the same incident from happening again. We found that staff had received appropriate training and that people were protected from the risk of abuse because there were appropriate arrangements in place to identify the possibility of abuse and prevent abuse from happening.

People spoken with said that they could do whatever they liked and could have meals in their bedrooms if they wanted to. One person said " I like to be by myself and staff understand this."

Comments such as "this is a really nice place to live " it is not home but the next best thing' and "it is a lovely place I have no complaints" were made. Relatives spoken with said " the home is great, really well run" and " good home no concerns at all "

We spoke with the people who used the service. One person told us that the food was " very good food' and ' the food is great I have put on weight since I came in here.' Another told us "the food is nice." A relative spoken with said " my relative always eats everything and says it is very good "

We found the people were well cared for and that their individual preferences were respected. One person told us 'I can get up when I like. They take you to bed but it is still up to you ' sometimes I go to bed and watch television.'

Most people told us that they felt safe and that they had no concerns about the staff or their care. One visitor told us "My relative is well looked after here. The matron runs a tight ship." Another person told us that they would rather be at home but as this was not possible "it is all right here."

We found that staff were happy working at Lakeside and that they had received relevant training in areas such as safeguarding, infection control and dementia. They told us that they were supported in their role and that the manager was approachable.

We saw that there were appropriate systems in place to monitor the quality of care that people received and the manager responded to comments and suggestions made by people, their relatives and members of staff.