About the service:

Lakeside Residential Home is a care home without nursing providing care and support to up to 72 older people, some of whom may be living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 68 people using the service.

People’s experience of using this service:

¿ Measures were in place which were designed to ensure people were safe. However, these

measures were not always followed. For example, the annual safety checks of thermostatic

mixing valves, due in January 2019, had not been carried out.

¿ People felt safe and the service assessed risks to the health and wellbeing of people who use

the service and staff. However, where risks were identified action was not always taken to

reduce the risks where possible. For example, annual legionella risk mitigation measures, due in

January 2019, had not been completed. Actions set by staff to help reduce an individual's risk

of falls were not always realistic.

¿ Staff refresher training, identified as mandatory by the provider, was not up to date for all staff.

¿ Systems in place to oversee the service and ensure compliance with the fundamental standards

were not always effective in identifying when the fundamental standards were not met.

¿ Since the last inspection in January 2018, the service had experienced a large turnover of staff.

In addition to the registered manager leaving in October 2018, 33 other staff members left during

the year and the service recruited and inducted 37 new staff. The new manager and the

management team, with the support of the provider's regional and head office team, had

worked hard to re-introduce consistency and the smooth running of the service. At the time of

this inspection their efforts were starting to pay off and people, their relatives and staff were

complimentary about the improvements and the changes at the home.

¿ The provider and staff had worked extremely hard to make improvements to the environment to

ensure it was more dementia friendly. The changes made on the two floors where people lived

with dementia were of a high standard and reflected current thinking and best practice.

¿ Recruitment processes were in place to make sure, as far as possible, that people were

protected from staff being employed who were not suitable.

¿ Medicines were handled safely by staff who had been assessed as competent to do so.

¿ People felt the service they received helped them to maintain their independence where

possible.

¿ People and their relatives said staff were caring and respected their privacy and dignity.

¿ People received care that was designed to meet their individual needs and preferences.

¿ 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 knew how to complain and knew the process to follow if they had concerns.

¿ People's right to confidentiality was protected and their diversity needs were identified and

incorporated into their care plans where applicable.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement. This was because the environment was not as dementia friendly as it could be for those living with dementia at the home. At this inspection we found the provider had carried out extensive work, in line with best practice, to make the environment dementia friendly.

Why we inspected:

This was a planned comprehensive inspection carried out in line with our aim to re-inspect a service within 12 months of being given a rating of Requires Improvement.

Enforcement:

We found breaches of three regulations relating to mitigating ri

This inspection took place on 15, 16 and 31 January 2018 and was unannounced. We last inspected the service in February 2016. At that inspection we found the service met all the fundamental standards and attained a rating of Good.

Lakeside Residential Home is a care home without nursing that provides a service for up to 72 older people, some of whom may be living with dementia. People receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is arranged over four floors. The ground floor has 20 rooms, the first and second floors have 22 rooms each and the third floor has eight rooms. People who are living with dementia are accommodated on the ground floor and the first floor. At the time of our inspection there were 67 people living at the service.

The service had a registered manager as required. 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.

Since the last inspection there have been two changes to the service's registration. Eight bedrooms were added to the service on the fourth floor. This increased the overall bedrooms from 64 to 72. The second change was that the previous registered manager moved to another of the provider's care homes and a new manager started working at the service 10 weeks before our inspection. Her registration as manager was approved by the Care Quality Commission on the second day of our inspection. The new registered manager was present and assisted us during this inspection.

At our last inspection we identified that the environment on the ground and first floors was not very 'dementia friendly'. The previous registered manager told us they planned to review and assess the environment on those two floors where people with dementia lived. However, we found little change at this inspection. While some actions had been taken to make the environment more 'dementia friendly', overall the measures taken did not help people to compensate for sensory loss and cognitive impairment as much as they could and did not contribute to supporting their independence. You can see what action we have asked the provider to take in the full version of this report.

In 2017 the local authority raised some concerns with the service that their staff training had fallen behind with their expected refresher training. Action was taken and people now benefitted from a staff team that was well trained and supervised. Where staff training refreshers were due, places had been booked on upcoming training dates. We have made a recommendation that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.

Staff had a good understanding of how to keep people safe and protect them from abuse. Personal and environmental risks to the safety of people, staff and visitors had been assessed and actions had been taken to minimise those risks. Recruitment processes were in place to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

The staff team were caring and respectful and provided support in the way people preferred. Their right to confidentiality was protected and their dignity and privacy were respected. 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 eat and drink enough and their health and social care needs were met.

People received care and support that was personalised to meet their individual needs.

This inspection took place on 16, 19 and 24 February 2016 and was unannounced. We last inspected the service in June 2014. At that inspection we found the service was compliant with all essential standards we inspected.

Lakeside Residential Home is a care home without nursing that provides a service for up to 64 older people, some of whom may be living with dementia. The accommodation is arranged over three floors. The ground floor has 20 rooms and the first and second floors have 22 rooms each. People who are living with dementia are accommodated on the ground floor and the first floor. At the time of our inspection there were 57 people living at the service.

The service had a registered manager as required. A registered manager is a person who has registered with the 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. The registered manager was present and assisted us during this inspection.

