We carried out a review of the data available to us about OSJCT Lake House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about OSJCT Lake House, you can give feedback on this service.
Lake House is a ‘care home’. People in care homes receive accommodation and nursing or 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 care home accommodates up to 43 people. At the time of the inspection there were 38 people living at the service.
At our last inspection on 13 September 2017, the overall rating was requiring improvement. One breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 was identified. Following the inspection, we received an action plan which set out what actions were being taken to bring the service up to standard. At this inspection we found improvements in the service. We could see that action had been taken to improve staff recruitment practices.
There was a registered manager in place. 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.
People told us they were safe living at Lake House. There were enough staff to meet people’s needs. Staff demonstrated they understood how to keep people safe and we saw that risks to people's safety and well-being were managed through a risk management process. There were systems in place to manage safe administration and storage of medicines. People received their medicines as prescribed.
People had their needs assessed prior to living at Lake House to ensure staff were able to meet people’s needs. Staff worked with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner.
People were supported by staff that had the right skills and knowledge to fulfil their roles effectively. Staff told us they were well supported by the management team. Staff support was through regular ‘Trust in conversations’ (one to one meetings with their line manager), appraisals and team meetings to help them meet the needs of the people they cared for.
People living at Lake House were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.
People told us they were treated with respect and their dignity was maintained. People were supported to maintain their independency. The provider had an equality and diversity policy which stated their commitment to equal opportunities and diversity. Staff knew how to support people without breaching their rights. The provider had processes in place to maintain confidentiality.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The registered manager and staff had a good understanding of the MCA and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.
People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. People had access to activities. However, these could be improved.
People, their relatives and staff told us they felt Lake House was well run. The registered manager and management team promoted a positive, transparent and open culture. Staff told us they worked well as a team and felt valued. The provider had effective quality assurance systems in place which were used to drive improvement. The registered manager had a clear plan to develop and further improve the home. The home had established links with the local communities which allowed people to maintain their relationships.
There was a registered manager at Lake House. 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 found improvements were required in respect of ensuring a robust process was in place to check potential employee’s employment history. Where there were gaps, there was no explanation of these as required by legislation.
We also found that The Trust had not communicated effectively about prioritising actions following a fire risk assessment. This meant it was unclear which actions should be completed by to ensure people’s safety was optimised.
The provider’s quality assurance system had not identified these issues prior to the inspection and therefore remedial action had not taken place.
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Records relating to the administration of topical medicines were not always complete or accurate. We have made a recommendation about the management of some medicines.
People were supported in line with the principles of the Mental Capacity Act 2005 (MCA). Staff had completed training in MCA and understood the principles of the act. Staff understood how to apply the principles when supporting people who may be assessed as lacking capacity.
People felt safe and were supported by sufficient staff that had the skills and knowledge to meet their needs. People were positive about living in the service and about the caring nature of the management and staff.
Staff felt valued and were supported through regular supervision and team meetings. Staff had access to training to enable them to improve their skills and knowledge.
People and relatives were involved in decisions about people’s support needs. People had care plans which detailed the support they required and how the support would be provided. Care plans were regularly reviewed and updated.
Where required, people were referred to health and social care professionals. Where guidance was provided this was followed by staff who knew people well.
People enjoyed the food. People who had specific dietary requirements received food to ensure their needs were met.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the end of the full version of the report.
We inspected this service on 10 September 2015. This was an unannounced inspection. Lake House is registered to provide accommodation for up to 43 older people who require personal care. At the time of the inspection there were 37 people living at the service.
At a previous inspection of this service in April 2015 we found that appropriate arrangements were not always in place for managing medicines, there were not enough staff to meet people’s needs staff were not always adequately supported to deliver care to service users safely and to a sufficient standard. The service did not have effective systems in place to; assess, monitor and improve the quality and safety of the service provided to people.
Following the inspection in April 2015, we asked the provider to write to us to say what they would do to make improvements. We also issued the provider and registered manager with a warning notice stating the service must take action by 30 July 2015 to ensure there were enough staff to meet people’s needs in a timely way.
We undertook this inspection to check that the provider had followed their action plan and to confirm the service now met legal requirements. We found the provider had taken the actions and made the required improvements. However, we have asked the service to continue making improvements to the safe storage of medicines because thickening powder that was prescribed to be used as part of the treatment for people with swallowing problems was not stored in line with safe storage guidance.
