Inspection on 03/03/09 for Lakeside Residential Home

This inspection was carried out on 3rd March 2009.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lakeside Residential Home 03/12/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lakeside Residential Home Smithybridge Road Littleborough Lancashire OL15 0DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lakeside Residential Home Smithybridge Road Littleborough Lancashire OL15 0DB 01706377766 01706370347 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Eldercare (Lancs) Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following categories of service only: Care home only - Code PC To people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is 40. Date of last inspection Brief description of the care home Lakeside is a purpose built care home for 40 older people. It is located on Smithybridge Rd, leading towards Hollingworth Lake (a popular country park). The home is on two floors, both of which are serviced by a passenger lift. The accommodation is predominately single bedrooms (eight of which are en-suite), although a small number of double bedrooms are provided. There are adequate aids and adaptations provided, promoting the independence of residents. A car park is available to the rear of the home. A sitting-out area for residents is also provided to the rear of the home with level access for people using wheelchairs. At the time of our visit to this service charges ranged from 347:00GBP to 400:00GBP. Additional charges were made for private chiropody and hairdressing. The provider makes information Care Homes for Older People Page 4 of 31 Brief description of the care home about the service available upon request in the form of a Service User Guide/Statement of Purpose, which is given to new residents Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inpection to this service took place on 14th January 2008. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. The site visit to Lakeside formed part of the inspection process and was conducted over one day in March 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private Care Homes for Older People Page 6 of 31 accommodation was viewed and all communal areas were seen. Comment cards were received from one person who was living at the home and six staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at Lakeside. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Commission for Social Care Inspection had received two complaints about this service since the last inspection in relation to moving and handling practices and protection issues. Both these complaints were referred as safeguarding alerts to social services. What the care home does well: Good information was gathered before people were admitted to the home so that staff were provided with a clear picture of individual needs to ensure that they were confident that the care and support required could be delivered. The plans of care provided staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. A variety of external professionals had been involved in the care of people living at Lakeside to ensure that their health care needs were being appropriately met. The routines of the home were very flexible and activities were arranged within the home for those who wished to participate. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they so wish. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was adequate and those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how they could make a complaint should they so wish. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was tastefully furnished and pleasantly decorated to a high standard and the premises, both internally and externally were well maintained providing those living at Lakeside with a safe, clean, comfortable and homely environment. Effective infection control measures were in place to ensure that the health and safety of people was adequately protected. Staff were well trained to provide the care and support which people needed and over half of the care staff had achieved a recognised qualification in care, which was pleasing to note. The health, safety and welfare of residents was protected by the policies, procedures and practices of the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. When asked what the home does well one staff member wrote on the comment card, Lakeside gives good practical care. It offers good training opportunities relevant to our jobs giving good support to all our clients and provides good homemade meals and another commented, The home always works well with the residents by understanding Care Homes for Older People Page 8 of 31 them. The home is always clean. When asked if there was anything else staff would like to tell us one person wrote on the comment card, the home is making improvements. Our managers are helping us to get back on track. We are getting more staff and the home is getting much better and another simply commented, I like working here. I like my job. What has improved since the last inspection? What they could do better: The carpet in the ground floor corridor was in need of replacing to ensure that people living at the home and those working there do not trip and injure themselves. The recruitment practices could have been better by ensuring that all required checks were undertaken before new staff started working at the home, including Criminal Record Bureau disclosures so that the home was sure that people living there were protected. Written references should be dated and retained in the home to ensure that robust recruitment practices are adopted by the home. Staffing levels could have been calculated in accordance with the assessed needs of people living at the home so that during busier periods additional staff were deployed and as the dependency levels of people fluctuate the staffing levels could be adjusted accordingly. The manager of the home had not submitted an application for registration to the Commission. This needs to be done as a matter of urgency as the home has been without a registered manager for some time. Care Homes for Older People Page 9 of 31 People living at the home could be supported to maintain community contact by arranging for them to go out on trips of their choice to places of interest during the warmer weather. