About the service: The Lakes Care Centre is a care home. It is registered to provide personal and nursing care for up to 77 people aged 65 and over within three units. At the time 71 people were receiving support at The Lakes Care Centre.

People’s experience of using this service:

Medicines were not always being managed in line with current best practice.

Systems of governance and oversight were not sufficiently robust to have identified the issues we found in relation to the management of medicines.

The service had appropriate checks and maintenance to ensure the service and equipment was safe for the people living at The Lakes Care Centre.

Staff were safely recruited and received the training and support they needed to undertake their role.

People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

There was a wide range of opportunities for people to engage in activities and follow hobbies and interests.

People were very positive about the staff and told us that their privacy and dignity was promoted.

The service had good community links and had a number of initiatives with local churches and schools.

Care records contained information about people's needs and risks. Preferences and choices were considered and reflected within records and work was ongoing to improve the new electronic system.

Environmental and individual risk assessments were in place. Risks considered included falls, malnutrition and choking risks.

More information is in the full report.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (16 January 2018). At that inspection we inspected the domains of safe and well led, both were rated as requires improvement. Following this inspection, the ratings for these domains remain unchanged.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

The Lakes Care Centre is registered with the Care Quality Commission to provide nursing and residential care for up to 77 older people. There are three Suites, the Derwent, the Kendal and the Coniston Suites. The Derwent Suite provides nursing care for up to 37 people. The Kendal Suite provides residential care for up to 15 people and The Coniston Suite provides care for up to 25 people with dementia related needs.

This inspection took place on 19 October 2017 and was unannounced.

This inspection was prompted by receipt of a Regulation 28 Coroner’s Report received on the ninth October 2017 informing of an incident that took place on 24 May 2017 following which a person using the service later died in hospital. Regulation 28 reports are issued by Coroners when the Coroner remains concerned that similar incidents could reoccur.

Information shared with the Care Quality Commission about the incident indicated potential concerns about the management or risk of falls and the subsequent investigation of falls by the registered provider.

The concerns raised form part of the two domains; is the service safe and is the service well led. Our findings are reported under these domains.

You can read the report form our last comprehensive inspection, by selecting the ‘all reports’ link for ‘The Lakes Care Centre’ on our website at www.cqc.org.uk.

At the time of our inspection, 74 people were using the service, 36 on the Derwent Suite, and 14 on the Kendal Suite and 24 on the Coniston Suite.

There was a registered manager in place and they were available throughout this inspection. 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.

Care records, risk assessments and systems were in place to help and support staff to minimise the risk to people of having falls.

Staff had received the moving and handling training they needed to help make sure people were supported safely when mobilising.

During this inspection we found two breaches of regulation. These breaches related to none notification to the Care Quality Commission of the serious injury of a person who used the service and action had yet to take place to minimise the risk of falls to people using the service, especially at mealtimes.

You can see what action we have told the provider to take at the back of the report. We are currently considering our options in relation to enforcement in relation to some breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

We carried out this inspection on 19, 20 and 21 April 2017 and the first day of the inspection was unannounced. We last inspection the service in August 2015 where we found the service required improvement.

The Lakes Care Centre consisted of three separate suites. The Derwent Suite providing nursing care for up to 37 people. The Kendal Suite providing residential care for up to 15 people and The Coniston Suite providing care for up to 25 people with dementia related needs. The home is registered to provide nursing and residential care and accommodation for up to 77 people and at the time of this inspection there was a total of 77 people using the service. One person was in hospital.

Accommodation comprises of all single rooms some of which have en-suite facilities. Each suite had a communal lounge and dining room and access to a safe, enclosed outdoor space.

At the time of our inspection a registered manager was 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 a 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 the legal requirements that had been made at the inspections conducted in February and August 2015 had been satisfactorily addressed.

People living in the home told us they were happy with their care and liked the staff that supported and looked after them and felt safe when their care was being delivered.

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care.

Care plans were person centred and included risk assessments that provided staff with instructions to follow when supporting people with their care needs. Care records showed they were reviewed and any changes were recorded.

Records looked at and talking with staff and the management team demonstrated that staff had been recruited to the service safely, appropriately trained and supported. Staffing levels were observed to be sufficient to meet the needs of people who lived at the home.

Medicines management were found to be safe. Nurses and senior care staff responsible for the administration of medicines had received appropriate training. All medicines and controlled drugs were safely kept with appropriate arrangements for storing in place.

People using the service had access to healthcare professionals and their healthcare needs were met.

Staff spoken with and records seen confirmed training had been provided. Staff were knowledgeable about the support needs of people living in the home.

Systems were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff spoken with and records seen demonstrated that staff understood their responsibilities in keeping people safe and to report unsafe care or abusive practices.

During our walk round of the service we found all areas to be clean, tidy and appropriately maintained.

People who used the service and their relatives knew how to raise a concern or make a complaint.

