Archived: Lakeview Lodge Care Home

The service is purpose built and has accommodation over three floors. Facilities within the service include a spa area, a cinema room, a fine dining room and a bistro café and shop.

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

Since the last inspection the provider had improved the systems to monitor accidents and incidents and the incidents of falls had significantly reduced. People’s care plans had been improved to include more information about how they preferred to take their medicines. This demonstrated a commitment to lessons learnt, to continuously improve the care of people living at the service.

Most of the people living at the service, relatives and staff spoken during the inspection confirmed staffing levels were good and staff were available when needed. Whilst some people that required the support of two staff for moving and handling and personal care told us sometimes, they had to wait longer periods for two staff to be available.

The provider used a dependency tool to calculate the number of care staff hours needed to meet the dependency levels of people using the service. Records showed that staffing hours and dependency levels were regularly reviewed and updated by the registered manager and senior management team.

The registered manager confirmed they and the human resources department were now closely monitoring staff sickness and absence management systems were being followed. Staff rota’s and timesheets evidenced that enough numbers of staff were available to meet people’s needs. On the day of the inspection staff were observed to spend time with people and work unrushed.

Robust staff recruitment procedures were followed. At the time of the inspection the provider was actively recruiting more staff for the service. Some new staff had been recruited and were undertaking induction training.

People using the service told us the staff administered their medicines safely. Medicines were stored securely and administered to people as prescribed. Staff were trained in the safe administration of medicines and their competency was assessed before they administered medicines to people.

The environment was clean, and people were protected from the spread of infection including COVID -19. Staff used personal protective equipment such as gloves and aprons, which were readily available. Staff undertook routine COVID -19 testing and government guidance regarding isolation was followed in response to any positive results. Upon arrival at the service visitors were asked to undertake a rapid flow COVID-19 test and provided with personal protective equipment (PPE) before entering the service.

The registered manager acted in line with the duty of candour requirements. People confirmed they felt supported to raise any concerns or complaints. CQC had been kept informed of notifiable events that had happened at the service. A notification is information about important events, which the provider is required to send us by law in a timely way. The ratings from the last comprehensive inspection were displayed in the front entrance of the service and on the provider website.

Records showed that rigorous management quality assurance processes were followed. Audits were carried out on all aspects of the service to identify areas for further development, and action plans were completed in a timely way.

Feedback on people’s experiences and the quality of the service was sought. Quality assurance surveys had been sent out to people using the service, relatives, staff and healthcare professionals. At the time of the inspection the provider was waiting on the results to complete their six-monthly quality evaluation.

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 (report published 29 October 2020).

Why we inspected

The inspection was prompted in part due to anonymous whistle-blower concerns received about staffing levels. The registered manager had responded promptly to all the concerns raised and fully co-operated with CQC and the local safeguarding authority in providing information and in carry out safeguarding investigations. A decision was made for us to inspect and examine those risks and we found no evidence that people were at risk of harm from the concerns. Please see the Safe and Well-Led sections of this report.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lakeview Lodge Care Home on our website at www.cqc.org.uk

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.

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.

Lakeview Lodge Care Home is a 66 bed residential home providing personal care to 63 people at the time of the inspection. The care home staff support people in a purpose-built building.

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

People did not always receive consistent safe care. People were not consistently safeguarded by staff. Though staff had been trained they were not clear how to assist people and prevent falls. There were inconsistencies in records which led to staff recording information inconsistently, and some record keeping had missing entries. Medicines were not always managed safely, where staff did not administer medicines in line with best practice. We recommend the provider considered the national guidance on the administering of medicines.

Infection control checks were in place and provided us with an assurance that the transfer of infection was minimalised by good staff practices.

Staff were knowledgeable about people’s individual needs and informed by their care plans. These contained varying degrees of consistent information, though the registered manager was working towards a greater degree of consistency and transferring them on to the providers care plan template.

The complaints process was managed effectively, and staff had been complimented on the service provided for some people. Staff had considered people’s end of life choices and made reference to this in care plans.

Some quality monitoring of files and documents had been undertaken. The audit systems that were in place were not operated effectively or overseen by the provider to ensure people received a consistent quality service. Staffing levels were adequate to provide acceptable levels of care.

