Lakeview Rest Home is a care home for 29 people. The building is on two floors and has lift access. Bedrooms have en suite facilities available. The home is situated close to Lytham promenade, near Lytham and St Annes town centres. Private car parking facilities are available.

At the last inspection in September 2016 the service was rated Requires Improvement. Ratings of requires improvement had been identified in the ‘safe’ and ‘well led’ domains with breaches in Regulation 15, 17 and 18 Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The home did not have effective systems or equipment for the management of clinical waste. Some areas of the building were not effectively maintained for their designated purpose. The laundry environment was not fit for purpose. Also systems and processes were not accurately reflected within the records kept. In addition there were not enough staff to meet the needs of people in the home in a timely manner.

At this inspection in July 2017 the issues had been addressed by the management team and regulations were met.

This inspection visit took place on 25 July 2017 and was unannounced.

From our observations, discussions with people who lived at the home and staff we found sufficient staff were deployed to ensure people had their needs met. One person who lived at the home wrote in a survey, ‘They answer the call bell immediately when I call for help’. A staff member we spoke with said, “We do have enough staff around now if we need extra the manager will bring people in.”

Systems and processes accurately reflected information within the records kept. Risk assessments were now up to date and implemented in care records of people who lived at the home.

We were shown improvements to the laundry and infection control systems. A new facility had been designated as a laundry room and building work was near completion. In addition new clinical waste systems were put in place to reduce the risk of infection.

We found medicines had been ordered appropriately, checked on receipt into the home, given as prescribed and stored and disposed of correctly. The registered manager had audits in place to monitor medicines procedures. These meant systems were in place to check people had received their medicines as prescribed.

People who lived at Lakeview told us they were happy with the care they received and with staff who supported them. We sat with people who lived at the home in the lounge areas and dining room and observed staff providing support for people throughout our inspection visit. We found they were kind, respectful and patient towards people who lived at the home. One person who lived at the home said, “Yes they are all lovely. They treat me with kindness and respect which is what all you can ask for.”

We found by looking at documentation and talking with staff they had been recruited safely, received ongoing training relevant to their role and supported by the registered manager. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who lived at Lakeview and they were deployed appropriately to ensure the needs of people were met.

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 told us they had choices of meals and there were always alternatives if they didn’t want what was on offer. We observed at breakfast time cooked breakfasts were provided as a choice for people. One person who lived at the home said, “I love the bacon butties in the morning.” Care records we looked at described people’s food preferences and any allergies.

We looked at the activities at the home and spoke with people about what was provided. The service employed activity co-ordinators and we saw advertised on the notice board of up and c

We inspected this service on the 29 June and 1 July 2016. This was the first time the home had been inspected under the comprehensive methodology.

The home was last inspected on 29 August 2013 where it was found compliant with the regulations inspected.

The home is close to Lytham St Anne’s promenade and has large windows to the front of the building with a flowered and landscaped garden and drive. The home can support up to 29 people with residential care needs and at the time of the inspection there were 22 people living in the home.

There is a large living room to the ground floor across the front of the property connecting to a large dining room. The kitchen is located on the ground floor at the centre of the home. Laundry facilities and a large adaptive bathroom are also available to the ground floor. The home is over two floors with lift access to the first floor. Each room has an ensuite bathroom which people predominantly use. When people require more support the bathroom on the ground floor is available.

Staff office space is situated between the lounge and dining room from which both rooms are visible. There is also a small quiet relaxation lounge for people to use with visitors or if they would like some time alone outside of their bedrooms.

At the time of the inspection the home did not have a registered manager but a manager was in post that was in the process of registering with the commission. 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.

On the day of the inspection people we spoke with in the home were happy with the service they received and spoke highly of the staff. We were told they were treated well but at times there was not enough staff. It was evident, from conversations we had with people and the staff in the home, this situation mostly occurred in the mornings and evenings. This was when people were getting up for the day or getting ready to retire for the evening. We noted that if people were at risk of falls it was mostly at this time they fell. We found this was predominantly a consequence of people trying to do things without support. We found the home in breach of the regulation for ensuring there was enough staff on duty.

We breached the home on two further regulations during the inspection and these are reported in full within the report. One of the breaches was around the records kept in the home. We found records were not always consistent with the care and support provided. This included, identified concerns within the care plans for people and for some of the risk management strategies the home said they were implementing, for the health and safety of the environment. The home was also found to be in breach of the regulation supporting good management of the building, equipment and facilities. Concerns included, that the laundry was not fit for purpose and further work was required to ensure the effective management of clinical waste.

Three recommendations were also made. Recommendations are made when the home has not breached a regulation but some further thought should be given to ensure provision remained at an acceptable standard. One recommendation was for the provider to review and reassess the support people were offered under the Mental Capacity Act 2005. This included ensuring all consents were acquired as they should be and all interventions were lawful. The other recommendation was for the provider to review and formalise effective quality audit and quality assurance. This would ensure the service provided was effective and continuously improved. The home had written to family members to request information on their relative living in the home, the third recommendation was fo

On the day of our visit we spoke with the manager, staff, relatives and residents. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Lake View.

During the inspection we looked at care planning, food preparation and staff training records. We also talked to residents and relatives about the home. Comments were all positive and included, “A lovely homely home.” Also, "The food is good, the standard of care is excellent what more do you want.”

Staff members we spoke with had an awareness of residents care needs. We discussed with staff individual needs of residents. Comments included, “Most staff have been here years we have a good idea if any resident is not themself.”

We spoke individually with residents living at Lake View. They told us they were satisfied living at the home and that they felt cared for and safe. One resident said, “I have certainly perked up since being here, it’s a lovely place.”

Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date.

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We spoke with a range of people about the home. They included the manager, staff, relatives and people who lived at the home. We also had responses from external agencies including social services. This helped us to gain a balanced overview of what people experienced living at Lake View.

We were able to speak with residents during the day of the inspection about their care and support. People we spoke with told us they could express their views and were involved in discussions about their care. They told us they felt listened to when discussing their care needs. One resident told us, “Fantastic staff they do a great job of making it like home.” Also, “They never seem rushed always able to spend time with you if you don’t feel so good.”

We spent time in areas of the home, including lounges and the dining areas. This helped us to observe the daily routines and gain an insight into how residents care and support was being managed. We observed staff treated people with respect and provided support or attention as people requested it. One staff member told us, “Respect is a big part of caring for people.”

We contacted the Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

Following the site visit we spoke to the person in charge ,staff ,people who live at the home, and received comments from other professional agencies such as social services and the environmental health agency. Responses we received were positive and reflected how well the home operates and supports people who live at Lakeview. One person living at the home said, "Its a lovely home".

We spoke to a group of residents in the lounge about there experiences of living at Lakeview and some comments were, "Its run well", And, "The staff and manager are caring people". Another resident said, "Its a pleasant atmosphere and they try and put on activities and games for us to enjoy".

We spoke to staff about individual care needs of residents and they are aware of each person's needs. This was confirmed by talking to people who live here and records looked at. One staff member said, "Most of us have been here a while and get to know people, we can tell if they have a problem and deal with it".

Comments about the food were good and people liked the way the meals are served, One person spoken to said, "Cannot complain always a choice if I dont like something", Another said, "She is a good cook".

People we spoke to about the layout of the home were happy with the way its decorated and maintained. One resident said, "Its tastefully done and comfortable".