Lakeland View Care Centre is situated on the outskirts of Morecambe. It is a building adapted for use as a nursing home, with a number of lounge areas and outside decking. Accommodation is provided on two floors. There are 32 single and one twin bedroom, with shared bathroom facilities.

Lakeland View Care Centre can accommodate up to 33 people who require nursing or personal care. There were 31 people living at Lakeland View Care Centre at the time of our inspection. People who lived in Lakeland View were older people who lived with dementia, mental health needs, a physical disability or a sensory impairment.

There was a 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.

At the last inspection in December 2015, the service was rated ‘Good’. At this inspection we found the service remained Good and met the all relevant fundamental standards.

We found the registered provider continued to provide a good standard of care to people who lived at the home.

We saw staff were responsive to each person’s changing needs and adopted revised care planning to improve upon assistance. We found care planning enabled staff to work in a highly personalised and holistic approach.

People who lived at Lakeland View Care Centre had care plans that reflected their complex needs and these had been regularly reviewed to ensure they were up to date. The care plans had information related to all areas of a person’s care needs. Staff were knowledgeable of people’s needs and we observed them helping people as directed within their care plans.

Relatives told us staff treated their family members as individuals and delivered personalised care that was centred on them as an individual. Care plans seen and observations during our visit confirmed this.

We saw staff were responsive to each person’s changing needs. They worked together to ensure people who became agitated were offered a selection of person centred interventions to meet their needs and soothe their agitation. One person told us, “They have time to sit down and talk to me.”

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they were happy and had no complaints.

The management team provided excellent opportunities to optimise people’s social and stimulation requirements. People received non-judgemental support with activities within the home and were supported to maintain lifestyle choices and hobbies outside of the home.

The service had systems to record safeguarding concerns, accidents and incidents and took action as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had consistently reported incidents to the commission when required.

People told us staff were caring and respectful towards them. Staff we spoke with understood the importance of providing high standards of care and enabled people to lead meaningful lives.

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner.

Staff we spoke with confirmed they did not commence in post until the management team completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were

The inspection visit at Lakeland View took place on 11 December 2015 and was unannounced.

Lakeland View Care Centre is situated on the outskirts of Morecambe. It is an old building adapted for use as a nursing home, with a number of lounge areas and outside decking. Accommodation is provided on two floors. There are 29 single and two twin bedrooms; two bedrooms have en suite facilities.

Lakeland View Care Centre can accommodate up to 33 people who require nursing or personal care. There was 32 people living at Lakeland View Care Centre at the time of our inspection. People who lived in Lakeland View were older people who lived with dementia, mental health needs, a physical disability or a sensory impairment.

There was a 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.

At the last inspection on 23 July 2014 we found there was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because there was a lack of support and lack of choice for people at mealtimes. The provider sent us an action plan outlining the action they had taken, which they stated would be completed by 01 May 2015.

During this inspection, we found the registered manager had met the requirements of the regulations. People were happy with the variety and choice of meals available. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.

We found people who lived at the care centre and were living with dementia were supported to be as independent as possible. At lunch time we observed staff encouraged people to eat their meal independently. Mealtimes were relaxed unhurried and sociable.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and took necessary action as required. Staff had received safeguarding training and showed they understood their responsibilities to report any unsafe care or abusive practices.

Recruitment and selection was carried out safely with appropriate checks made before new staff could start working in the care centre. This was confirmed from discussions with staff.

The environment was clean and hygienic when we visited. No offensive odours were noted on the day of the inspection.

We found staffing levels were sufficient with an appropriate skill mix to meet the needs of people who lived at the home. Staffing levels were determined by the number of people being supported and their individual needs.

We found medication procedures in place were safe. Staff responsible for the administration of medicines had received regular training to ensure they maintained their competency and skills. Medicines were safely kept and appropriate arrangements for storing were in place.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People’s representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Interactions we observed demonstrated people were satisfied with the service they received. The registered manager and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people in their care.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included audits, clinical governance meetings and questionnaires which were issued to people to encourage feedback about the service they had received. The relatives and friends we spoke with during our inspection visit told us they were happy with the service. Quality audits had been used and reviewed at the time of our inspection. The registered manager did have oversight of the service provided.

We observed care in the home, talked with staff and visitors and examined records. We also met with the owner and his wife. We found that while a very busy home, Lakeland View was well staffed with people who were in tune with residents’ needs. Maintaining a high ratio of staff to residents, and training staff were high priorities. There were two nurses on duty at the time we inspected, enabling one to manage care staff to support the residents during the busy early morning period, while the other could focus on the large medication round. Nursing and care staff were supported by domestic and activities staff.

