Lakeview

Lakeview is a residential care home providing personal and nursing care to up to 30 people. The service provides support to people with complex needs, people living with dementia and people living with a brain injury. At the time of our inspection there were 30 people living at the service.

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

People and their relatives generally felt care was provided safely. Risks relating to the provision of people's care were generally well managed in practice; however, some people’s risk assessments contained inconsistencies. Medicines were administered safely; however, some improvement was needed in relation to medication records and the storage of people’s topical creams. We raised this with the registered manager who responded immediately; however, we identified minor recording issues at our last inspection and found similar concerns again. Staff and management had a good understanding of safeguarding and how safeguarding incidents should be managed. Staffing levels were sufficient to meet the needs of people safely and recruitment processes included appropriate checks to ensure staff had the right skills and suitability to work with vulnerable people. We have made recommendations that good practice in reporting accidents and incidents is carried out by all staff and people’s risk assessments and support plans are reviewed to ensure information is consistent. We have also recommended improvements made in relation to medication records and storage of medicines are maintained.

The volume of auditing and governance systems was substantial. However, when utilised, audits had not always identified the same areas for improvement as we did at this inspection. Staff were supported in various ways with a robust programme of supervision and sessions which empowered staff to share their thoughts, feelings and ideas about the service. This information was then used to create team meeting agendas. The provider worked well with colleagues from partners across health and social care and worked holistically to meet all of people's needs. The provider and registered manager understood their responsibilities in relation to duty of candour and informed relatives, professionals and relevant bodies when things went wrong. However, some relatives felt a minority of staff could improve their communication when accidents and incidents occurred. We have made recommendations the provider utilises audits effectively.

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.

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 good (published 15 July 2022)

Why we inspected

This inspection was prompted in part due to concerns received about falls and risk management and the registered manager and providers timeliness in seeking support from external professionals. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. However, we have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

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

Recommendations

We made recommendations relating to safe care and treatment and good governance.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People and their relatives felt care was provided safely. Staff and management had a good understanding of safeguarding and how safeguarding incidents should be managed. Risks relating to the provision of people’s care were assessed and well managed. Staffing levels were sufficient to meet the needs of people safely and recruitment processes included appropriate checks to ensure staff had the right skills and suitability to work with vulnerable people. Medicines were administered safely; however, some improvement was needed in relation to medication records. We raised this with the registered manager who responded immediately and evidenced this in an up to date medication audit and weekly record checks.

Auditing and governance systems were robust. Audits identified areas for improvement and action was taken to implement the improvements in a timely manner. Staff were supported in various ways with a robust programme of supervision and sessions which empowered staff to share their thoughts, feelings and ideas about the service. This information was then used to create agendas for staff team meetings. The provider worked well with colleagues from partners across health and social care and worked holistically to meet all of people’s needs. The registered manager understood their responsibilities in relation to duty of candour and informed relatives, professionals and relevant bodies when things went wrong.

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.

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 (published 23 June 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

At our last inspection, we identified concerns about people potentially being placed at risk of choking and aspiration due to them being provided with foods of the wrong texture. We found improvements had since been made, with accurate records maintained by staff about what people had eaten. People living at the home and their relatives told us the home was a safe place for people to live. There were enough staff to care for people safely and proper recruitment checks were carried out when staff started working at the home. Medicines were administered safely and correct infection control procedures were followed.

At our last inspection, we identified concerns regarding the effectiveness of the provider’s governance system. We also found accurate records were not always maintained regarding the care people received. We found improvements had been made at this inspection. The feedback we received about management and leadership was positive, with the current staff team speaking of a positive culture at the home.

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 (published September 2019) and the provider was in breach of regulations relating to safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the overall rating to at least ‘good’.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

Prior to this inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions (Effective, Caring and Responsive). We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement 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 on our website at www.cqc.org.uk.

We looked at infection prevention and control (IPC) measures under the Safe key question. We look at this at all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lakeview is a purpose built nursing and residential home located in Leigh. The home provides care and support for people living with dementia or related conditions, mental health diagnosis and physical disability. The home is registered to accommodate a maximum of 30 people across three floors; named Fir Tree, Bridgewater and Pennington. At the time of inspection 20 people were living at the home.

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

We found improvements were required in the management of modified diets, consistency of record keeping and with the homes auditing and quality monitoring processes. We identified regulatory breaches in each of these areas.

People told us they felt safe living at the home and felt enough staff were deployed to provide the necessary care and support. Staff were knowledgeable about how to identify and report any safeguarding concerns, which had been reported to the local authority as required. Accidents, incidents and falls had been documented consistently, with reviews completed to look at ways to prevent a reoccurrence.

Medicines were managed safely, by staff who had received training and been assessed as competent. The home and provider had quickly identified concerns with a new medication administration system and put steps in place to ensure these were addressed timely.

Care files contained detailed risk assessments, which had been regularly reviewed to reflect people’s changing needs. This ensured staff had the necessary information to help minimise risks to people living at the home.

People told us staff were both competent and professional and knew how to do their jobs. Staff told us they received sufficient training to carry out their roles, with a comprehensive induction completed which was aligned to the care certificate. This is an agreed set of standards that define the knowledge, skills and behaviours expected of people working in the health and social care sector.

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.

People told us staff were kind, caring and treated them with dignity and respect. Staff had taken time to get to know people, which was evident from the interactions we observed and in people’s feedback to us.

People received personalised care which met their needs and wishes. People were supported to complete activities and interests of their choosing, which included social and leisure opportunities within the community.

People spoke positively about the food and drink provided, confirming they were offered choice and received enough. We identified some concerns with two people who required a modified diet, as they had been given foods contrary to professional guidance. This issue was addressed during the inspection.

The management team were reported to be friendly, approachable and actively engaged in supporting and making improvements. A range of audits and monitoring systems were used to assess the safety and quality of the care provided, however we found these needed to be more robust to ensure they captured the issues noted during inspection.

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

Rating at last inspection

The home was registered with us on 24 July 2018 and this was the first inspection.

Why we inspected

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Newly registered services are inspected within 12 months of registration.

Enforcement

We have identified breaches in relation to the management of modified diets, record keeping and the auditing and quality monitoring process. Please see the action we have told the provider to take at the end of this report.

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.