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Reports


Inspection carried out on 1 March 2018

During a routine inspection

Lakeland View Care Centre is situated on the outskirts of Morecambe. It is a building adapted for use as a nursing home, with a number of lounge areas and outside decking. Accommodation is provided on two floors. There are 32 single and one twin bedroom, with shared bathroom facilities.

Lakeland View Care Centre can accommodate up to 33 people who require nursing or personal care. There were 31 people living at Lakeland View Care Centre at the time of our inspection. People who lived in Lakeland View were older people who lived with dementia, mental health needs, a physical disability or a sensory impairment.

There was a registered manager in place. 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.

At the last inspection in December 2015, the service was rated ‘Good’. At this inspection we found the service remained Good and met the all relevant fundamental standards.

We found the registered provider continued to provide a good standard of care to people who lived at the home.

We saw staff were responsive to each person’s changing needs and adopted revised care planning to improve upon assistance. We found care planning enabled staff to work in a highly personalised and holistic approach.

People who lived at Lakeland View Care Centre had care plans that reflected their complex needs and these had been regularly reviewed to ensure they were up to date. The care plans had information related to all areas of a person’s care needs. Staff were knowledgeable of people’s needs and we observed them helping people as directed within their care plans.

Relatives told us staff treated their family members as individuals and delivered personalised care that was centred on them as an individual. Care plans seen and observations during our visit confirmed this.

We saw staff were responsive to each person’s changing needs. They worked together to ensure people who became agitated were offered a selection of person centred interventions to meet their needs and soothe their agitation. One person told us, “They have time to sit down and talk to me.”

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they were happy and had no complaints.

The management team provided excellent opportunities to optimise people’s social and stimulation requirements. People received non-judgemental support with activities within the home and were supported to maintain lifestyle choices and hobbies outside of the home.

The service had systems to record safeguarding concerns, accidents and incidents and took action as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had consistently reported incidents to the commission when required.

People told us staff were caring and respectful towards them. Staff we spoke with understood the importance of providing high standards of care and enabled people to lead meaningful lives.

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner.

Staff we spoke with confirmed they did not commence in post until the management team completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were

Inspection carried out on 11 December 2015

During a routine inspection

The inspection visit at Lakeland View took place on 11 December 2015 and was unannounced.

Lakeland View Care Centre is situated on the outskirts of Morecambe. It is an old building adapted for use as a nursing home, with a number of lounge areas and outside decking. Accommodation is provided on two floors. There are 29 single and two twin bedrooms; two bedrooms have en suite facilities.

Lakeland View Care Centre can accommodate up to 33 people who require nursing or personal care. There was 32 people living at Lakeland View Care Centre at the time of our inspection. People who lived in Lakeland View were older people who lived with dementia, mental health needs, a physical disability or a sensory impairment.

There was a registered manager in place. 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.

At the last inspection on 23 July 2014 we found there was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because there was a lack of support and lack of choice for people at mealtimes. The provider sent us an action plan outlining the action they had taken, which they stated would be completed by 01 May 2015.

During this inspection, we found the registered manager had met the requirements of the regulations. People were happy with the variety and choice of meals available. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.

We found people who lived at the care centre and were living with dementia were supported to be as independent as possible. At lunch time we observed staff encouraged people to eat their meal independently. Mealtimes were relaxed unhurried and sociable.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and took necessary action as required. Staff had received safeguarding training and showed they understood their responsibilities to report any unsafe care or abusive practices.

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working in the care centre. This was confirmed from discussions with staff.

The environment was clean and hygienic when we visited. No offensive odours were noted on the day of the inspection.

We found staffing levels were sufficient with an appropriate skill mix to meet the needs of people who lived at the home. Staffing levels were determined by the number of people being supported and their individual needs.

We found medication procedures in place were safe. Staff responsible for the administration of medicines had received regular training to ensure they maintained their competency and skills. Medicines were safely kept and appropriate arrangements for storing were in place.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People’s representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Interactions we observed demonstrated people were satisfied with the service they received. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included audits, clinical governance meetings and questionnaires which were issued to people to encourage feedback about the service they had received. The relatives and friends we spoke with during our inspection visit told us they were happy with the service. Quality audits had been used and reviewed at the time of our inspection. The registered manager did have oversight of the service provided.

Inspection carried out on 21, 23 and 24 November 2014

During a routine inspection

We inspected Lakeland View Care Centre in the 21st, 23rd and 24th November 2014. This was an unannounced inspection. This meant the staff and the provider did not know we would be inspecting the home.