The service had a new registered manager. ‘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.’ People, their relatives and staff were very complimentary about the new manager and the positive changes that had been made at the service.
People told us they were happy living at the service. People were cared for in a kind and respectful way. Staff engaged with people and offered support to promote people’s independence. Staff knew the people they cared for and what was important to them. People's choices and wishes were respected by care staff and recorded in their care records.
People had been involved in reviewing their care. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. People were assessed regularly and care plans were detailed. Staff followed guidance in care plans and risk assessments to ensure people were safe and their needs were met. Where required staff involved a range of other professionals in people’s care. Staff were quick to identify and alert other professionals when people’s needs changed.
People were supported to have their nutritional needs met. People liked the food, regular snacks and drinks were offered and mealtimes were relaxed and sociable.
People felt supported by competent staff. Staff were motivated to improve the quality of care provided to people and benefitted from regular supervision, team meetings and training in areas such as dementia awareness.
Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.
We inspected the service on 8 April 2015. This was an unannounced inspection. We previously inspected the service in January 2014. The service was meeting the requirements of the regulations at that time.
Lake House is registered to provide accommodation for up to 43 older people who require personal care. At the time of the inspection there were 38 people living at the service. The service was arranged into five units, each with their own dining and communal space. There was a large dining and lounge area in the centre of the service but this was undergoing redecoration and building work so was temporarily unavailable for people to use.
Prior to this inspection we had received concerns about how people’s needs were being met because of the levels of staffing. During the inspection we found there were not enough staff to meet people’s needs or to keep them safe. People told us there were not enough staff to meet their needs and the rotas showed that target levels of staff had not always been achieved. Staff were not always available to support people in communal areas and left the units unattended whilst they had a break or went to help on other units. Staffing issues also meant some people were rushed and not given time to make choices.
People were not always cared for by suitably skilled staff who had kept up to date with current best practice because not all staff had attended training or received adequate supervision and appraisal.
People felt safe and told us they liked living at the home. People were complimentary about the staff and felt staff did their best to support them in a friendly and caring way. People’s privacy and dignity was maintained during care tasks.
People were assessed regularly and care plans were detailed. Where required staff involved a range of other professionals in people’s care to ensure their needs were met. Staff were quick to identify and alert other professionals when people’s needs changed. Some records in relation to peoples care and treatment were not always accurate.
People did not always receive their medicines in line with their prescription and there were gaps and omissions in the recording of topical medicine administration.
The registered manager had left the service shortly before the 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. A registered manager was in the process of transferring from another of the provider’s locations and was spending one day a week at the service during the transition process. A peripatetic manager was covering the service in the interim. Some of the improvements needed to the service had been identified by the interim management team and there was a plan in place to address them.
Senior staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Staff knowledge in this area required improvement.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we took and what action we told the provider to take at the back of the full version of the report.
People were protected from the risk of choking. For example, we noted that all care workers had received training from Oxfordshire NHS Trust on swallowing difficulties and thickened fluids. One care worker told us, "we had training about thickened fluids; this has really helped us to understand how we need to prepare drinks and some foods". We noted that one person required a soft diet, as they had difficulty chewing food. We observed that this person was provided with an appropriate diet.
People were protected from the risk of pressure sores. For example, we looked at the care file for one person who was at risk of pressure sores on their heels. We noted that the person's care plan stated that district nurses and occupational therapists had been involved in assessing the person's needs.
People benefitted from meaningful engagement. We conducted a SOFI observation and saw that people were treated with warmth and respect. People who wished to remain in their rooms were also engaged by care workers.
People we spoke with told us they were involved in their care. One person told us, 'I'm asked if I want to do things'. Another person told us, 'I get plenty of choice'. One relative told us that they were involved in their relatives care.
People benefitted from engagement from care workers. We saw a care worker talking to a person. They ensured they were at eye level. The care worker talked to one person and encouraged and included another person in the conversation. Both people smiled and were happy talking to the care worker. People were not always protected from the risk of choking as professional guidance was not always followed.
People were given choice over their meals, and had access to a suitable amount of food and fluid.
We looked at the recruitment files of seven staff members. These files demonstrated that effective recruitment procedures were in place.
People and relatives we spoke with told us they felt able to raise concerns. One person told us, 'If I'm not happy, I can tell one of the girls'. Another relative told us, 'I've got no concerns. I can't fault it'. This meant that peoples and their relatives concerns were acknowledged and acted upon.