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Lakeside Care Centre Requires improvement

Reports


Inspection carried out on 16 September 2019

During a routine inspection

About the service

Lakeside Care Centre is a nursing home registered to provide nursing care for up to 53 older people. At the time of the inspection 27 people were residing in the service. Lakeside Care Centre accommodates people in one adapted building over three floors.

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

During this inspection we found a continued breach of Regulation 12 of the Health and Social Care Act 2008. Although some improvements had been made we still had concerns. This was because the management of risks was not always documented clearly, and medicines were not always safely managed.

At the previous inspection records were not suitably maintained, up to date and accessible. At this inspection we found improvements had been made. However, this was work in progress and there were several areas where improvements were required to be made to records, in order to become compliant. The manager was aware of this shortfall and was working with the staff team to make further improvements. This was a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Improvements had been made to the training of staff and how staff responded to concerns of abuse. This meant the service was no longer in breach of Regulation 13 and 18 of the Health and Social Care Act 2008.

During our previous inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, because the service was not following the Mental Capacity Act 2005 (MCA) code of practice. During this inspection we found this had improved. 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.

At the previous inspection in February 2019 we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because person centred care was not promoted, and information was not accessible to people. During this inspection we found improvements had been made and the service was now compliant with the regulation.

During the previous inspection the registered provider had failed to comply with duty of candour Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. During this inspection we found both areas had improved, and they were now compliant.

At the previous inspection in February 2019 we found the care provided to people was not personalised and people’s needs were not always met. During this inspection we found improvements had been made. We made a recommendation about care plans and risk assessments being individualised to people’s needs.

At our previous inspection we found the environment was not always safe, due to corridors being blocked by equipment and fire doors being propped open. During this inspection improvements had been made.

Peoples’ privacy and dignity was respected by staff. People and their relatives spoke positively about the staff and the care they received. Comments included “Couldn’t ask for anything better. The [staff] are absolutely wonderful. Attitude of staff is brilliant.” Where possible people were involved in the review of their care. People had access to other health professionals such as the GP, speech and language therapist, community mental health and palliative care teams. People were supported to participate in activities and maintain interests and hobbies. This went some way towards protecting them from social isolation.

Other improvements implemented by the manager included audits in areas such as care plans, meal audits and medicines audits amongst others. Where improvements were required these were actioned. Staff spoke p

Inspection carried out on 9 January 2019

During a routine inspection

This inspection took place on the 9, 10 January and 11 February 2019. The inspection was unannounced.

Lakeside Care Centre is 'a care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides nursing care for up to 53 older people. At the time of the inspection there were 45 people living at the service. The home is set in beautiful surroundings overlooking a lake. It is made up of three floors with six bedrooms and the communal lounge and dining room on the ground floor. The remaining bedrooms are situated on the first and second floor. The main kitchen, laundry room and offices are situated on the ground floor.

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.

At our previous comprehensive inspection in August 2015 the service was rated as good overall, with a requires improvement rating in the responsive domain. At this inspection we found multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Following this inspection, the service has been rated inadequate.

Some people and relatives were happy with the care provided. However, some people raised concerns about the skills of staff and some relatives and professionals were dissatisfied with the way the home was run and managed.

The delivery of high-quality care was not assured by the leadership, governance or culture in the service. People's records and other records such as staff files were not suitably maintained, accessible and accurate. The service was not effectively managed or audited. The service had systems in place to audit the service but the auditing failed to address the issues we found. There was no external auditing carried out which meant the service was not working to best practice in relation to the delivery of care.

Risks to people and people’s medicines were not appropriately managed. New staff were not inducted and staff were not suitably trained. Their competencies were not properly assessed for their role and tasks they performed. Most staff told us they felt supported but the records did not support that staff had the one to one supervisions recorded on the supervision matrix.

Systems were in place to safeguard people. However, we saw practices and concerns which should have been reported to the local authority safeguarding team to safeguard individuals had not been reported.

People were supported to make day to day choices and decisions. However, the service was not working to the Mental Capacity Act 2005 and procedures were carried out which were not agreed as part of a best interest decision.

Staffing levels varied and some people felt the staffing levels were sufficient. Whilst other people and their relatives told us staff were rushed, call bells were not answered in a timely manner and there was a delay in people being supported with their personal care needs such as toileting and meals.

People had care plans in place but they failed to provide the detail around how person centred care was to be delivered and how people’s communication needs were to be met in line with the Accessible Information Standard. .

Systems were not in place to comply with the Duty of Candour Regulation and the registered manager failed to notify the Commission of issues that they were required to.

People had access to other health professionals to meet their needs however, the service did not always

Inspection carried out on 26 & 28 August 2015

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

This unannounced inspection took place on the 26 and 28 August 2015. Lakeside Care Centre provides accommodation and nursing care for up 53 older people. At the time of the inspection there were 47 people living there. The service also provides respite care for people who need support on a short term basis.

During our last inspection in July 2014 we had concerns about the cleanliness of the kitchen, the lack of knowledge of staff regarding the Mental Capacity Act 2005 and the deprivation of liberty safeguards. Further concerns related to the lack of quality assurance feedback and audits which did not identify the areas requiring improvement that we found. During this inspection we found improvements had been made in these areas.

Lakeside Care Centre has an experienced 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.

People told us they felt safe living in the home. Systems were in place to ensure people’s care was delivered in a safe way, for example all staff had been training in how to safeguard people from abuse.

