The Lakes Care Centre

We found the following examples of good practice

¿ The home was observed to be clean and free of malodour. The home had designated cleaning staff who were observed cleaning the home throughout the inspection. There was a cleaning schedule in place to ensure that all areas of the home were adequately cleaned.

¿ The service had implemented personal protective equipment (PPE) stations which were situated in the reception area of the home near the main entrance and in several cupboards. When visitors came to the home, a designated member of staff supported the visitors to ensure they followed safe infection control processes, understood PPE guidance and to check whether they had any symptoms of coronavirus before entering the home. This included taking the visitor's temperature.

¿ The service was due to refurbish the home within the next week, to make ‘visiting pods’ available with Perspex screens to ensure visits were safe and followed policies and procedures.

¿ Where people were shielding or self-isolating, PPE stations were set up inside or just outside the individual bedrooms. Each station was equipped with all required PPE in line with government guidelines.

¿ All people being admitted to the home were tested for COVID-19 by the care staff on admission. People were asked to self-isolate in their bedrooms for 14 days following their admission into the home, even if a negative test was received. Staff were being tested weekly and residents monthly as per national guidance and in line with the governments 'whole home' testing approach. The unit not currently being used was prepared for any contingency around COVID-19 and for residents to isolate if and where appropriate.

¿ Individual risk assessments had been conducted on staff which identified any vulnerabilities they may have in relation to coronavirus and any mitigating action that the provider needed to implement. This included Black, Asian and Minority Ethnic (BAME) people.

¿ The service had appropriate infection control policies and procedures in place. These were developed in line with current government guidance. There was prominent signage around the home for staff and visitors on what measures were being taken to minimise the risk of spread of infection and keep themselves and those around them safe. These messages were also communicated through email and on the provider's website.

The Lakes Care Centre 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 home can accommodate 64 people across four separate units, each of which have separate adapted facilities. At the time of the inspection 23 people lived in two units (two further units were not yet used). The home specialises in meeting the needs of those who live with dementia but also meets people’s physical health needs.

Accommodation for people comprised of single bedrooms with private toilet and washing facilities. All bedrooms were provided with bedroom furniture, a window and heating. Each unit, called a household, had its own dining and kitchen area with communal lounges. Additional toilets and adapted bathrooms were also available on each unit. On the ground floor another communal area was used for activities. This was also the home’s in-house tea/coffee room.

There was not a registered manager in position. A newly appointed home manager was however in post and they had started the application process to be the registered manager of the home. 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 had lacked consistent management and effective leadership for some time. Challenges from this had arisen, which the new managers had a good understanding of and were addressing. At the time of this inspection the home was being well-led and strong leadership was being provided. On-going quality monitoring of the services provided was in place and from this identifiable improvements had already taken place. The new managers were in control of the service and a more robust management structure was emerging. Clear lines of delegation, responsibility and accountability were being established throughout the staff team. These improvements needed to be sustained for the rating of is the service well-led? and the overall rating of the service to alter from requires improvement to a rating of good.

Feedback had been previously given by relatives and staff regarding the issues arising from inconsistent management of the home. New managers had sought further feedback since being in post. They had taken this into consideration when making necessary changes to improve the service. A significant decision had been made by the provider to no longer admit people who had been assessed as requiring nursing care. This was so staff could ensure people’s needs were met. It was confirmed during the inspection that there was no one living at the home with nursing needs. A supportive approach was being taken by managers to help some staff adjust to the new ways of working. People spoken with [apart from one] told us the changes were making the home a better place to live in. All relatives spoken with told us they felt reassured by the new management arrangements and the changes managers were making.

People’s needs had been assessed before their admission to The Lakes Care Centre and subsequently. There were arrangements in place to keep people safe and to protect them from harm. For example, improvements had been made to how people’s medicines were managed and how people’s risks were assessed and managed. This had resulted in safer medicine administration practice and a subsequent reduction in medicine errors. It had also resulted in risks to people being correctly assessed and managed. People were protected from potential abuse because staff knew how to recognise this and report any concerns they may have. People were supported to maintain their nutritional well-being and the new chef was providing people with a good choice of food.

The principles of the Mental Capacity Act were being followed. People were supported to have maximum choice and control of their lives and where support was needed, this was in the least restrictive way possible. The policies and systems in the home supported this practice. Adaptations had been made to the environment, to support people’s mental and physical needs, and to help retain their independence.

Action was being taken to ensure all staff completed the provider’s necessary training and that they received the support they needed to ensure best practice. Some staff had acquired new roles and needed further professional development to fulfil these effectively. Despite some training having not been completed, staff did not lack knowledge and skills they needed to support people. Some alternative support had been provided to improve staff practice and further support and training was planned. Safe staffing numbers had been maintained by the new managers to ensure people received the care and attention they needed. Additional staff had been appropriately recruited and further staff recruitment was planned to support the home moving forward. There were on-going arrangements in place to keep the home clean and well maintained.

Care was provided in a kind and compassionate way. People and their relatives (where appropriate) were involved in planning the care delivered to them. Staff took into consideration their wishes and preferences and tailored people’s care around these. Staff showed an interest in supporting people to live well with dementia. This was particularly seen when supporting people to feel included and when helping them to take part in social activities. People’s dignity and privacy was upheld. Relatives and friends were made to feel welcome.

There were arrangements in place for people to raise complaints or areas of dissatisfaction. In the past some of these had not been satisfactorily resolved so new managers had focused on making sure these were resolved where at all possible. People’s end of life wishes were explored with them and there were staff, experienced in this care, to provide this when it was needed.