Archived: Lake View Nursing Home

We carried out an unannounced inspection on the 2nd October 2014. We did this to check whether the provider had met the requirement of the breaches in relation to regulations 9, 10, 13, 15, 18, 22 and 20. We found evidence of ongoing concerns and furthers breaches in regulations.

The service did not have a registered manager in post on the day of our inspection. The previous manager left their post in March 2014 and there had been several changes of the management team in the home since March. There was an interim manager in day to day charge of the home who had been in post for 12 weeks. 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 and associated Regulations about how the service is run.

Lake View Nursing Home is registered to provide care for up to 51 people. At the time of our inspection there were 31 people living in the home. The home was providing nursing and personal care for people, including those living with a dementia.

Prior to this inspection we had previously visited the home on 12th and 13th March 2014 and identified breaches of regulations 9, 10, 13, 15, 22 and 20. We asked the provider to send us an action plan in relation to regulations 9, 13, 22 and 20 to tell us how and when they would ensure they met their regulatory requirements.  We issued the provider with a warning notice for regulations 10 and 15 and told the provider by what date they needed to meet their regulatory requirements.

We revisited the home on 6th June 2014 to check whether the provider had met the requirements of the warning notice. However we identified ongoing concerns with regulations 10 and 15 and identified further concerns in relation to regulation 18.

During this inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

During our inspection we found there were some improvements in relation to regulation 9; for example we spoke with people who used the service and their family about the care they received in the home. We received some positive feedback about the care provided by staff employed by the provider. However people were not as confident about the use of agency staff providing care for them.

There was a lack of provision for people in relation to their personal care needs in the home. For example there was no provision for people to have access to a bath on one of the floors due to the ongoing refurbishment work and one person told us they had not had a bath for some time.

We saw copies of notifications that had been sent to CQC in relation to allegations of abuse but could see no evidence of the investigation that had taken place. We were made aware of a concern raised by a relative of one person in the home. We discussed these concerns with the regional manager during a feedback session who told us they had not been made aware of these concerns and confirmed they would investigate them.

During our inspection we found some improvements had been made in relation to the administration of medicines. We found medicine administration records (MAR) documented when a medicine was given and we saw completed records detailed the reason why a medication had not been given. Medicines were stored in a lockable trolley. However we saw the medication trolley had been left unattended on two occasions during our inspection and we noted one occasion a medication liquid was left on top of the trolley and we saw evidence that the recording of the fridge temperature identified abnormal readings that had not been reported to the interim manager.  This meant the provider did not protect people who used the service against the risk associated with the unsafe use and management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection on we looked at how people who used the service were supported with their nutritional needs in the home. Staff were seen engaging well with people who used the service; we noted positive eye contact and communication as well as staff assisting people with their dietary needs. Staff were observed offering a choice of meals including alternatives to the menu. However we noted some concerns; these included a lack of consistency when staff completed nutritional monitoring records We also observed inaccurate recording of the intake of food and fluids for one person who used the service.  We spoke with the interim manager about this who commenced an investigation. People told us the meals were poor when the chef was not in.

During our inspection we found there were some improvements to the premises including the refurbishment and redecoration of some areas of the home. However we observed there were significant health and safety risks which had not been appropriately managed during this process of refurbishment. We noted there was also a lack of pictorial signage to aid people with orientation in the home.

During our inspection we could not see evidence that people living in the home or their family had been consistently involved in decisions relating to their care. However a relative of one person we spoke with confirmed they had discussed the care of their relative with the staff. There was a breach of regulation 17of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because the provider did not have suitable arrangements to ensure people who used the service were enabled to make, or participate in in making decisions relating to their care or treatment.

We looked at how the provider dealt with notifications to the Care Quality Commission (CQC). We noted there was some evidence of notification being sent to us in relation to serious injuries, allegations of abuse and deaths, as required by law.  However we found the manager had failed to notify CQC of to two authorisations under the Deprivation of Liberty Safeguards and three falls which resulted in people being admitted to hospital.

We looked at how the provider dealt with complaints. We saw there was a complaints file in place. There was evidence of the complaints received by the provider and actions that had been taken to resolve these.  We discussed a complaint that we had been made aware of with the manager and regional manager. They told us they had been made aware of the complaint and taken actions relating to this but the details had not been recorded. We were told complaints were discussed at staff meetings; however we noted in records relating to a recent staff meeting that the topic of complaints was not documented. Staff had access to a copy of the complaints policy for them to follow and staff we spoke with told us were they were aware of the policy; however we noted the date for review of this policy was four months prior to our visit.   

We looked at how the provider monitored the quality of service provision and saw some evidence of checks and audits taking place, however there were some concerns that these audits were not always being fully completed and one audit had last been completed in 2013.

During our inspection we looked at the care files for six people who used the service; these were kept securely in the home.  We saw each person had an individual care file in place; however they lacked accuracy, consistency in their chronology, were brief and difficult to navigate. We saw reviews of care plans were taking place however we noted there were inconsistencies in the documentation relating to their completion. For example we saw a monthly support plan evaluation form that had been commenced recently but it not been completed in full.

During our inspection we looked at staffing numbers in the home. We were told recruitment was ongoing in the home and staff we spoke with confirmed appropriate recruitment systems when they joined the service.

We found ongoing concerns regarding the number of staff available to meet people’s needs, for example we saw evidence of cover for catering duties noted on some days; however on other days we noted gaps in the duty rota where no staff member had been allocated to cover catering duties. People who used the service were at risk of inadequate provision to provide their meals because there was no evidence of allocated staff to cover catering duties.  

There was very little evidence of meaningful activities taking place in the home and records relating to activities had not been completed for some time. Staff told us they didn’t have time for activities. Relative and people who used the service we spoke with told us activities were lacking in the home and there was also a lack of staff.

A dependency assessment tool was used to identify approximate numbers of staff were in place to care for people’s individual needs; however we noted this did not take account of people who were receiving one to one supervision and the tool had not been completed for three weeks. Staffing rotas were difficult to follow and it was difficult to identify staffing cover. Details relating to the training and details for agency staff was in place however, we could find evidence of checks on some of the staff who were identified on the staffing rota.