The last inspection was in June and July 2014. That was a responsive inspection undertaken because we had received information of concern regarding this service. At that inspection we identified breaches in the regulations related to the care and welfare of people, safeguarding, the safety and suitability of the premises, the staffing levels, assessing and monitoring the quality of the service and the lack of notifying the Commission regarding safeguarding and serious injury notifications. At this inspection we undertook checks to see what improvements had been made.

Lakeland View Care Centre can accommodate up to 33 people, who require nursing or personal care, diagnostic and screening procedures and the treatment of disease, disorder or injury. People who live in Lakeland View are older people and may have conditions such as dementia, mental health needs, a physical disability or a sensory impairment.

At the time of our inspection the home was fully occupied. Lakeland View Care Centre is situated on the outskirts of Morecambe. It is an old building adapted for use as a nursing home, with a number of lounge areas and an outside decking area. Accommodation is provided on two floors. Most rooms are single, with shared bathroom facilities.

The home did not have a registered manger in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. They share the legal responsibility for meeting the requirements of the law; as does the provider.

We spent time in the communal areas of the home, including the lounge and dining areas. This helped us to observe the daily routines and gain an insight into how people`s care and support was managed.

We found the registered provider had breached Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found people were not always supported to make a choice at mealtimes. Some people were not effectively supported at mealtimes. You can see what action we told the provider to take at the back of the report.

Following the last inspection in June and July 2014 the provider had sent us an action plan telling us what improvements they intended to make. During this inspection we found the provider had made steady improvements with their safeguarding systems. The provider and staff team had worked collaboratively with a range of external agencies to support their safeguarding systems. Relatives we spoke with told us they felt their family member was safe living at the home. We were told that staff were always helpful when they visited and the home felt welcoming.

We also found the provider had made improvements in other areas including their staffing levels, and with their infection control measures. There was a rage of stimulating activities provided for people to participate in. The provider had recently recruited a new manager who was fully aware of the shortfalls within the service. In the care plan records we looked at we saw evidence to show the provider was responding to changes in people`s condition by seeking advice from a range of healthcare professionals. This was also supported by our observations during the inspection when health care professionals visited people in the home when requested by the qualified nurse on duty.

The provider had policies and guidance in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty safeguards (DoLs). The MCA and DoLs provide legal safeguards for people who may be unable to make decisions about their care. We spoke with the provider who demonstrated an awareness of the code of practice. However we noted further work was required to ensure the measures they had in place reflected the needs of the client group who lived at the home. Although the provider had a policy in place regarding pain management this information was not evident in the treatment room where medicines were administered from. This was of particular concern because some of the people living in the home were unable to express when they were experiencing pain.

The provider had undertaken extensive work in their clinic area. The area had been completely refurbished, with new wipe down surfaces and lighting. The provider had taken advice and guidance with regard to their infection control measures. They had purchased a new medication storage facility located in the clinic area. Medication was safely stored and clearly labelled to assist staff with the safe administration and management of medicines. Other improvements undertaken included the provision of new hand washing and drying facilities in people`s bedrooms. We found these improvements helped to protect people with the additional prevention and control of infection measures.

Although we found the provider had made progress with improvements in a number of areas, we identified some areas that required further work. This would ensure people benefitted from living in a well-managed home.

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.

Inspection carried out on 23 May 2013

During a routine inspection

We observed care in the home, talked with staff and visitors and examined records. We also met with the owner and his wife. We found that while a very busy home, Lakeland View was well staffed with people who were in tune with residents’ needs. Maintaining a high ratio of staff to residents, and training staff were high priorities. There were two nurses on duty at the time we inspected, enabling one to manage care staff to support the residents during the busy early morning period, while the other could focus on the large medication round. Nursing and care staff were supported by domestic and activities staff.

Activities, both group and one to one, were very much part of the daily routine. A quiet room was set aside for relaxation, where we saw that hand massage was being given as part of a “pampering” programme.

A high proportion of people being looked after had mental health issues, in addition to dementia. This demanded high levels of vigilance. We saw that care plans were appropriate and up to date, supporting individual needs and wishes. We saw that the owners had invested in refurbishing the home, and it was clean and comfortable. Visitors we spoke with spoke highly of the care their relatives were receiving.

We found the manager and owner responsive to making improvements, and actions were taken immediately to address issues raised during the inspection.

Inspection carried out on 29 August 2012

During an inspection to make sure that the improvements required had been made

As this was a follow up to review improvements, we did not talk with service users on this visit.

Inspection carried out on 4 July 2012

During a routine inspection

We spoke with some residents and three visitors to the home. Many of the residents were unable to give direct feedback because of their conditions. Those who did were all positive about the staff and the care they received. One visitor told us that although the place was "shabby" the staff were very kind and looked after people well. She said, "It's better than a smart place where nobody cares". We also spent time observing care and watching while a meal was served.