Care plans and risk assessments were in place to minimise the risk to people when care was being delivered. We have made a recommendation about how the accuracy of care plans could be improved. Staff protected themselves and others from the risk of infection by wearing gloves and aprons when assisting people with personal care and eating and drinking.

Equipment in the home had regular service checks and audits had been completed to ensure the environment and the care provided was safe.

Safe recruitment methods and checks were carried out to ensure as far as possible staff were safe to work within the home. There were sufficient numbers of staff to meet the individual needs of people. Staff had received training and knew how the Mental Capacity Act 2005 was applied to people living in the home. One referral had been made to the local authority for a Deprivation of Liberty Safeguard (DoLS). Staff received training and support, they had supervision with a more senior staff member and their competency was checked by the registered manager and the deputy manager.

People’s nutrition needs were assessed and care plans and risk assessments were in place to ensure the care provided enabled people to be healthy.

People’s chosen lifestyle and interests were maintained and supported by staff that cared for and about them. Staff were kind and gentle and encouraging when speaking to people, they know how to show people respect and the people living in the home told us they valued that. People were encouraged to make decisions and choices about how they spent their time. Care plans reflected people’s choices. A range of activities was available and people told us they enjoyed participating in them.

Residents and relatives meetings were held and questionnaires were sent to people and their relatives to gain feedback on how the home was run. Responses were positive. Staff spoke positively about working in the home, how they cared about the people who lived there and how supportive the management were.

Complaints were dealt with quickly, staff knew how to deal with complaints and people living in the home understood how to make a complaint, although they had not had any reason for doing so.

There was an open and honest culture in the home, with positive attitude to the care being provided and the people living there.

Inspection carried out on 7-8 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection during which we found the care home provider required improvements in the following areas: assessing and managing risks related to infection control and cleanliness; obtaining consent from people and how the quality of the service was managed. You can see what action we told the provider to take at the back of the full version of the report.

Lakeside Care Centre is registered to provide residential and nursing care, for up to 59 older people. The service also provides respite care for people who need support on a short term basis. At the time of our inspection 48 people were living in the home. The service is managed by a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We observed the communal areas and people’s bedrooms were clean and comfortable. We identified concerns about the hygiene standards in the kitchen. Food was not stored correctly and safely and the environment required cleaning. The cleaning schedule was not accurate and did not match with what we saw. An audit of the health and safety standards in the kitchen had not identified these concerns.

Care plans and risk assessments were in place for each person.  People’s health needs were monitored and staff worked well with other professionals such as GP’s to ensure their needs were met.

People told us they were pleased with the care they received, these views were shared by people’s relatives. We saw staff were kind and caring towards people and treated them with respect. We saw staff responded to people’s needs quickly and in a caring way.  The call bell records showed staff responded quickly to people’s requests for assistance.

People told us they liked the food in the home, and there was plenty of food and drink available to them at all times. People’s cultural and dietary needs were respected. A wide range of activities were available to people.  

Staff received training, supervision and appraisals. We spoke with staff about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA is a law about making decisions and what to do when people cannot make some decisions for themselves. The Deprivation of Liberty Safeguards (DoLS) are part of the Act. They aim to make sure that people in care homes, are looked after in a way that does not inappropriately restrict or deprive them of their freedom. Some staff demonstrated minimal understanding of capacity and consent, and acting in people’s best interests. The registered manager told us the majority of staff had not received training in this area, but training for all staff was planned for in the coming weeks.

People’s care plans included assessments of people’s capacity to make decisions and choices. However, the documentation was not in line with the MCA code of practice. It was unclear which decision the person was making and if they had the capacity to make it.

There were no records to show the provider regularly requested feedback from staff or people or their representatives on how the service could improve.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 15 August 2013

During a routine inspection

We read how peoples care was assessed prior to admission. Care plans and risk assessments were in place and reviewed on an on-going basis. We observed how staff cared for people in a respectful way.

We observed people throughout the home, in their own rooms and in the communal areas. People appeared well cared for and told us they were happy with the care they received. We spoke with people who lived in the home. One person told us they “Would not change a thing.” Another person told us “I feel safer here than I did at home.”

We read the staff rota for the two weeks prior to the inspection. We saw that there were sufficient numbers of staff with the right skills and knowledge to meet the needs of the people living in the home.

We read documentation related to staff training and support. Staff were offered core training and induction as new staff members along with a mentor to support them through the induction process. Further training was available to staff as part of their professional development. Staff told us they felt supported by the senior staff and were aware that their practice was observed and monitored. They told us they found the feedback useful to assist them to understand the expectations of their role and provide a good service to people.

Inspection carried out on 19 October 2012

During a routine inspection

Comments from people included ''They're all wonderful here, I'm very happy'' and ''I'm looked after alright here.'' People told us they were usually looked after by the same group of staff, which provided them with consistency of care. Three staff we spoke with said staffing levels were sufficient to meet people's needs.

People’s privacy, dignity and independence were respected at the service. Care plans were person centred to reflect people's wishes and preferences. We saw risks were identified and measures put in place to reduce likelihood of injury or harm. People had access to healthcare professionals to help keep them healthy and well.

Equipment such as hoists and pressure relieving mattresses was provided at the service to meet people's needs. Equipment was serviced to make sure it was safe to use. Staff had been trained in moving and handling techniques to make sure they carried out manoeuvres safely.

We found the service was using robust recruitment processes for the safety and protection of people using the service. However, in one case there was no evidence on the file of the person's continuing entitlement to remain in the country, since they had been appointed.

There was a system in place to listen to any complaints people had. Records were kept of complaints received at the service and how they had been responded to. People we spoke with did not have any complaints about their care.