A range of activities were available and people were encouraged to participate in those activities that interested them.

The registered manager and senior management team used a variety of methods to assess and monitor the quality of the service. This included regular audits of the service and meetings held to seek the views of people using the service, their relatives and the staff team.

We found that The Lakes was a caring, supportive home for three different client groups. Staff responded and cared for each person in a dignified and respectful manner.

We spoke with people who lived in the home and those who were able to express their views told us that they were satisfied with the care and support they received from staff. The care plans we observed identified assessment and risk recorded to promote people’s safety and welfare.

People told us the staff “Are very good” and “If I want something they sort it out for me.” They said it was “Friendly here.”

We found that staff were aware of the importance of gaining consent from people who use the service and that the service user had a right to withdraw that consent. Staff had received safeguarding of vulnerable adults training.

We found that there was a complaints system in place which had been used effectively and information was available to service users, their relatives and staff on what to do in the event of making a complaint.

Staff working at The Lakes said they enjoyed their work. Comments included “I like working here and feel valued as an employee” and “It’s like a little family, I have never enjoyed working somewhere so much.” The staff felt they received appropriate training to do their job and were supervised by senior staff.

We talked to relatives during the visit. The relatives we spoke with were happy with The Lakes. They felt they had been consulted in their relatives care. Comments included “It’s brilliant here, it’s a caring, nurturing place”, “The unit manager is like a guardian angel”, “They (service users) are attended to in every way” and, “ So caring and very homely, I wouldn’t change anything.”

We spoke with five residents and three visitors, and asked the about the care provided.

One person said: “I’m very happy here, when I’m poorly I get all the attention in the world.” Another said: "I'm being well looked after, very comfortable." Another comment was: “I think the care is excellent.”

Another resident said: "I like it here. They (the staff) are very good. They know what to do and how to help me. It’s nice living here, I can look out of the window and see the trees and watch the birds."

We found that The Lakes Care Centre treated its residents with respect and maintained their independence. The standard of care was generally high, and when problems had occurred action had been taken swiftly to deal with the cause.

We found that residents were protected because the staff were well trained to deal with issues of safeguarding and abuse.

We looked at a recent recruitment process and found that The Lakes Care Centre had followed all the necessary steps to ensure that competent staff of good character were recruited.

We found that The Lakes Care Centre had good systems in place to monitor quality and to address any issues that came to light.

This review took place to check the provider had made improvements in relation to some concerns we identified in the last review. At our last visit to the service we spoke to some people using the service. Everyone we spoke with gave us positive feedback about the care they were receiving. Therefore, we did not seek feedback from people using the service during this review.

People living in The Lakes Care Centre told us that they felt supported and well cared for and that care workers understood their needs and how to meet them. They also told us that they were kept safe at the home. Comments made included;

"I feel safer living here that I did at home, 24 hour care."

"Annette (manager) really listens to you. I feel comfortable speaking with her."

"Every one of the staff are brilliant."

One regular visitor to the home told us, "Staff are very welcoming, they are eager to tell me how mum is. They ring me if mum is not well."

We carried out an unannounced comprehensive inspection of this service on 16 and 17 February 2015. Following that inspection the service was rated as requires improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Lakes Care Centre on our website at www.cqc.org.uk

We undertook this unannounced, focused inspection on 25 and 26 August 2015 because we received some information of concern. These concerns included allegations that inadequate safeguarding procedures were in place that did not protect people living at The Lakes Care Centre. That inadequate complaints procedures were in place which did not support staff to learn from people’s experiences, concerns and complaints.

Prior to this inspection Tameside’s safeguarding adults team had looked at how the home had investigated an allegation of physical abuse that involved a person using the service. Following their investigation some recommendations had been made to the service as to how they could improve their investigation procedures.

The Lakes Care Centre is a care home for up to 77 elderly people who require personal or nursing care. It has a residential unit known as The Kendall Suite, with 15 beds, a nursing unit, known as The Derwent Suite with 37 beds and a specialist dementia care unit, known as The Coniston Suite, which had 25 beds. It is situated in a quiet location in its own grounds in Dukinfield, close to public transport links.

Accommodation comprises of all single rooms some of which have en-suite facilities. Each suite had a communal lounge and dining room and access to a safe, enclosed outdoor space.

There was a registered manager in post although they were not present during this inspection. 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.

We saw there were sufficient numbers of staff working in the home to meet people’s needs and staff spoken with confirmed this.

We saw that the Coniston and Kendal suites were not visibly clean and there were no detailed cleaning schedules in place to indicate exactly what cleaning had been undertaken.

We saw that there were no systems in place to analyse safeguarding incidents to identify triggers or evidence of action taken to look at minimising the risk of reoccurrence of incidents.

There were systems in place to record complaints however they were not robust or detailed.

There was a lack of robust systems in place to monitor the quality of service people received and this had resulted in many of the shortfalls and breaches of regulations we found during the inspection process.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.