Lakeside Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment and safe and effective staffing.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

The registered manager had established new processes for recording incidents. Staff said the incident forms would be reviewed by the registered manager. Issues would be investigated and analysed helping to identify any trends with the aim of preventing further incidents through training and risk assessments. However, a review of training records showed not all staff had completed training in areas of risk, such as, Moving and Handling and Falls Awareness. Also, the recording and monitoring recommendations in relation to nutrition risks had not been fully implemented by staff.

Staff had not been appropriately supported to embed good practices. One staff member told us "The new system is brilliant at identifying errors but it's not fixing the root cause". Records of recent flash meetings did not contain sufficient detail regarding safety events or lessons learned. These meetings were not held on a regular basis and, on one occasion, did not record any staff attendance.

The registered manager had developed an action plan. This focused on environmental issues and lacked detail regarding other key areas of improvement such as training and development.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

The registered manager introduced a ‘family meeting’ as part of the pre-admission assessment phase, helping to ease people's transition into the service by gathering relevant information about people’s wishes and preferences. The providers service user guide also contained relevant information to support people when transitioning to the service.

Information from people’s assessments and care plans was shared effectively with relevant partners, such as District Nurses to assist with dressing changes and wound care. In addition, a hospital pack had been developed, this provided information about people’s health and support needs should they be admitted to hospital.

The registered manager told us they had previously helped a person move to another service following a review of their care needs which deemed another care provider to be more suitable to meet their needs.

People told us they felt care was delivered safely. However, we observed a person being admitted to the service for a period of respite and staff told us they were not aware of this until after the person had arrived.

The provider did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect.

There was a clear process to record concerns, and the manager reviewed safeguarding concerns and conducted investigations where necessary. However, it was not consistently clear how the actions taken following investigations reduced the risk of incidents reoccurring. For example, areas of learning to improve practice had not been shared with the whole team.

Staff were not sufficiently trained to identify safeguarding concerns. One staff member told us they had not received safeguarding training, and staff training records showed a low completion rate in Safeguarding Adults training. However, safeguarding information, including details of the local authority, was available to staff and people and recent concerns had been reported appropriately to partner agencies.

Processes were in place to ensure people’s human rights were met. A Deprivation of Liberty Safeguards (DOLS) application had been submitted to the supervisory body on behalf of people who lacked capacity to consent to their own care. Policies in line with best practice guidance were available to guide staff. However, some staff had yet to complete training in the Mental Capacity Act and Deprivation of Liberty safeguards.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

Care plans did not always include sufficient information to guide staff in supporting people safely and in a consistent way. For example, care plans did not fully reflect people’s needs and how they were to be supported with the use of prescribed thickener or other nutritional risk.

Risk assessment in place for people identified where additional monitoring and checks were required so changing needs could be quickly identified and supported. However, where people required their food and fluid intake monitoring, records were incomplete and did not provide accurate information. One person’s care plan stated their whereabouts should be checked every 30 minutes, due to recently leaving the home without staff knowledge. We found checks had not been completed this frequently.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider did not carry out appropriate risk assessments of the environment. The provider did not hold an asbestos management survey to assess whether asbestos was present, and its fire risk assessment had not identified that the designated fire evacuation route did not reflect fire exit signage. The provider rectified this during our assessment. Records, such as fire drills, were insufficient and due to the increase in use of agency staff and turnover of staff, an increase in the frequency of fire drills including simulated evacuations would be expected in line with best practice. When asked about fire safety training, one member of staff told us "I’ve not had any training, and I don’t know who the Fire Marshall is.”

We saw one fire exit was blocked. This was raised with the registered manager and the floor plan reviewed. We found this doorway was not a designated fire exit. Action was taken during our visit to address this.

We also found a beeping carbon monoxide alarm in the laundry and a broken window restrictor that had not been identified by staff. This was discussed with managers and immediate action was taken to address this.