People felt safe living at the service and were protected from abuse and risks relating to their care and welfare. They were protected against environmental risks to their safety and furniture and fixtures were of good quality and well maintained. The registered manager planned to review and assess the environment on the two floors where people were living with dementia. This was to ensure the environment was as dementia friendly as possible and helped to encourage and promote people's independence and sense of wellbeing.

People received effective care and support from staff who knew them well and were well supervised. Staff training was not all up to date but, where there were deficits, training had been booked to bring staff up to date within the next four months. People received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans formally reviewed six monthly or as changes occurred.

People received effective health care and support. People saw their GP and other health professionals when needed. Medicines were stored and handled correctly and safely. Meals were nutritious and varied and people told us the food at the service was good.

People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure people's rights to make their own decisions were promoted.

People benefitted from living at a service that had an open and friendly culture. They were treated with care and kindness and their privacy and dignity was respected. During our visit there was a positive atmosphere as people and staff chatted and laughed with each other. People felt staff were happy working at the service and had a good relationship with each other and the management. They told us they felt the service was managed well and that they could approach management and staff with any concerns. Staff also stated that the management was open with them and communicated what was happening at the service and with the people living there.

We found people were provided with suitable and nutritious food and drink to meet their needs. Staff identified when people were at risk of inadequate nutrition or dehydration and took appropriate action where such a risk had been identified.

Care was planned with the involvement of the people who use the service and their relatives. People who use the service told us they were involved in discussions about any changes to their care. We found people were provided with appropriate care to meet their needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

A system of staff supervision and appraisal was in place to support workers. However, staff did not always receive appropriate training and professional development to enable them to deliver care and treatment to people safely and to an appropriate standard, particularly during the induction period.

Staff records and other records relevant to the management of the service were not accurate or fit for purpose. People were not protected against the risk of unsafe or inappropriate care because of a lack of proper information about them. We found that records were not kept securely.

We spoke with the person managing the service on the day of our inspection. The location did not have a registered manager at the time of our inspection.

During our inspection we spoke with staff and looked at people's care plans and daily records and found that their needs were fully assessed. People's care and treatment was planned and delivered in line with their individual care plans. Risk assessments were detailed and were updated .There were arrangements in place to deal with foreseeable emergencies.

People using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us that they felt safe at Lakeside. One person who uses the service commenting on her care in the home said “You couldn’t get better.” Another person said” Simply a wonderful place.”

We spoke with eleven people who used the service, six relatives and a visiting medical practitioner during our inspection. People who used the service were entirely happy with the quality of care provided at the home. They told us they felt the staff team were "kind and helpful", "very nice people" and "go out of their way to help". People felt that staff listened to them and respected their opinion. They said staff offered appropriate levels of support and did so with patience and kindness.

People told us the choice of food available was "excellent, just like a hotel" and was well presented in comfortable surroundings. People were complimentary about the accommodation provided which they said was "very nice". Visitors told us they were "impressed" by the levels of cleanliness at the home. Relatives told us they were always welcomed to the home and offered appropriate hospitality. One relative told us "I'm having lunch with my wife today. I do so regularly".

The inspection team who carried out this inspection consisted of two adult social care inspectors. They visited the location and spoke with two people who use the service, one relative and a friend. We spoke with the deputy manager, commissioning manager, three members of staff, a student and two visiting health care professionals. We also reviewed various records relating to the management of the service which included six people’s care plans and risk assessments, staff training records and complaints.

The inspectors gathered evidence against the outcomes we reviewed to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary describes what people who use the service, relatives and staff told us, what we observed and the records we looked at.

Is the service safe?

Possible risks to people had been identified in their care plans and the appropriate action taken to manage those risks. These included risk of developing pressure ulcers, falls and moving and handling.

The provider had taken appropriate action to ensure people’s care records, staff records and other records relevant to the management of the services were accurate and fit for purpose. Records were also kept securely.

At this inspection we found the provider had taken appropriate action to address concerns identified with regard to infection prevention and control. We found people were being cared for in a clean hygienic environment.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager was aware of a recent Supreme Court judgement relating to ‘deprivation of liberty’ and had liaised effectively with the local authority DoLS team.

Is the service effective?

People's needs were assessed and care was planned and delivered in line with their individual care plan. We looked at six people's care records. The plans of care contained all the relevant information to enable staff to appropriately care for people.

At this inspection we found the provider had suitable arrangements in place in order to ensure that staff employed were appropriately supported in relation to their responsibilities. The provider had enabled them to deliver care and treatment to people who use the service safely and to an appropriate standard because they had provided appropriate training and induction.

Is the service caring?

During the inspection we observed care workers supporting people who use the service. Staff were respectful and caring. A relative told us: “X is obviously well cared for” and “as far as I’m concerned the home is great”.

Is the service responsive?

We saw care records and risk assessments had been recently reviewed and updated. If any changes to people’s needs were identified these were made. Care plans were then updated and staff informed.

People were made aware of the complaints system. People had their comments and complaints listened to and acted on. People’s complaints were fully investigated and resolved, where possible, to their satisfaction.

Is the service well led?

We found the provider had taken appropriate action to address all of the issues we identified at the last inspection on 3 & 4 February 2014.