Activities, both group and one to one, were very much part of the daily routine. A quiet room was set aside for relaxation, where we saw that hand massage was being given as part of a “pampering” programme.

A high proportion of people being looked after had mental health issues, in addition to dementia. This demanded high levels of vigilance. We saw that care plans were appropriate and up to date, supporting individual needs and wishes. We saw that the owners had invested in refurbishing the home, and it was clean and comfortable. Visitors we spoke with spoke highly of the care their relatives were receiving.

We found the manager and owner responsive to making improvements, and actions were taken immediately to address issues raised during the inspection.

As this was a follow up to review improvements, we did not talk with service users on this visit.

We spoke with some residents and three visitors to the home. Many of the residents were unable to give direct feedback because of their conditions. Those who did were all positive about the staff and the care they received. One visitor told us that although the place was "shabby" the staff were very kind and looked after people well. She said, "It's better than a smart place where nobody cares". We also spent time observing care and watching while a meal was served.

We inspected Lakeland View Care Centre in the 21st, 23rd and 24th November 2014. This was an unannounced inspection. This meant the staff and the provider did not know we would be inspecting the home.

The last inspection was in June and July 2014. That was a responsive inspection undertaken because we had received information of concern regarding this service. At that inspection we identified breaches in the regulations related to the care and welfare of people, safeguarding, the safety and suitability of the premises, the staffing levels, assessing and monitoring the quality of the service and the lack of notifying the Commission regarding safeguarding and serious injury notifications. At this inspection we undertook checks to see what improvements had been made.

Lakeland View Care Centre can accommodate up to 33 people, who require nursing or personal care, diagnostic and screening procedures and the treatment of disease, disorder or injury. People who live in Lakeland View are older people and may have conditions such as dementia, mental health needs, a physical disability or a sensory impairment.

At the time of our inspection the home was fully occupied. Lakeland View Care Centre is situated on the outskirts of Morecambe. It is an old building adapted for use as a nursing home, with a number of lounge areas and an outside decking area. Accommodation is provided on two floors. Most rooms are single, with shared bathroom facilities.

The home did not have a registered manger in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. They share the legal responsibility for meeting the requirements of the law; as does the provider.

We spent time in the communal areas of the home, including the lounge and dining areas. This helped us to observe the daily routines and gain an insight into how people`s care and support was managed.

We found the registered provider had breached Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found people were not always supported to make a choice at mealtimes. Some people were not effectively supported at mealtimes. You can see what action we told the provider to take at the back of the report.

Following the last inspection in June and July 2014 the provider had sent us an action plan telling us what improvements they intended to make. During this inspection we found the provider had made steady improvements with their safeguarding systems. The provider and staff team had worked collaboratively with a range of external agencies to support their safeguarding systems. Relatives we spoke with told us they felt their family member was safe living at the home. We were told that staff were always helpful when they visited and the home felt welcoming.

We also found the provider had made improvements in other areas including their staffing levels, and with their infection control measures. There was a rage of stimulating activities provided for people to participate in. The provider had recently recruited a new manager who was fully aware of the shortfalls within the service. In the care plan records we looked at we saw evidence to show the provider was responding to changes in people`s condition by seeking advice from a range of healthcare professionals. This was also supported by our observations during the inspection when health care professionals visited people in the home when requested by the qualified nurse on duty.

The provider had policies and guidance in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty safeguards (DoLs). The MCA and DoLs provide legal safeguards for people who may be unable to make decisions about their care. We spoke with the provider who demonstrated an awareness of the code of practice. However we noted further work was required to ensure the measures they had in place reflected the needs of the client group who lived at the home. Although the provider had a policy in place regarding pain management this information was not evident in the treatment room where medicines were administered from. This was of particular concern because some of the people living in the home were unable to express when they were experiencing pain.

The provider had undertaken extensive work in their clinic area. The area had been completely refurbished, with new wipe down surfaces and lighting. The provider had taken advice and guidance with regard to their infection control measures. They had purchased a new medication storage facility located in the clinic area. Medication was safely stored and clearly labelled to assist staff with the safe administration and management of medicines. Other improvements undertaken included the provision of new hand washing and drying facilities in people`s bedrooms. We found these improvements helped to protect people with the additional prevention and control of infection measures.

Although we found the provider had made progress with improvements in a number of areas, we identified some areas that required further work. This would ensure people benefitted from living in a well-managed home.