Work was being completed to enhance areas of the home. We were told there was a programme of redecorating bedrooms, which was ongoing. We saw people had personalised their rooms with belongings from home. Aids and adaptation had been provided throughout to promote people’s safety and independence. Where people had been identified at risk of falls, specialist equipment had been put in place to alert staff.

Regular servicing of appliances, such as gas, electric and hoists, were completed and up to date. Maintenance staff also carried out regular checks to ensure the facilities were kept safe and any work required was responded to.

We review the plans in place in the event of an emergency arising. Personal emergency evacuation plans (PEEPs) were available in people’s electronic care records. However, these were not easily accessible in the event of an emergency. This was discussed with managers and immediate action was taken to address this.

The provider did not always make sure there were enough qualified, skilled, and experienced staff. They did not always make sure staff received effective support, supervision, and development. They did not always work together well to provide safe care that met people’s individual needs.

We reviewed the staffing arrangements within the service. It was not clear how the provider had determined staffing levels based on people's dependency level. We saw two differing dependency assessments for each person using the service. One assessment explored care tasks but did not give consideration to people’s social and emotional needs or potential behaviours which may impact on the time required to complete care tasks. The scoring tool was also unclear with regards to what these scoring levels meant. The second assessment, completed as part of the persons' care plan, was not always completed in full. The two tools did not provide corresponding information. Therefore, it was unclear how staffing levels had been determined to meet people’s needs fully.

Feedback from people using the service regarding staffing levels was generally negative with one person telling us, "There are not a lot of staff, they are definitely short staffed. At night they only have three staff. It isn't really enough as two can be needed to take one person to the toilet. It takes a lot longer to put people to bed. It's mainly regular staff but some new faces occasionally". From our observations we saw people shouting for assistance as no staff were visible in communal areas as they were supporting other people within the building. Support centred on care tasks and provided little opportunity for staff to engage with people. Following our visit, we received further information from a family member raising similar concerns to our findings.

A review of staff rotas showed regular use of agency staff to meet people's needs and on-going recruitment was being undertaken. A review of recruitment files was being completed to ensure relevant information was in place. We found relevant recruitment checks had been carried out for newly appointed staff. However, shortfalls were identified with agency staff profiles in relation to visa requirements and a current photo. Immediate action was taken to address this.

Whilst we were aware some staff were completing health and social care qualifications and feedback from the course assessor was positive, training offered to staff by the provider had low completion rates. Records also showed team meetings were not consistent and individual supervision sessions were not routinely held, to provide staff with meaningful opportunity to discuss their work.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly

We found management systems were not as thorough as they should be. A ‘home audit and catering audit’ had not identified issues regarding cleanliness in the kitchen. One staff member told us “The kitchen could do with a deep clean at least once a year, but I can’t remember the last time it was done.”

The provider’s own guidance and best practice with regards to the wearing of false or polished nails, was not being followed. One staff member told us "I know not to have nails on, but the manager has them, so we all do." Records showed an insufficient number of staff had completed training in infection prevention and control, and health and safety.

Designated staff were responsible for the laundry and cleaning of the home each day. Whilst the laundry was small, staff were mindful of infection prevention procedures when managing soiled items. Rooms were clean and tidy and there were no malodours, other than 1 area which managers agreed to explore. There were ample supplies of personal protective equipment, such as aprons and gloves and cleaning supplies. Staff wore personal protective clothing when assisting people with aspects of care. Items were cleaned away and disposed of properly.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff did not always involve people in planning.

There were gaps in medication records, including missing signatures and overdue reviews. Some ‘as needed’ medicines lacked clear guidance on their use, and creams and patches were not consistently recorded using body maps. In some cases, creams were distributed without labels or instructions. Medicines were stored outside their required temperature range compromising their effectiveness and safety, potentially leading to ineffective treatment or harm.

One person’s medication record was missing a front sheet containing key information about the administration of their medicines. However, most medication records were well-maintained and one relative reported feeling well-informed and satisfied with the care and communication provided by the home.