This inspection took place on 24 October 2017 and was unannounced. We carried out a comprehensive inspection in April 2015 and the service was rated as good overall however the safe question was rated as “requires improvement”. This was because we found medicines were not always managed safely. The provider took immediate action to implement more robust processes and at this inspection we found the provider had met the regulations.

Lakeside Nursing Home provides accommodation, nursing care and support for up to 32 elderly people some of whom were living with dementia. The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us they felt safe with the service they received. Relatives also told us they considered Lakeside to be safe and that people were well cared for. We saw there were arrangements in place to help safeguard people from the risk of abuse. The provider had appropriate policies and procedures in place that informed the registered manager and staff as well as people who used the service about how to report suspected abuse.

People had risk assessments and risk management plans to reduce the likelihood of harm to them. Staff knew how to use the information to keep people safe and work with them positively to help them be as independent as possible.

The provider ensured there were robust recruitment practices to help protect people from the risks of being cared for by staff assessed as unfit or unsuitable. There were appropriate numbers of staff on duty to meet people’s needs.

Medicines were stored, managed and administered safely. People had individual medicines profiles which were reviewed every six months. An appropriate risk management plan was in place that related to the administration of medicines to people.

People received effective care because staff were appropriately trained and supported to do their jobs.

Staff had received appropriate training and had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure people are only deprived of their liberty in a safe and correct way.

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.

People were supported to have a varied and balanced diet and food that they enjoyed. They were enabled to eat and drink well and stay healthy.

People and relatives told us the service was very caring and they spoke highly of the care and support that was provided. People felt they mattered and they said they felt understood by staff.

People were encouraged and supported by staff to maximise their abilities through the activities programme they told us they enjoyed.

When people needed care and support from healthcare professionals, staff ensured people received this promptly. From our observations we saw staff respected people’s privacy and treated them with respect and dignity.

People had care plans outlining the goals for their care they had contributed to and what support they required from staff to achieve them. People were involved in planning their care and their views were sought and planned for as a central and important part of the process. The service regularly monitored people’s changing needs and involved them in discussions about any changes needed to be made to their care plans.

People were encouraged to maintain relationships with the people that were important to them. Relatives and other visitors were made to feel welcome and told us they were free to visit people living at Lakesi

We spoke with eight people who said they were happy living at the home. One person told us ‘I have been here 18 months and I like it.’ Another said ‘it’s very enjoyable’.

The home used the Namaste Programme to help staff provide a calm and stimulating environment through the use of music, aromatherapy and activities. One person told us ‘I like coming to the activities club; there are people to talk to and no telly.’ Another said ‘you meet a lot of people to socialise with.’

People who were unable to communicate verbally looked calm and comfortable and seemed to enjoy the aromatherapy given by the staff. We spoke to four relatives of people living in the home who praised the service and the staff. They commented on the positive atmosphere, the love, care and support given to their relatives and the support staff gave to them. They were glad that there were things their relatives could do in the day and felt that people were safe and well cared for.

Few people in the home were able to give consent to their care. It was clear from our observations that people's consent was obtained where possible and care given was in line with people’s assessed needs.

People had plenty of home cooked food and drink and there was enough assistance to help people to eat if they needed it. Staff recruitment procedures included checks on suitability of staff and their qualifications. Confidential records were kept securely and the premises were suitable for their use.

We spoke with some of the people who use this service and they confirmed that they were happy. However they all had varying degrees of dementia and communication with them was difficult. The views of people who were able to comment on their experience can be summarised as follows "the staff are kind " and "they are good". All the people we met appeared to be happy and looked well cared for. Views expressed by visiting relatives during our visit indicated that the home provided a safe, pleasant and welcoming environment.

We saw the satisfaction surveys that had been completed recently by representatives of people using the service and they were happy with the care being provided in the home.

Due to their needs, many people that we met during our visit were unable to share their views about the standards of care. The views of people who were able to comment on their experience can be summarised as follows” the staff are nice ” and “staff are very kind”.

Due to their needs, many people that we met during our visit were unable to share their views about the standards of care. The views of people who were able to comment on their experience can be summarised as follows. “its good here”, “the staff are kind” and ,” staff are absolutely wonderful”.

We spoke to a number of relatives during our visit to the home and they were very pleased with the care given and were kept well informed and involved in the care of their family members. All those who took part in this review are thanked for their time and contribution to share their views about the service.

The service changed ownership in October last year. The people who were able to give feedback and their representatives/relatives were happy with the new management and the way the home is running. One relative commented that the care was excellent.

This inspection took place on 24 April and 1 May 2015 and was unannounced.

Lakeside Nursing Home provides nursing care for up to 41 residents with dementia and mental health issues. There were 28 people using the service at the time of our inspection.

We last inspected Lakeside Nursing Home in September 2013. At that inspection we found the service was meeting all the regulations that we assessed.

There is no requirement for a manager to be registered at this service as the registered provider is in day to day charge of the service. However, the service does have a manager. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that medicines were not always managed safely. The provider took immediate action to implement a more robust method of receiving medicines into the home.

Staff were aware of their responsibility to protect people from harm or neglect. Recruitment procedures were robust and ensured only suitably vetted staff were employed.

Individual risk assessments were in place for people that identified risks and appropriate control measures were operated to minimise risk. These were regularly reviewed to provide correct guidance and support and enable staff to deliver safe care.

People’s nutritional needs were met and people could choose what to eat and drink on a daily basis. The meal times were an enjoyable experience for people. People received support with eating and drinking sufficient amounts to meet their needs. Care arrangements and risk management considered when a person required a special diet or had particular problems with their food or with swallowing.

Staff received on-going professional development through regular supervisions, and training that was specific to the needs of people was available. Staff felt the dementia care training they received helped them understand what could make a difference; this helped them provide a better quality of care for people with dementia.

People found care staff were kind and compassionate. Staff engagement was positive, and interactions demonstrated staff had built a good rapport with people. People who required support were assisted in a dignified manner with care staff interacting and supporting the person.

Care staff provided a consistent level of care. They were familiar with the people they looked after and knew their life histories, and they were able to apply this knowledge to the care and support they offered to people on a daily basis.

Staff were supported in practice and were aware of their responsibilities and the standards expected of them when providing care and support to people living at the home.

The provider worked well with other agencies to help drive improvement in the service, an example was seen in how the service implemented the Namaste programme and trained staff to improve dementia care. An external social care professional told us the provider was willing to listen to the views of external professionals and take on board their advice and recommendations.