The Lakes Care Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 3 breaches of regulation in relation to how medicines were being managed; how risk was being managed and mitigated and lessons learnt; and the training and support staff received to ensure they were able to fulfil their role. People felt the service was generally safe, but records did not always reflect that safety was suitably mitigated and staff had all the training needed to provide safe care. Staff felt happy and supported in their roles. There had been several changes in management and at unit level, and in how the service operated. These changes had positively impacted on the safety of the service, but processes needed to be embedded into practice. The service mostly had safe systems for appropriate and safe handling of medicines. Medicines were stored safely. However, people’s transdermal patches for pain relief were not managed safely. All controlled drugs were accounted for but an error in the CD register had not been noticed when staff checked the stock. Records for some people who were prescribed medicines to be given only when required or disguised in food or a drink were insufficient to support staff to give these medicines safely.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt safe living at The Lakes Care Centre and their relatives were happy with the care people were receiving. However, suitable processes were not always followed meaning that people’s risk was not always effectively managed and mitigated.

Staff told us they felt confident on reporting accidents and incidents and were clear on the processes used. One member of staff told us, “We discuss incidents in handovers with staff or speak one to one with staff if needed.” The manager told us they reviewed incidents to check that suitable action had been taken. However, documentation did not always reflect this was being completed effectively.

Processes in place were not being utilised to analysis accidents and incidents for themes and trends and ensure lessons were learnt. A monthly log sheet of accidents and incidents was in place but was not being fully completed. Oversight following incidents was in place from both senior care staff and the manager. However, actions had not been followed up to ensure people had suitable risk assessments and care plans in place. Following an incident, we found one person who’s care plans and risk assessments had not been updated to guide staff on how to mitigate the risk for them.

People told us they felt safe, and their needs were managed suitably from admission. One relative told us, “They came to speak to [family member] and me at the hospital. Staff were aware of [their] needs when [they] moved in.” However, another relative noted that information had not been shared about a risk from the hospital and the person had a similar incident following admission. Aspects of communication needed to improve to ensure assessments were comprehensive and risk assessment and care plans implemented in a timely way to ensure people received a safe transition into the service.

Staff told us they had access to information about people’s needs through care plans and information shared during handover meetings. However, staff told us there had been some challenges with the information shared by other services as part of the transition between services with some information not being disclosed or accurate. This made it difficult for the service to ensure suitable care plans were implemented. We found an instances where risks found following admission had still not resulted in care plans being implemented in a timely way.

Partner organisations gave mixed feedback about how the service worked to ensure smooth transition between services. One professional commented that assessments were not always as effective and robust as needed, and another professional commented that information had not always been shared in a timely way. However, partner agencies felt that relations with the staff team and manager were improving.

Processes were followed to ensure people’s needs were assessed and people and families were involved in this process. This information was used to develop care plans and assess risk. However, not everyone had these risk assessments and care plans implemented in a timely way in line with the provider’s policies. This meant that action to manage and mitigate risk and meet people’s needs was not always taken and staff did not always have access to accurate information and guidance on how to manage people’s needs.

People and relatives spoke positively about the service and felt confident that people were kept safe. One relative said, “The staff are very friendly, and I feel comfortable that she, and the others, are being looked after.” We observed staff were readily available to meet people’s needs. Although there were no current concerns, since the provider has taken over the service there have been several safeguardings and concerns about the care people have received, meaning that people’s experience of being safeguarded was not always been positive and people had not always had their care needs met in a timely way.

Staff understood their responsibilities to keep people safe and felt confident about how to report abuse and that action would be taken. The manager told us they worked with the local safeguarding team to investigate concerns. Staff understood the principles of the mental capacity act. One member of staff said, “If someone’s got capacity they can refuse support, we won’t force them. We try to prompt and encourage people, give them reasons why they should have the support and they then often say okay.” People’s capacity was assessed and where people lacked capacity best interest decisions were made involving relevant people to ensure people were not unnecessarily restricted when protecting them from risk of harm.

We observed staff were responsive to people's needs and safe practices, such as moving and handling were used.

Suitable processes were in place to safeguard people including oversight of people’s mental capacity and any deprivation of liberties safeguards (DoLS) applied for and granted. However, it was not clear that statutory notifications were being submitted in relation to authorisations of DoLS and allegations of abuse. The manager worked with the local authority to investigate any safeguarding concerns.

People felt safe and relatives told us they were involved in discussions about people’s needs and the management of risk. One relative told us, “We have meetings as and when [family member’s] needs change.” However, care plans were not always clear and detailed to ensure that people’s risk was mitigated and managed as much as possible.

