The Lakes Care Centre

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. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained 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 the ways people’s medicines were managed.

This service scored 50 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

There were processes and procedures in place within the organisation intended to promote and support learning culture. However, these were not always consistent and effective. Although audits, checks and internal monitoring systems had been completed, they did not always identify the concerns highlighted during this inspection. For example, regarding how people’s medicines were managed and administered. Inconsistent processes and ineffective monitoring meant the service failed to identify key risks and areas of improvement. Safety incidents were identified in a timely way, however learning were not always robustly identified or used to improve the outcome for people or support organisational learning.

The provider worked well with people and healthcare partners to establish and maintain safe systems of care. However, they did not always consistently manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

People were not always consistently supported through safe systems, pathways and transitions.

People had risk assessments in place, however, the quality varied. Some of the assessments contained sufficient details, while others did not fully describe the actions staff should take to mitigate the identified risks. This meant it was not always clear how risks were being managed in practice. There was limited evidence that people were involved in developing or reviewing their own risk assessments, which reduced opportunities for people to understand their risks and make informed choices about their care.

Staff knew how to raise and communicate concerns. Most people and relatives told us staff was responsive when issues were raised. For example, one relative told us, “I speak to the manager. He is very good. He sorts problems out rapidly.”

However, the systems in place to monitor and oversee this information were not aways used consistently, resulting in leaders lacking the oversight needed to recognise and act on areas requiring improvement.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always consistently concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Feedback from people and relatives was mixed. Whilst some people told us they felt safe, others said they did not always feel safe. One relative told us, “My loved one has been here for some time now and, under the circumstances I have no quibbles with their care.” Another relative told us, “My loved one constantly gets bruises, and I don’t always know about it”.

This inconsistency meant the provider could not be assured that everyone experienced care in a way that made them feel protected and supported.

There were systems, processes, and policies in place to protect people from avoidable harm.

Staff demonstrated a good understanding of safeguarding responsibilities and how to keep people safe. Staff knew how to raise concerns and were confident these would be taken seriously and acted upon. One staff member told us, “I would look for signs of abuse such as bruises or changes in behaviour and report it straight away.” Staff told us, they completed safeguarding training, however this was not recorded on the provider’s training matrix.”

People were supported in line with the principles of the Mental Capacity Act 2005. We saw evidence that appropriate decision‑making processes were followed to ensure care was delivered in people’s best interests when they were assessed as lacking capacity. Although not all staff had completed the provider’s mental capacity training, they demonstrated a good understanding of what capacity meant in practice and how to support people who were unable to make specific decisions for themselves.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s individual risk assessments were overall completed. However, these did not always consistently provide the level of detail required to support safe and person-centred care.

There was very limited evidence to demonstrate how people and their relatives were involved in decisions about how their risks were managed. Records did not always show that discussions had taken place, nor did they always reflect how people’s views, preferences, or goals were considered. This limited the extent to which risk management supported people’s independence, choice and control.

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

Although some environmental improvements had been made since the last inspection, significant compliance issues remained. Several areas of the home were worn or unsafe, including missing door fittings and unsecured furniture, which posed avoidable risks to people. The provider took a prompt action when we told them about this. In addition, key fire safety requirements had not always been fully met. For example, the fire risk assessment was out of date meaning the provider was not consistently ensuring people were protected from fire‑related harm.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

We have received mixed feedback from people and staff regarding current staffing levels within the home. One staff member told us, “If I could improve one thing I think this would be staffing.” Another staff member told us, “I would love to have more time just to talk to people.” One relative told us, “Sometimes there are enough staff, at other times not. In the lounge it can be problem as if someone needs the toilet, they have to wait.”

Staff rota was not always managed effectively. However following our feedback, the provider introduced a dependency tool to ensure that staff was deployed more effectively, and people’s needs were met.

Staff received training of which most of this was completed online. One staff member told us, “I had moving and handling training when I first started and online training on my phone.” Another staff member told us, “I completed level 2 diploma in Health and Social Care.” However, despite some evidence of training completed not all of the staff appeared to have their mandatory training completed. The provider could not demonstrate full compliance in areas such as safeguarding, mental capacity or learning disability and autism. There was no evidence showing how the provider complied with the Oliver McGowan Code of Practice. The Oliver McGowan Code of Practice sets the legal standards that all health and social care providers must follow for mandatory training on learning disability and autism. This Code sets out the statutory standardsfor training on learning disability and autism for all CQC‑registered health and social care providers in England.

Staff received supervision, appraisal and competency checks, but this was not carried out consistently, and medicines competency assessments were not always completed as required.

Staff were recruited safely, with evidence of completed DBS checks, right‑to‑work verification, exploration of any gaps in employment and the obtaining of appropriate references. Recruitment files showed that required pre‑employment checks were carried out before staff started work, ensuring the provider met safe recruitment standards designed to protect people from unsuitable individuals.

People and their relatives overall spoke positively about staff, describing them as kind and supportive. One relative told us, “I find the staff friendly and helpful.” Another relative told us, “I find staff caring and friendly.” Some people and relatives also raise some concerns about communication with staff where English was not their first language. One relative told us, “At times there is a language barrier between staff and residents.”

The provider did not always consistently assess and managed the risk of infection. They did not always consistently detect and controlled the risk of it spreading. Concerns with appropriate agencies were followed up promptly.

The service had appropriate infection prevention and control policies and procedures in place, but these were not always implemented effectively. During our visit, the home was generally clean and free from malodours. However, several fittings were in poor condition, which reduced the overall effectiveness of infection control measures. The provider told us refurbishment work was ongoing after we raised these concerns. Some people and relatives also reported issues with cleanliness, particularly in bedrooms. One relative said, “My loved one stays in their room most of the time and the room is dirty. They are supposed to deep clean it, but I don’t think they do it properly.” Staff had access to the PPE(Personal Protective Equipment), and we observed them using this effectively.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

We saw improvements in medicines management since the previous inspection. However, there were still some areas of improvement.

Medicines were stored safely and securely and there were effective processes to manage stock. Controlled drugs were kept securely and balances checked regularly. However, records were not accurate and amendments in the registers were not being done appropriately. This was always also highlighted on a previous inspection.

People received their medicines as prescribed, including medicines that were time specific. We saw Medication Administration Records (MARs) were being completed accurately when administered medicines. There was documentation when people refused or needed to omit their medicines, such as for medical reasons, but this was not always available. Staff had identified this issue on medicines audits and outlined need for improvement in this area. Additional administration charts used for prescribed topical medicines were not completed fully and did not enough contain enough information. For example, it was unclear where patches had been placed and if daily checks had always been completed.

There were protocols to support the safe administration of ‘when required’ medicines and high-risk medicines. They were person-centred and had clear information on monitoring, side effects and escalation to other healthcare professionals.

Care plans were person-centred but did not always contain medicine specific information. People who had been prescribed topical medicines, such as creams, did not always have risk assessments in place to outline the potential fire risks associated with their use. People receiving medicines via covert administration, where medicines are hidden in food or drink to support them taking them, were not completed in full.

Staff training and competencies in medicines administration were up to date. Medicines audits were completed regularly and identified some of the areas for improvement. Whilst we saw example of improvements being made, the audits had not identified all concerns that were raised on inspection. We were not assured that audit process was effective.

We saw effective collaboration between the service and other healthcare professionals, particularly in response to a recent infection outbreak.