Lakeside View Nursing Home

We found the following examples of good practice.

The home facilitated face to face visits, in line with government guidance. Revised guidance on visiting had recently been introduced at the time of our inspection and the registered manager had updated policies to implement the changes.

The home had a designated visiting area which had its own entrance, which helped keep people safe by minimising traffic within the home. Alternatives to in-person visitation, such as virtual visits, were also supported.

A ‘booking in’ procedure was in place for visitors to the home including a health questionnaire and evidence of a negative lateral flow test. This helped prevent visitors spreading infection on entering the premises. We spoke to two visitors with essential care givers status who told us they felt safe when conducting visits, and were kept fully updated by the home with any changes.

People and staff were tested regularly for COVID-19. Staff employed at the home had been vaccinated, to help keep people safe from the risk of infection. Some staff had received their COVID-19 booster vaccinations.

Infection control policies and procedures helped ensure that the home adopted best practice which complied with current guidance.

The home was clean and hygienic. Some areas of the home were in the process of being renovated and there were plans to redecorate the main lounge.

Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection. During times of a COVID-19 outbreak, the layout of the home meant any people who were COVID-19 positive could be cared for separately from those with a negative status.

Staff were trained and competent in infection prevention and control best practices and how to put on and take off PPE. The home had adequate supplies of appropriate PPE. Staff had a designated area of the home where they could change into their uniforms and put on PPE before each shift. Additional uniforms for staff had also been provided.

The registered manager maintained links with external health professionals to enable people to receive the care and intervention they needed. Virtual consultations took place as and when necessary.

We found the following examples of good practice:

• Staff donned, doffed and disposed of personal protective equipment (PPE) safely and in line with the relevant guidance. Throughout our inspection staff were wearing the required levels of PPE and maintaining social distancing as much as possible.

• Visiting was suspended at the time of this inspection but a designated room with appropriate infection prevention and control measures had been set up enabling safe visiting. Relatives were also supported to safely visit their loved ones in exceptional circumstances, such as when people were receiving end of life care.

• Staff and people living at the home were tested regularly for COVID-19.

• Staff at the home had used the layout of the building effectively to implement isolation, grouping of staff and people living at the home and zoning when necessary minimising the risk of transmission of infection in the home.

• Staff had made changes to the layout of the communal areas in the home to support social distancing and ensure people were as safe as possible when using these areas.

• The provider had arranged additional staffing support, when necessary, to assist people when they had to isolate.

• The home was clean and hygienic. Frequent cleaning was carried out throughout the day ensuring good standards of hygiene and cleanliness were maintained.

Lakeside View is a care home. The home is registered to provide personal and nursing care for a maximum of 45 people. At the time of this inspection 35 people were receiving care at the home.

People’s experience of using this service

Improvements had been made in accordance with the provider’s action plan and the breach of regulation found at the last inspection had been met. Risk in relation to; the administration of medicines, management of the environment and completion of records had been reduced. Staff understood their responsibility to report abuse and neglect. Staff were recruited safely and deployed in sufficient numbers to provide safe, effective care. Lakeside View was bright, homely and clean.

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.

Quality and safety audits had improved since the last inspection and were effective in identifying issues and reducing risk. The registered manager and provider completed regular safety and quality audits. The manager and the staff that we spoke with demonstrated their commitment to providing high-quality, person-centred care. This commitment was reflected in records and in their interactions with people. People living at Lakeside View, relatives and staff were informed of any changes and encouraged to contribute to discussions.

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 June 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lakeside View Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People’s experience of using this service: People were placed at risk of avoidable harm because records relating to their care were not completed correctly. There was additional risk because the safety of the physical environment was not well-managed. The procedure for ordering medicines was not robust. This demonstrated a breach of regulation.

There was an over-reliance on the presence of senior staff to ensure that important tasks were completed as required. The registered manager and provider completed regular safety and quality audits, but these processes had not always been effective in identifying risks and errors. We made a recommendation about this.

Staff were aware of the relevant standards and guidance and used this effectively to assess people’s needs and plan their care. Relatives were involved in discussions about people’s care and their outcomes were good. One relative told us, “(I’m) very involved. They always tell me what’s going on.”

Safe recruitment practices were used and staff were deployed in sufficient numbers to provide safe care.

