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Inspection report

Date of Inspection: 23 June and 2 July 2014
Date of Publication: 23 October 2014
Inspection Report published 23 October 2014 PDF | 119.28 KB

Overview

Inspection carried out on 23 June and 2 July 2014

During an inspection in response to concerns

This was a responsive inspection because we had received information of concern regarding this service. This related to poor care practises, concerns regarding the environment and high levels of agency staff working at the home.

The inspection team included two inspectors and a specialist adviser. We observed care and support, looked at care plan records, looked at safeguarding processes and the staffing levels within the home. We looked at the management of medicines, checked the suitability and safety of the home, and the recruitment practises in place. We looked at the quality monitoring systems the provider had in place. We spoke with visitors, relatives, staff and other professionals. We checked our systems to see if the provider had submitted notifications regarding incidents affecting people who lived in the home. We undertook a SOFI; this was because some people living at Lakeland view were unable to tell us about their experience of living at the home.

Information we gathered during the inspection helped answer our five questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked to see how the service kept people safe and protected them from abuse or the risk of abuse. All staff had recently attended specialist training relating to managing challenging behaviour and break away techniques. Staff were also issued with personal alarms so that they could summon assistance if the required it.

During our inspection we noted two people had facial bruising. When we spoke with staff and the management team, no one was aware of the injuries or how they had occurred. When we referred to the care plan records and incident reports related to these people, they lacked information to show us how these injuries had been sustained or what actions had been taken. This showed us that people were not safeguarded against the risk of abuse.

One of the resident`s received one to one staff support. This was provided to safeguard other people from the risks this resident posed to other people living in the home due to their unpredictable and aggressive behaviour. The staff providing support were taken from the staff complement within the home. The provider had no actions in place to improve the situation. This affected the care other people received and to the detriment of care delivery to other residents. Despite the increased level of staff support provided, during the inspection this resident assaulted a frail elderly person. We reported this incident to the Local Authority Safeguarding Team.

We looked at the suitability and safety of the environment. We saw that some refurbishment had taken place to improve the standards within the home. However we did identify several areas for action and reported this to the provider. There was a lack of oversight regarding the concerns we had identified. This posed a risk to people.

Is the service effective?

Lakeland View is a busy home, and we saw there were instances when in the large lounge when there was inadequate staffing to support people safely. During the inspection we saw some people were sat for long periods without any stimulation or activities provided to meet their needs. At times there was only one staff member in the lounge with up to 15 people to care and support.

We noted there was a sensory activity provided for a small group of people in one of the smaller lounges and in the afternoon a group activity in the lounge was organised. However in the large lounge we saw some people who were withdrawn, sleeping, or carrying out repetitive behaviours with limited staff support to offer assistance or distraction.

We looked at the recruitment and selection procedures in place to ensure people were supported by suitably qualified and experienced staff. In the staff files we saw evidence of pre-employment checks being undertaken. However the provider may like to note in one person`s file, not all the pre-employment checks undertaken were robust. The manager told us it could be difficult to obtain references but told she would ensure a more up to date reference was in place. This would support the provider to uphold robust recruitment processes for the safety and well being of people living in the home.

Is the service caring?

We observed staff to treat people with respect and dignity. Staff were patient, kind and caring with people. Some staff told us they had worked at the home for a long time, and we saw staff had formed positive working relationships with people they supported. We saw some good practice, where people were supported sensitively and with respect.

We spoke with some people living in the home and some relatives. Relatives we spoke with told us they were happy with the care at the home. One relative said, “They have done well for him. They settled him down as he was agitated. They have a lot of time for him.” They told us they mainly see activities in the afternoon. A second relative told us, “He seems to have settled in and they have been absolutely marvellous. They are very patient with him and I couldn`t think of him being anywhere else.” They added “I think these guys do a marvellous job.” A third relative told us, “I can always talk to any of the staff if I need to. They do a good job. They’ll always tell me if something’s happened or he’s unwell.”

Is the service responsive?

Records of accidents, incidents and behavioural incidents within the home were not being accurately recorded, reported or appropriate action taken to protect people from the risks posed to them. Although we saw there were some incident records, we did not see incidents were effectively managed. We noted there had been four incidents involving one resident over the past week; however the records showed us that only one incident had been recorded. This meant the frequency and severity of incidents were not being highlighted and so measures to keep people safe had not been considered. This put people at risk.

During our inspection we noted two people had facial bruising. When we checked their records we could not see that any actions had been taken to safeguard these people from harm. Two care plan records we read did not give any adequate explanation for these injuries.

Is the service well led?

Although the management team had a range of systems in place to monitor the quality of the service we did not see evidence they were being effective. At a senior level, the management team were not aware of the severity and frequency of some of the serious incidents taking place within the home. Staff concerns were not always being reported appropriately so that action could be taken to protect people, staff and others from risks posed to them. Records of accidents, incidents and behavioural incidents within the home were not being accurately recorded. This showed us the risks posed to people were not being effectively managed.

Notifications regarding serious incidents and injuries to people and reporting safeguarding concerns were not always being completed and reported to the appropriate authorities including the Commission. This situation meant that no action by outside agencies had been able to be taken to protect people from harm.

There was a new manager in post who had submitted a registered manager`s application to the Commission.