Lakeview Rest Homes

We found the following examples of good practice.

• Visiting at Lakeview Rest Homes was restricted. Visitors were required to follow best practice guidance and wear appropriate personal protective equipment (PPE). Their visiting policy and restrictions had been discussed with people, their families and friends.

• New admissions and people who had returned from hospital were risk assessed and their immediate care and support followed government guidance. This included people having to isolate in their bedrooms.

• Testing for Covid-19 for people and staff had occurred and was ongoing on a regular basis. The registered manager had ensured people who had tested positive were quarantined and cared for in their bedrooms.

• Processes were in place for staff to put on, take off and dispose of PPE when entering and leaving higher risk environments. Additional PPE measures were in place when supporting people who had tested positive for Covid-19. We observed staff wearing PPE appropriately.

• Staff said the registered manager was very aware of what precautions needed to be in place and felt everything was in place to keep them safe. We saw up to date infection prevention policy, covid risk assessments and a business continuity plan. We observed the home looked clean and hygienic.

• People received support to maintain their relationships with their families and friends. This was achieved through telephone and video calls. The provider was in the process of building a visitors pod in the garden to allow face to face visits to take place.

Further information is in the detailed findings below.

Lakeview is registered to provide personal care for up to 28 people. Accommodation is accessible by a lift between the floors. There are two lounges, a large dining room and a garden for people to use. At the time of the inspection there were 20 people living at the home.

People’s experience of using this service and what we found

People were protected from the risk of abuse and harm by staff who understood how to recognise and respond to any concerns. Staff continued to be recruited safely. In addition, people told us sufficient staff were available to support people who lived with dementia. Medicines were managed safely and administered by staff who received training. Infection control systems and audits continued to ensure a clean environment and reduce any risks to people.

The manager ensured staff received training that met their needs and supported people. People received support with their healthcare needs promptly. Comments about meal provision and quality of food were all positive. For example, one person said, “Yes good cooks make sure the food is very good.” People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us how staff were kind, caring and treated them well. A relative said, “We have never known such caring people they could not have looked after [relative] any better.” Information about local advocacy services was available, to ensure people could access support to express their views if required.

People's communication needs had been assessed so staff were aware how to understand and talk with them. Activities were provided daily they included regular trips out and entertainers visiting the home.

The manager and organisation were clear about their roles and provided care which resulted in good outcomes for people. They worked in partnership with a variety of agencies to ensure people’s health and social needs were met. The manager used a variety of methods to assess and monitor the quality of the service. This ensured they continued to be monitored and improve.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rating for this service was good (published 30 March 2017)

Why we inspected

This was a planned inspection based on the previous rating

Follow up:

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

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 coming events, entertainers and trips out.

The registered manager guided staff to support people in line with their requirements and wishes. Care records we looked at were personalised and contained detailed life histories of each person who lived at Lakeview. Documentation was reviewed and updated with people and their families where applicable. This ensured responsive care planning matched their ongoing needs.

Lakeview had a complaints procedure which was made available to people on their admission to the home and their relatives. No complaints had been received. However people who lived at the home and relatives we spoke with were aware of the process to follow should they have any concerns.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits and surveys sent to relatives/residents. Also we looked at staff and ‘resident’ meetings minutes. These were held to seek their views about the service and improvements that were suggested to ensure the home continued to develop.

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 for the provider to ensure that people living in the home were involved with the collection of this information. We recommended if the person had capacity the home ensured they have given their consent to involve their family member

We found the home was meeting the requirements of most of the regulations including providing support to people that meet their needs. We found people were confident they could influence their care and support and were offered frequent opportunities to maintain their personal care needs. We also found people in the home were supported effectively with their hydration and nutrition with extra support being provided as required. People we spoke with were happy with the food quality and choice.

People were asked for their opinion on the service they received and we saw the provider took action to improve situations when people were not happy or made complaints. Predominantly people thanked the provider and the staff in the home for the care and support they provided and we saw recent notes and cards of appreciation.

Peoples’ needs were effectively assessed and risks to the care and welfare of people were managed ensuring people were safe. Staff at the home were recruited equitably and were supported well once in post. Staff were happy in their role and enjoyed their job.

Staff were well trained and understood how to keep people safe. Assessments were completed on the needs of people and these were reviewed. The home needed to ensure they were reviewed at point of change but we saw that people received the support required, as it was required, ensuring they were kept safe and their health and wellbeing was supported.

People’s medicines were well managed and people received their medicine as and when it was required. Medicines and other care was delivered in a way people wanted it to be delivered. This included how they liked to take their medicine and how and when they liked to sleep.

We were told and we saw that people had lots to do. This included activities arranged both in and out of the home. People enjoyed trips to the local pub for lunch and enjoyed playing board games and carpet skittles in the home. People also had access to individual activities including knitting and daily papers.

You can see what action we told the provider to take at the back of the full version of the report.

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 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.