About the service: The Lakes is a provides residential care for up to 47 older people living with dementia. There were 43 people receiving care at the time of the inspection.

People’s experience of using this service:

¿ The provider failed to have sufficient oversight of the home as there were failings in the quality and safety of people’s care.

¿ People were not protected from the risks of abuse as staff and the registered manager had failed to recognise or report allegations of abuse, unexplained injuries and poor moving and handling; they had not alerted the relevant authorities.

¿ Staff did not consistently ensure people were supported to eat their meals. People were at risk of losing weight and dehydration.

¿ The provider did not employ enough staff to meet peoples’ needs; they relied heavily on agency care staff. Recruitment of staff was on-going.

¿ People’s experience of care differed depending upon how many permanent staff were on duty. People living with dementia did not always respond well to agency staff as they did not know them well. Permanent staff showed kindness in the way they spoke and reacted to people’s anxiety.

¿ The provider failed to ensure agency staff had a suitable induction to the service, employment checks, training and competencies required to carry out their roles. Both agency and permanent staff had not always received the training and supervision they required to provide care that met people’s needs.

¿ Staff were not adequately deployed to meet people’s needs. People’s dignity was not always maintained as their personal care was not always carried out in a timely way.

¿ The provider was not working within the principles of the MCA. They had not identified people who required a Deprivation of Liberty Safeguards (DoLS) assessment or made the appropriate applications.

¿ Staff did not always have information about people’s needs as people’s risk assessments and care plans did not always reflected their current needs. The registered manager had started to update the care plans.

¿ People did not always receive their medicines in a safe way. Staff did not always follow the provider’s medicines policy.

¿ People living with dementia had access to substances that are hazardous to health as toiletries including denture cleaner was readily accessible in people’s rooms.

¿ People did not receive care that reflected their personal preferences such as diet, bedding and clothing. The registered manager recently introduced deployment of staff that reflected people’s preference for female care staff.

¿ People had not had the opportunity to express their preferences or wishes for their end of life care.

¿ People had not been supported to express their views about their care or be involved in creating their care plans. However, the registered manager had recently written to relatives to invite them to people’s reviews.

¿ People and their relatives had not been asked for their feedback. People did not have any involvement in the running of the home.

¿ People’s verbal complaints were not recorded or responded to. The registered manager did not always follow the provider’s complaints procedure.

¿ The provider did not have adequate systems to assess, monitor, evaluate and make changes to improve the service. The provider failed to have systems in place to evaluate the quality and effectiveness of deployment of staff.

¿ The home was purpose built to meet the needs of people living with dementia. However, not all areas of the home were adequately used for the purpose they were intended.

¿ People were supported to access planned healthcare. Staff were prompt in referring people to their GP when they showed signs of ill health. Staff followed infection control procedures.

Why we inspected: We brought forward a planned inspection as we had received information of concern from families, staff and the local authority.

Enforcement: The provider was in breach of 10 regulations of the Health and Social Care Act 20

This unannounced inspection took place on 5 December 2017. The Lakes is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Lakes accommodates a maximum of 45 people in one adapted building. On the day of the inspection there were 30 people living at the home. The Lakes support older people and people living with dementia.

The Lakes had a registered manager 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This was the home’s first inspection.

Improvements were required to ensure that people were given the opportunity to express their end of life wishes and that care planning supported people with this. Improvements were also required to ensure that the home was meeting the Accessible Information Standards to ensure that people’s preferred communication needs were planned for.

People were supported by staff that understood how they could people safe. Safeguarding procedures were in place to help protect people from harm and staff understood their responsibilities to do so and to report any concerns. All concerns were investigated and appropriate action was taken.

Infection control systems were in place to support people to receive their personal care appropriately. Staffing within the home was good and ensured people received their care in a timely way. Staff responded to people quickly and suitable recruitment systems were in place to recruit staff from appropriate backgrounds.

People’s medicines were administered safely and people were given the appropriate support they needed to take them safely. Medicines were stored securely and medicines records were completed appropriately. Accidents and incidents were investigated and if learning was identified this was shared across the staffing team.

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. The service worked within the principles of the Mental Capacity Act and the registered manager completed appropriate documentation to evidence this.

The registered manager completed an assessment of people’s needs before they moved into the home to ensure the care staff would be able to support people effectively. People’s healthcare needs were monitored and when people required external support from other services, for example, the mental health team, this was requested at appropriate intervals.

Staff had the skills and knowledge to provide people with safe and compassionate care. Staff were able to have regular supervision with a senior member of staff and feedback was given to staff to help improve their performance. People were supported to have a balanced diet and to have their nutritional needs met.

People were supported by staff that treated them well and were friendly and kind. Staff were attentive and encouraging and people’s independence was respected. People were encouraged to do what they could do for themselves and to make their own choices. The registered manager had a good understanding of advocacy services and details of this was available for people that may require independent support.

Care planning supported people’s diverse needs, and the service was able to support people with complex needs as a result. Staff had a good understanding of people’s preferences and supported people to participate in activities they enjoyed. The service had appropriate complaint procedures in place and complaints were investigated thoroughly.

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