Staff understood people’s needs and risk and told us this information was readily available with the electronic care planning system and shared as part of handover meetings. The manager acknowledged care plans were brief and needed more detail. We were told training was being arranged to support staff in effective care planning.

Staff were consistently available to support people in communal areas.

People’s risk was not always well managed. Where risk had changed, an update was added to care records. However, care plans were not rewritten to ensure staff were clear on action needed to meet the person’s changing needs. The summary of care needs was not always updated to reflect a person’s change of needs making it difficult for staff to readily find the accurate information about people’s current needs and support plan.

People spoke positively about the environment. Relatives told us the service was uncluttered and safe and any requests for things in people’s bedrooms, such as repairs, were addressed quickly.

Staff told us they knew how to report any environmental concerns. A programme of redecoration was in place.

The environment was tidy and clear of trip hazards. Measures to reduce risk for people, such as coverings for radiators were in place, and suitable equipment for moving and handling was available and being used appropriately.

Suitable processes to ensure the environment was safe were being completed. We noted improvements since our last visit to the service, under the previous provider. A range of weekly and monthly checks were in place including for the fire alarm, fire doors, water temperatures, wheelchairs, and window locks. Equipment was serviced in line with legal requirements, for example lifts, hoists, gas safety and electrical system.

People and relatives felt there were enough staff to meet people’s needs and spoke positively about the staff team. One relative commented, “[Staff] work well as a team and know what they are doing.” However, people may not always have been supported by staff who were suitably trained as there were a number of shortfalls in the training completed.

Staff said there were enough staff to meet the current people’s needs. They felt supported in their roles and told us training had improved since the new providers had taken over the home. Staff were encouraged to completed additional training including national vocational qualifications (NVQ) to develop in their roles. The local authority was supporting the service with delivering training including around pressure care and continence and had further training arranged. Staff fed back that the morale in the service had improved with one staff member commenting, “The staff I work with now know what it takes to be a carer and what to do at the appropriate time. Colleagues are now welcoming so it makes the job easier.” However, we found shortfalls in the training records and limited oversight in this area.

During the days of site visit enough staff were noted and people’s needs were being met in a timely way. Staff were consistently available within communal areas to attend to people’s needs.

Staff were not consistently receiving sufficient training and support in their role. The were shortfalls in the training records, particular for care staff in areas relevant to their roles such as dementia care, falls awareness, end of life care, safeguarding and infection prevention and control. The systems in place for oversight was not effective to allow for easy identification of gaps in training. Not all staff had received regular supervision and there were no clear systems of oversight of supervision to ensure staff were suitably supported. Staff were safely recruited, with all employment checks completed prior to starting work. Staff completed an induction when they started and were enrolled on the care certificate.

The home was clean and tidy and feedback and relatives told us the home was always kept clean and tidy.

The housekeeper worked across the units to keep the service clean. The manager told us they were completing daily checks of the housekeeping audits.

We observed the home was visibly clean. There were areas of the home which were tired and would benefit from redecoration to enable good infection prevention and control.

Suitable systems for record keeping and checks of good infection prevention and control were in place. The head housekeeper completed monthly audits, and daily checks of the environment were completed by the management team. However, feedback from partner agencies suggested that concerns in relation to outbreaks of infection were not always escalated in a timely manner but that the action plan was progressing to ensure good infection prevention measures were being adhered to and improvements were noted.

Relatives said medicines were administered safely and as prescribed. One relative told us, “I had queries around the medicines [family member] is on. Staff went through what medicines [they] take, why / what they were for and why a decision had been taken to change [their] medicines.” Another relative told us, “[family member] wasn’t taking [their] medicines at home. I know [they are] getting them now.” We observed people were given their medicines in a safe, kind and patient way and at the correct time. However, robust processes to ensure certain medicines, such a patches applied to the skin, and medicine people may take covertly, hidden in food or drink, were not always in place to ensure people were protected from potential risk associated with the administration of these types of medicine.

Staff were aware improvements were needed to how medicines were managed and training was being rolled out to by the local authority to support staff. Staff told us there had been a recent change in the pharmacist used and this had worked well.

Medicines were not always being safely administered. Buprenorphine transdermal patches were not managed safely. There were no records to protect people’s skin from harm by ensuring the site of application of the patch was rotated. Records for people who received medicines covertly, including guidance from a pharmacist on disguising each medicine safely, were insufficient. The medicines policy needed updating. Medicines were suitable stored and checks of medicine administration records (MAR) were being completed, thickening powders and creams were managed safely. Medicines that needed to be given at exact times of day to be fully effective were given at the right time.