Staff told us that they felt well supported. Records indicated that staff received regular group and individual supervision. However, some nursing staff had not received a formal supervision recently.

We received positive feedback regarding the quality of the food available. The home employed a hostess who served the meals and drinks. Care staff provided support for people to eat their meals as required.

Staff were aware of people’s individual healthcare needs and were able to explain how they met these needs through the provision of care and support.

The original design and configuration of the building made it difficult to navigate and adapt to meet the needs of people living with dementia. People’s bedrooms were spacious and individually decorated. Communal areas were free from unnecessary clutter and made effective use of signage.

The service operated in accordance with best-practice and the principles of the Mental Capacity Act (2005).

The people that we spoke with were very complimentary regarding the caring nature and approach of staff. We saw a number of examples where staff spoke to people with kindness and respect throughout the inspection.

People living at Lakeside View were supported to practice their faith. Staff were clear about their responsibilities in relation to equality and diversity.

We saw clear evidence that people’s individual needs and preferences were consistently considered as part of the care planning process. We also saw that needs and preferences were reflected in the way care was provided.

People were involved in planning individual and small group activities. Important information was made available in a range of accessible formats to help people understand and to promote their involvement.

There were a small number of complaints received in the previous 12 months. Each complaint had been addressed in accordance with good practice and the provider’s policy.

The managers and the staff that we spoke with demonstrated their commitment to providing high-quality, person-centred care. This commitment was reflected in records and in their interactions with people. They demonstrated an understanding of their responsibilities in relation to the people living at Lakeside View and the need to act with honesty and integrity.

Rating at last inspection: Lakeside View was rated Good at our last inspection.

Why we inspected: This comprehensive inspection was brought forward after we received information of concern in relation to people’s safety.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re inspect in line with our inspection timescales for Requires Improvement services.

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

Lakeside View is a care home located in a residential area of Southport, near to the town centre. The aim of the service is to provide nursing care for people who are living with dementia and enduring mental health needs. All floors are accessed by a passenger lift and on the mezzanine level there is a stair lift. There is car parking space to the front of the home and a terraced garden.

The service had a newly appointed 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 HSCA and associated regulations about how the service is run.

When looking round the home we saw there were some adaptions to promote an environment suitable for people with dementia.

We recommend however that further consideration needs to be given to further developing the environment in accordance with ‘best dementia practice’ to support people’s physical/ emotional wellbeing and promote their independence.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 (MCA) were followed, in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. Applications were monitored by the registered manager.

The staff we spoke with described how they would recognise abuse. Staff received safeguarding training and understood their responsibilities to report any concerns.

Staff were recruited safely, with appropriate background checks to ensure people who were barred from working with vulnerable people were not employed.

Staff were present in sufficient numbers to enable people's care and support to be provided in a timely manner. Appropriate intervention was provided by the staff when people needed support. Changes were, however being made regarding the deployment of staff to ensure more staff were available in the lounges/dining room as key times.

People had a plan of care which recorded their care and support needs. Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst minimising risks to their safety.

We saw relative involvement with the plan of care and care documents were kept up to date through regular care reviews.

Appropriate referrals were made to external health professionals for advice and support to ensure people’s health and wellbeing.

There were systems in place to make sure medicines were given safely in the home. Management undertook checks of records to ensure medicines were managed safely.

A varied programme of social activities was offered to people living at the home based on individual need and preference. This helped to promote people’s social independence.

Staff received an induction and worked with more experienced staff. Staff received training and support to ensure they had the skills and knowledge to undertake their job role effectively.

Staff were polite, patient and caring in their approach. Staff had a good knowledge of people’s care needs and how they wished to be supported.

People’s nutritional needs were managed in accordance with their dietary requirements. People were offered a good choice of hot and cold meals and drinks.

Risks within the environment were assessed to help maintain a safe environment for people to live in.

We found the home clean on our inspection though following our visit concerns were raised regarding some cleanliness issues and the provider will be providing a written response.

A complaints procedure was in place and relatives we spoke with were aware of how they could complain. We saw that a record was made of any complaints and these had been responded to.

Quality assurance systems and processes were in place to help assure the service. This included a number of audits and also obtaining feedback from people who used the service and their relatives. This was obtained via daily discussions, meetings and surveys. We saw some actions were taken to improve practice and to drive forward improvements.