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are thoroughly assessed before they are admitted to the home to ensure that the staff team can deliver the appropriate care. Evidence: The service users guide had been updated since the last inspection and a copy of the homes terms and conditions of residence was included so that people could read them before making a decision to live at the home. We tracked the care of three people living at the home during our visit to this service. Very detailed and person centered information had been gathered from a variety of sources about peoples needs before they were admitted to the home. This enabled the staff team to be sure that they could provide the care and support required by each person moving in to Lakeside. Care Homes for Older People Page 12 of 31 Evidence: The plans of care had been generated from the information obtained before people were admitted to the home so that staff were fully aware of peoples individual assessed needs. We received a comment card from one person who was using the service who said that they had received enough information about Lakeside before they moved in so that they could decide if it was the right place for them to live. Two people living at Lakeside told us that someone from the home went to visit them before they were admitted so that their needs could be fully assessed. When asked what the service does well, the regional manager told us, all residents receive a full and comprehensive assessment before admission, taking the social workers assessment into account. The relatives and prospective residents, where able, are encouraged to visit the home at any time before making a decision. They are encouraged to ask questions and to see how the home is functioning on a day to day basis. Appointments are not necessary and people are encouraged to visit unannounced if they wish to do so. All admitted residents receive terms and conditions and service user guides with the company statement of purpose. This is also available for prospective residents to read to enable them to make an informed choice in selecting their home. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was good. Evidence: The plans of care were person centered and well written documents, providing staff with clear guidance about how the assessed needs of people were to be met. Those living at the home had been involved in planning their own care and detailed evaluations had been conducted at least every month, which reflected any changes in needs well so that staff were kept up to date with the care and support needed by those living at the home. Specific policies were in place at the home in relation to the care planning process so that staff were aware of the correct procedures to follow when developing the plans of care. Two relatives spoken to told us that the needs of people living at Lakeside were always met and that the care provided was very good. One of these people said, this home is about as good as you will get and the other commented, Lakeside is second Care Homes for Older People Page 14 of 31 Evidence: to none. The privacy and dignity of people living at the home was consistently respected. Staff were seen knocking on bedroom doors before they entered and we heard them speaking to people in a respectful and very caring manner. Discussions took place with six people living at the home who all said that the staff at Lakeside treated them well and that their privacy and dignity was always maintained. A good percentage of staff members had enrolled on the dignity in care training programme so that they were fully aware of how to support people to protect their privacy and dignity. Policies and procedures were in place in relation to respecting people who lived at the home and the induction programmes for new staff included the importance of protecting peoples privacy and dignity. Several staff members had been designated as dignity champions to ensure that the privacy and dignity of people living at Lakeside was consistently maintained, which was considered to be very good practice. Two relatives spoken to said that people living at the home were treated with respect. One of these people said, the staff are all marvelous. They really are very kind. The management of medications was good. Records were appropriately maintained and there were relevant policies in place at the home so that staff were aware of the correct procedures to follow in relation to the safe administration and storage of medications. Staff who were responsible for giving out medications had received training so that they could safely administer the medications. Records showed that a wide range of external professionals were involved in the care of people living at the home to ensure that their health care needs were being fully met. At the time of our visit we heard the person in charge of the home requesting a District Nurse visit for one person who required some nursing intervention showing that peoples nursing needs were addressed. A wide range of assessments had been conducted to ensure that peoples pressure, nutritional and continence care needs were being appropriately met and strategies were in place so that any potential risks were eliminated or minimised. Specialised equipment had been provided for those assessed as being at risk of developing pressure wounds to ensure that appropriate pressure relief was provided. The regional manager told us on the homes self assessment what the service does well and gave some good examples of how this was achieved. Care Homes for Older People Page 15 of 31 Evidence: Comment cards were received from six members of staff who felt that, in general they had the right support, experience and knowledge to meet the differing needs of people who use the service. When asked what the service does well, one member of staff wrote on the comment card, we try very hard to help everyone. We have good training courses. The person who submitted a comment card and lived at the home said that they usually received the care and support that they needed but added, the care in the home has declined due to the fact that cuts have been made and there isnt enough staff to support the number of clients within the home. