The inspection took place on 17June 2015 and was unannounced.
Lakeview has six units spread across the ground and first floors. The home offers care and nursing care, dementia care, and care for behaviours that challenge. The home can accommodate 151 people.
A manager was in post who was in the process of applying to become registered manager. 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.
People’s risks were assessed in a way that kept them safe from the risk of harm but these did not always reflect people’s current needs. There was not always enough staff around to ensure that people were supervised and/or that people’s needs were met.
Medication systems were in place to ensure that people received their medication safely. Some staff were unfamiliar with the computerised medication recording system.
People felt there was not always enough staff around who knew how to meet their needs. The provider was in the process of recruiting more staff to work at the home.
A staff training programme was in place to ensure that staff were trained to carry out their role and the provider had plans in place for updates and refresher training.
Staff were aware of their role in safeguarding procedures and told us they would report poor practice. Staff received training to ensure they could meet people’s needs including training in how to keep people safe.
The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. Not everyone who needed a mental capacity assessment had got this in place and staffs knowledge around MCA and DoLS was variable. This meant that decisions had been made for some people without gaining appropriate consent.
People were supported with their nutritional needs but it was not always clear if people had received enough to drink. Where people had significant weight loss referrals to healthcare professionals were not always made in a timely way.
People’s health care needs were monitored and where people were at risk of developing pressure ulcers there was a plan in place to minimise the risk. However where people were receiving treatment for pressure ulcers these had not always been consistently followed by nurses.
On Kendal and Keswick unit’s staff understood people’s needs. Care was delivered with a person centred approach. On another unit care was delivered in a more task driven way and people did not always receive care and support at the time and in the way they preferred it.
Some staff displayed a more caring and interactive approach with people than others. People’s dignity was not always promoted but people’s privacy was upheld and people were treated with respect.
There was an activities programme in place but people had limited opportunities to be involved in hobbies and interests that were important to them.
The provider had a complaints procedure available for people who used the service and complaints were appropriately managed. People who used the service and their families felt able to raise any concerns they might have with the manager or other staff members.
Not all staff felt that the atmosphere of the home was open and inclusive. Some staff felt that they were not always listened to. Where there was a unit manager in place (Kendal and Keswick) the unit ran more smoothly and people received more consistent care and support.
The registered manager had systems in place to monitor the service but this was not always effective in bringing about improvements. Recent user surveys highlighted a need for improvements in several areas. The manager and operations director were developing an action plan for this.