Lake View is a residential care home which provides personal care to a maximum of 29 older people, including those who may be living with dementia or who may have a learning disability. Lake View does not provide nursing care. People who live at Lake View access healthcare through local community health services.
At the time of the previous inspection two people living at the service were accommodated in a bungalow in the main house’s grounds. This bungalow was not being used at the time of this inspection and all of the 19 people currently living at the home were accommodated in the main house. All of the people living at the home were living with dementia or a learning disability and three people were being cared for in bed due to their frail health.
Lake View is owned by South West Care Homes Ltd, which operates 11 residential care homes in South West England.
There was 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.
The home was last inspected on 5 and 6 November 2014 and was rated as requiring improvement. We found improvements were needed in the way medicines were managed; how care planning, risks to people’s safety and mental capacity assessments were recorded; how infection control was managed; the training provided to staff; how the quality of the service was reviewed and how complaints were managed. We also found improvements were needed in relation the environment. Two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2010 were identified. The provider sent us an action plan telling us what they were going to do to meet the regulations and we found at this inspection that improvements had been made.
Prior to this inspection we received information that staff were not wearing protective aprons or gloves when assisting people with personal care or while serving meals, as well as there being insufficient soap available for hand washing. We had asked the registered manager to look into these issues and they provided us with a report of the actions they had taken. During the inspection we saw staff wearing aprons and gloves when assisting people and when serving meals. Toilets and bedrooms had sufficient hand washing soap and paper towels.
The registered manager said the home had sufficient staff to meet people’s daily care needs both during the day and night, and throughout the inspection we saw call bells were attended to promptly. People told us they received timely assistance during the mornings and when they rang their call bells. Staff told us they had time to meet people’s needs and were not under pressure to rush when assisting people with their personal care. However, staff did not have time to sit with people and engage them in conversation or support them with meaningful activities. Other than the planned activities for entertainers to come in to the home several days a week, staff confirmed they only had time to provide spontaneous short interactions such as painting someone’s nails. Also, it was not clear from people’s daily care notes whether staff had spent time with people who were being cared for in their room. The results of recent questionnaires and meetings indicated people felt more social activities were needed to provide meaningful occupation for people during the day.
The registered provider confirmed they had plans to increase the staffing in line with guidance from specialist dementia care organisations. Following the inspection, the registered manager confirmed they were recruiting an additional member of staff into a ‘social’ assistant role.
We found the home to be clean and generally odour free, however, some of the chairs in the lounge room did not appear clean and were stained with food debris. The carpets in the hallways and in some bedrooms were still to be replaced and this had been arranged for later in the year. The joins in some carpets had been temporarily repaired to reduce the risk of people tripping.
People and their relatives where appropriate, were involved in planning their care both prior to their admission to the home and throughout their stay, and we saw, some people’s involvement had been recorded at the time the plans were reviewed. However, for those people who were living with dementia and may not have been able to comment directly about the information in their plan, there was no evidence staff had explored whether they felt their needs were being met.
The care plans provided guidance for staff about people’s preferences in how their care needs should be met and what they were able to continue to do for themselves. The plans also provided information about how people wished to spend their time and the things that were important to them.
Those people who were able to express their views told us they felt safe at the home. They said the staff were always caring, friendly and respectful and they were being well cared for. One person told us “yes, it’s lovely” and another, “oh yes, I’m safe.” When asked what would make life better for them at Lake View, people said, “nothing, I have everything I need” and “I can’t think of anything, no I’m fine.” For those people who weren’t able to share their experiences with us, we saw them approaching staff and holding their hands, or smiling when staff approached them, indicating they felt safe in staff’s company. We saw staff treating people with kindness and patience. Staff no longer wore a uniform to remove a potential barrier to forming relationships with people.
The home was currently being redecorated and clear signage had been placed around the home indicating where the toilets and bathrooms were. A further smaller seating area with a television was being created in the hallway to promote interaction between people. The front door had been disguised as a book case and the registered manager confirmed this reduced the risk of people who may be unsafe to leave the home unsupervised using this door. At the previous inspection, people told us their belongings were not always safe and other people wandered into their room. We saw locks had been fitted to the bedroom doors providing privacy and security.
Risks to people’s welfare and safety had been assessed and management plans described how to reduce these, such as those associated with reduced mobility or with swallowing difficulties. People’s personal emergency evacuation plans had been updated since the previous inspection and now held more detailed information about how to protect people in the event of a fire. Medication practices were safe and people received their medicines as prescribed. People had regular access to healthcare professionals such as GPs, and staff were observant for changes in people’s usual self as an indication they may be unwell.
Staff recruitment processes were safe, with references from previous employers and police checks being carried out prior to staff starting to work at the home. Staff knew people well and told us they enjoyed working at the home and they were well supported by the registered manager. One staff member said, “I love my job. It’s a nice place to work” and another said, “we want people to feel happy and comfortable, to know they matter.”
Since that inspection, staff had received training in supporting people living with dementia, safeguarding people who may be vulnerable due to their poor physical or mental health and understanding the principles of the Mental Capacity Act 2005 (MCA). Throughout the inspection, we saw staff routinely ask people’s consent before staff assisting them. We heard them say, “can I help you with that?”, “have you finished, shall I take it” and “would you like to?” We saw some people were unable to make decisions over their care and required best interest decisions to be made for them by people who knew them well and healthcare professionals, where relevant. Records of these decisions were seen in people’s files, although some had not been fully completed. Authorisation had also been sought to legally deprive some people of their liberty as the home used a keypad lock on the front door to prevent people who would be at risk if they were to leave the home unsupervised.
People told us they enjoyed the food at the home. Comments included “the food is very nice” and “yes lovely”. We observed the lunchtime meal and saw some people could not remember the choice they had made the day before, and said they did not want the meal when it was presented to them. Staff provided them with the alternative, which they accepted. We discussed with the registered manager the way in which people who may have memory difficulties were supported to choose their meals. The registered manager agreed to change this. People would now be shown both choices at the time of the meal to allow them to choose which they preferred.
People, staff and social care professionals told us the home was well managed. People said they were listened to and felt able to discuss any issues of concern they may have with the staff and registered manager. Prior to the inspection, a number of social care professionals contacted us to inform us of the “excellent care work being carried out at Lakeview residential home.” The company’s philosophy is “to encourage and support our residents in making choices, in being independent.” The registered manager recognised there were improvements to be made at the home and said they were determined to “continually improve”. They had recently completed a Diploma in Health and Social Care at Level 5 and they regularly attended meetings with other care home managers in the local area where good practice and resources were shared.