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home were flexible and people were encouraged to maintain their leisure interests whilst living there, although community contact could have been better. Meals were managed well and visitors were made to feel welcome to the home. Evidence: At the time of our visit some people were enjoying a game of Bingo, but it was evident that those living at the home were not pressurised to join in if they did not want to. People were seen to be offered a variety of choices throughout the day so that they remained as independent as possible and had some control over their lives. People living at the home were able to freely access all communal areas as well as their own private accommodation. They could choose where they wished to spend their time and were able to make a lot of decisions about daily life at Lakeside. One person told us, I can come and go as I please. I get up when I want and I go to bed when I want. The general routine here is fairly flexible. The plans of care described what leisure activities people liked to do and we saw that they were supported to maintain their interests whilst living at the home. When asked Care Homes for Older People Page 17 of 31 Evidence: what she enjoyed doing one person told us, I like to play Bingo and have my hair done. The hairdresser was on site at the time of our visit and this lady was later seen enjoying a visit to the salon. Another person said, it can be a bit boring sometimes as there is not a lot to do. We saw a lot of interaction between the people working at the home and those living there. The atmosphere was very friendly and welcoming and it was nice to see those living at the home enjoying a bit of light banter with the staff. One relative said, the only thing is they (people living at the home) dont go out any more and this comment was supported by another relative. However, both confirmed that regular activities were provided within the home so that stimulation was encouraged. We discussed the provision of activities with one member of staff. An activities programme was in place and records showed that a variety of activities were provided at the home by the activities co-ordinator, but that trips out in to the community were not regularly organised. We were told that monthly events were organised, such as, tea parties and evening quizzes, to which relatives and friends were invited. A policy was in place in relation to people being supported to maintain contact with friends and relatives whilst living at the home and also for them to be assisted in following their religious beliefs if they wished to do so. We noted that arrangements were being made for one lady to visit her own hairdressers in the community so that she could meet up with her old friends, which was good practice. We were told that Ministers of different denominations visited the home to give Communion so that peoples religious needs were being met. Two relatives told us that they are made to feel very welcome to Lakeside and that they can stay and have a meal with their relative if they wanted to. One of these people said, we are on first name terms with the staff who are all lovely and the other said, I feel very comfortable visiting Lakeside. The staff always have a welcoming word. They are like family. A detailed policy was in place at the home telling people how they could access an independant person to act on their behalf if this is what they wanted. We were told that an advocate was arranged for people as requested and during our visit a staff member contacted Age Concern on behalf of one person using the service to give them support. We observed lunch being served and we found that meals were managed well. The menu was clearly displayed in the dining room, which offered a choice of meals and people spoken to confirmed that alternatives to the menu were also available in case people did not like what was on offer. The dining room was tastefully decorated with Care Homes for Older People Page 18 of 31 Evidence: nicely laid tables and good quality furnishings, providing a pleasant area for people to eat in. The meals looked appetising and nutritious so that people received a well balanced diet. Those requiring assistance were helped in a discreet manner and everyone was able to eat at their own pace so that the dining experience was enjoyable. People spoken to said that they always enjoyed their meals. One person said, well I never leave anything, so that tells you how good it is and another said, the chef is really good. The food is always lovely. We spoke to two relatives who have had a meal at the home. One of them said, the food is first class and the other said, I enjoy having a meal at the home occasionally. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were managed well and people living at Lakeside were safeguarded by the robust policies and procedures adopted by the home. Evidence: A complaints procedure was in place, which was clearly displayed throughout the home and which was included within the service users guide, so that people were aware of how to make a complaint, should they wish to do so. A system was in place for the recording of complaints, although none had been received by the home in the past twelve months. The person who submitted a comment card and who used the service said that staff listen and act on what they say and that they would know how to make a complaint, should they need to do so. This individual wrote, I find the staff very helpful and they are always there to help. Policies and procedures were in place in relation to safeguarding vulnerable adults, so that staff were aware of what they should do if they were concerned about the treatment anyone living at Lakeside. All six staff members who submitted comment cards said that they would know what to do if a person living at the home, their relative, friend or advocate had any concerns about the home. Clear policies and procedures were in place in relation to the Protection Of Vulnerable Care Homes for Older People Page 20 of 31 Evidence: Adults so that staff would know what to do should an allegation of possible or actual abuse be reported to the home. Staff spoken to said that they received training in the Protection Of Vulnerable Adults and training records seen supported this information. The staff spoken to told us that they would know what to do should they feel that someone living at the home was being abused. