Our inspection took place on 10 and 11 February 2016 and was unannounced. We last inspected the service on 18 November 2014. The service was rated as requires improvement after that inspection but there were no breaches of regulations.

Lakeview is registered to provide care and accommodation up to 60 for older persons, some of whom may be living with dementia. There were 51 people living at the service when we carried out our inspection.

While the service had a registered manager, they were not working at the service at the time we carried out the inspection. There was an acting manager in place and the provider had recruited a new manager that was due to take over the registered manager post in the near future. 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 said they felt safe living at Lakeview although we saw some occasions where staff had assisted people to move unsafely. People told us there was enough staff to keep them safe, but some requests for assistance were occasionally delayed. Staff knew what the signs of abuse may be and how to raise concerns and to whom. People said they had their medicines when needed. We saw new staff were vetted to ensure they were safe to work at the service. We saw individual risks to people were identified by the service, and staff were mostly aware of these. There was however some scope to improve some people’s records to ensure that risks to people, and how they were to be minimised, were clear so staff had access to accurate information about people.

People’s rights were promoted, and their best interests considered. Most people were confident in staff that they saw as skilled and competent. People had a choice of, and enjoyed, the food and drinks that were available to them. People’s health care needs were promoted.

People said staff were kind, caring and respectful. People said staff treated them well. People’s privacy was promoted by staff, and they were able to make choices about the care and assistance staff provided to them. People’s independence was promoted.

People felt involved in their care. Staff were aware of people’s needs and preferences. Most people said they were able to pursue pastimes that they enjoyed and follow their chosen lifestyles. People said they were able to complain if they were dissatisfied and were confident any issues raised would be resolved.

People and staff felt able to approach management, who were said to listen to them, and what they had to say. There were systems in place to monitor the quality of the service. While there was scope to make some improvements, these were identified by the provider or, when reported to the provider we found there was a quick and robust response. Staff felt well supported and enjoyed their work.

We undertook this inspection on 18 November 2014. The inspection was unannounced. At our last inspection in March 2014, the service was meeting the regulations inspected.

Lake View Care Home provides care and accommodation for up to 60 older people with a range of needs. There were 58 people living in the home when we visited and 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.

Overall people were positive about the care they or their relative received at the home. Although people told us they felt safe they said more staff were needed.

We saw staff had received training to keep people safe and knew their responsibility to protect people from harm or potential abuse.

We saw people received their medicines as prescribed and the service worked closely with healthcare professionals to make sure there was a joined up approach to meeting people’s needs.

Most of the people we spoke with considered staff were knowledgeable about their individual needs and preferences. Staff told us they were supported in their work and had received an introduction to the service and completed essential training. Care records we saw did not show that people’s ability to make decisions had been assessed. People we spoke with were happy overall with the food provided by the home and its presentation. Although some people commented on the lack of choice of food particularly at tea time.

Overall people described positive experiences about the care they or their relative received at the home. People were clean, appropriately dressed and well cared for. We saw people’s privacy and dignity was respected and their independence was promoted.

People we spoke with felt they had contributed to the assessment and planning of their care but care records did not always evidence this. Some people considered the service was not always responsive to their individual needs due to staffing levels. People were encouraged and supported to maintain their own interests. We observed people in communal rooms engaged in a choice of group and one-to-one craft activity. However, people who remained in their own rooms at times lacked social interaction. We saw complaints received by the home had been responded to and dealt with in accordance with the policy.

The registered manager demonstrated an awareness of their role and responsibilities. They were aware of the improvements required to ensure people consistently received a high quality service. They were being supported by senior management to do this.

We found the service had good systems in place that ensured the safe management of medicines. We found the increased awareness of how to administer medicines with special instructions had improved the health and welfare of people who used the service. We also found that medicines were being stored safely and the service had good systems in place to monitor the management of these medicines. This meant that people who used the service were protected against the risks associated with medicines.

At the time of the inspection there were 54 people living at Lake View Care Home. This consisted of 14 people on the ground floor, 22 people on the first floor and 18 people on the second floor.

Not all the people we met were able to verbally tell us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We visited the service because we had received concerns about issues relating to care and welfare, infection control, staffing and supporting workers.

Everyone we spoke with told us they were satisfied with their care, although everyone raised the issue that the home appeared to be short staffed.

People were cared for in a clean, hygienic environment. People told us the standard of cleanliness was good.

Although there had been staff shortages, we found the registered manager had taken appropriate steps to address this.

Senior staff were trained in the safe handling and administration of medication.

We inspected Lake View Care Home in response to an inspection visit in April and July 2013 where we had identified six outcomes of non-compliance. These included shortfalls in outcomes relating to care and welfare, safeguarding people who used the service from abuse, management of medicines, staffing, assessing and monitoring the quality of service provision and records.

We discussed with the registered manager and regional manager the actions taken to address the areas of non-compliance as indicated in their action plan and we found with the exception of management of medicines these issues had been addressed.

Not all the people we met were able to speak with us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people. This helped us to make a judgement on how their needs were being met.

Everyone we spoke with told us they were satisfied with their care. A person visiting their family member told us, "Staff are very kind and caring here". Care plans were written in a way that ensured people were given choice about living their lives.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse from happening.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

There were enough qualified, skilled and experienced staff to meet people's needs.

We looked at the provider’s quality assurance systems and found a range of monitoring processes in place to monitor the quality of the service provided.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

At the time of the inspection there were 39 people living at Lake View. This consisted of 11 people living on the ground floor, 24 people living on the first floor and four people living on the top floor. Not all the people we met were able to verbally tell us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people. This enabled us to make a judgement on how their needs were being met.

People including one relative we spoke with told us they were satisfied with their care. They told us, “The staff are wonderful here” and, “They are particularly busy at night but they come to me as soon as they can, the care is of a high standard”.

We found that systems were not in place to protect vulnerable people from abuse. The provider had not followed reporting procedures following safeguarding incidents that had occurred at the home.

People were not always adequately supervised to ensure their safety or wellbeing. A needs analysis and risk assessment as the basis for deciding sufficient staffing levels based on people's changing needs and the layout of the home had not been carried out.

Records were not effectively maintained to ensure the safety of the people living at the home or the safe running of the service.

The provider did not have an effective system to regularly assess and monitor the quality of the service that people received.

People shared positive experiences of the care they or their relative received. Comments included, “The staff look after me well” and, “The care is really good here”. People’s health needs were closely monitored by the staff and visiting health professionals.

We saw that people were given help and assistance with their personal care needs. Staff demonstrated a good understanding and knowledge of the individual needs of the people in their care. Care plans were detailed and provided staff with clear instructions on how people preferred their care needs to be met.

We found shortfalls in poor record keeping and the administration of medicines that could affect the health and welfare of people living in the home.

The home was sufficiently staffed to ensure people’s safety and wellbeing. A number of new staff had been appointed and had attended a range of training courses to equip them with the knowledge and skills to carry out their duties. However, due to the significant changes in the management and leadership of the home, we found that staff had not had the opportunity to regularly meet with managers. This meant staff did not have a forum to share any issues or concerns or to review their practice.

There have been significant changes in the management and leadership of the service that has impacted on people’s experiences. People felt the running of the home had much improved over the last few weeks but improvements needed to be sustained.