People’s views of the service were sought on a day to day basis, through regular meetings and six-monthly surveys. The registered manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good. The last report was published September 2018.

Why we inspected

The inspection was prompted in part by notifications of concern from concerned family members and the local authority. A decision was made for us to inspect and examine those risks and concerns.

The overall rating for the service has now deteriorated to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report. The provider has started to make changes to reduce risks, these will take some time to be fully embedded.

Follow up

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.

Lakeview Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 can accommodate up to 66 people, at the time of our inspection 30 people were using the service.

A registered manager was 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.

The registered manager and staff team were committed to following the vision and values of the service in providing high quality care. The registered manager was fully aware of their legal responsibilities and provided effective leadership and support to staff. Quality assurance systems were effectively used to monitor and assess the quality of the service to drive continuous improvement. The provider worked in partnership with other healthcare professionals and external agencies to continuously meet people’s needs. The registered manager ensured the Care Quality Commission (CQC) were kept informed of serious incidents and other events they were required to notify to CQC.

People received a personalised service which was responsive to their individual needs and there was an emphasis on each person's identity and what was important to them. There was a commitment to ensuring strong links with the community and an emphasis on enhancing people's lives through the provision of meaningful, imaginative activities and opportunities.

The services at Lakeview Lodge Care Home were tailored to meet the needs of individual people and they were delivered in a way to ensure flexibility, choice and continuity of care. There was a full and varied programme of activities and day trips for people to join in as they wished. The feedback we received from people using the service and their relatives was extremely positive about the activities provided at the service. Staff went the extra mile to find out about people’s individual backgrounds, hobbies and interests, to accommodate activities that were person centred, meaningful and engaging.

The registered manager and staff had an excellent understanding of people’s social and cultural diversity, values and beliefs. People’s diverse needs were celebrated, and their human rights were respected. Health professionals were impressed with the knowledge of staff and their attention to providing high quality care.

People were involved in all aspects of their care. People were pleased with how staff provided their care and they had developed positive trusting relationships with staff. There was a strong culture of treating people with dignity and respect. The staff and the registered manager were always visible and listened to people and their relatives/friends, offered them choice and made them feel that they mattered. This high standard of care enhanced people's quality of life and wellbeing. The whole staff team were extremely passionate about providing people with support that was based on their individual needs, goals and aspirations.

There was a culture of openness and transparency. Staff were extremely positive about the management and leadership which inspired them to deliver a high-quality service. Exceptional leadership was demonstrated by the registered manager who welcomed and fostered ideas from people using the service, relatives and staff to further benefit the care people received. The staff and management all shared the same goal in working to the organisational vision and values to ensure people benefitted from the best possible care. Feedback from people who used the service and their relatives was used to make changes to the service and drive improvements. There was a robust system of monitoring checks and audits identified any improvements that needed to be made and immediate action was taken as a result.

People were protected from the risk of harm. Staff had been trained in safeguarding people and understood how to report any concerns of abuse. Risks to people’s safety were assessed to ensure preventative action was taken to reduce the risk of harm to people. People were supported with their medicines in a safe way. Their nutritional needs were met and they were supported with their health care needs when required. The service worked with other organisations to ensure that people received coordinated care and support.

People were involved in recruiting staff, and safe recruitment procedures were followed to ensure staff were suitable to work in care services. There were enough staff to meet people's needs and staff received a range of training and ongoing support to work effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The registered manager and staff understood the importance of working in accordance with the principles of the Mental Capacity Act, 2005 (MCA) in seeking people’s consent to receive care and support.

People received varied and nutritious meal options, which included health and cultural dietary requirements that were based upon their specific dietary needs. Staff worked closely with other professionals to ensure people’s health and well-being needs were fully met.

The service was designed around people’s needs. All areas around the service were maintained and decorated to a very high standard. There were different areas both inside and outside of the home for people to use for their preferred activities. There was private space for people to spend time with their families or visitors, or to spend time alone.

People, relatives and staff were involved and encouraged to provide feedback about the service and this was used to drive continuous improvement. People and relatives were highly positive about the staff team and how the service was managed. Effective systems were in place for people to raise any concerns or complaints directly with the registered manager, the provider and outside of the company.