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided a safe and comforatable environment for the people living there. Evidence: A lot of upgrading had taken place at Lakeside during the past twelve months to improve the environment for the people living there, which was commendable. Many of the bedrooms and some corridors had been tastefully decorated and refurbished. The reception area of the home and the lounge had also been upgraded and we noted at the time of our visit that two bedrooms were in the process of being decorated. Furnishings were of a good quality and people were able to take their own belongings to the home with them, which created a homely environment for those living at Lakeside. A rolling programme of maintenance was in place to ensure good environmental standards were maintained. The premises were warm, comfortable and clean, providing pleasant surroundings for people to live in. Good measures were in place for the control of infection and the home was pleasant smelling providing people with a comfortable environment in which to live. Clinical waste was being disposed of in the correct manner so that the risk of cross infection was minimised. Relevant policies and procedures were in place in relation to the control of infection and staff had received appropriate training so that they were aware Care Homes for Older People Page 22 of 31 Evidence: of infection control precautions. The laundry department was well organised and sufficient equipment was provided to meet the needs of the home. The carpet in the ground floor corridor at the bottom of the stairs needed replacement as it had been temporarily taped down to prevent trips. The regional manager wrote on the homes self assesssment, the home is well maintained and attention to the health and safety of residents and staff is paramount. We also recognise the areas where we need to improve the ambience of the building. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lot of training was provided for staff so that they could give the care and support required. However, the number of staff on duty was not calculated in accordance with peoples needs and the recruitment practices did not sufficiently protect those living at Lakeside. Evidence: The duty rota was examined, which showed the staff that were on duty at any time of the day or night so that the skill mix of the staff team could easily be identified to ensure that it was appropriate to meet peoples needs. We were told that staffing levels were calculated in accordance with the number of people living at the home and not in according to their assessed needs. This did not show that the number of people on duty was adjusted when people living at the home needed an increased level of care and support. Duty rotas showed that no agency staff were being used at the home, ensuring continuity of care for the people living there. Staff and relatives who were spoken to felt that there were enough staff on duty to meet the needs of those living at the home. At the time of our inspection there were 20 care staff employed at the home, ten of who had achieved a recognised qualification in care so that the staff team were collectively trained to provide the care Care Homes for Older People Page 24 of 31 Evidence: and support needed by the people living at the home. Induction records showed that new staff completed the skills for care programme to ensure that they were competent to do the job before working alone. A clear policy was in place in relation to the induction of new staff so that those starting work at the home were aware of what their induction period would involve. The training matrix showed that a wide range of training was provided, including mandatory courses as well as training specific to the individual needs of people living at the home to ensure that staff were appropriately trained to meet peoples needs. The personnel files of two staff members were viewed. These were selected at random and both were in relation to overseas staff. The recruitment practices used by the home could have been better. Records showed that staff were being allowed to start work once the Protection Of Vulnerable Adult register was checked and the home did not always wait until the Criminal Records Bureau (CRB) disclosures had been received. New staff should only be employed before a CRB is obtained in exceptional circumstances, in which case the home should record the reason and should ensure that they are supervised at all times with a written record in place, until the CRB is received. We were told that overseas staff were employed through a recruitment agency, which was not entirely satisfactory because references had not been forwarded to the home to show that the people working there had been thoroughly checked before they were recruited. We later viewed the references, some of which were not dated so we were unable to determine if they had been obtained before people started work at Lakeside or after employment had commenced. Staff who sent us comment cards said that their employer had carried out relevant checks before they started working at the home. They also told us that they were given training which was relevant to their role, helped them understand and meet the individual needs of people and which kept them up to date with new ways of working. One of these people wrote, we are given a lot of training. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed well so that the health, welfare and safety of the people living and working there was protected. Evidence: The manager of Lakeside had taken up her post quite recently and was therefore not yet registered with the Commission for Social Care Inspection. Application to the Commission must be addressed as a matter of urgency as the home has been without a registered manager for quite some time now. During the time she had been in post she had worked hard to improve the service and to provide an increased quality of life for the people living there. There was a strong belief of being open and transparent in all areas of running the home so that people were kept informed of matters involving them. The manager had completed a variety of additional training courses and supported the staff team well. We spoke to three staff members who all said that they were well supported by the Care Homes for Older People Page 26 of 31 Evidence: management of the home and that the manager was very approachable and encouraged an open door policy so that anyone could go to her at any time to discuss any concerns or issues. How the home monitored the quality of service provided was very thorough. Surveys had recently been conducted so that the views of people living at the home, their relatives and stakeholders in the community had been obtained about how the service was performing. A variety of meetings had been held and these were recorded as minutes, so that people were kept informed of any relevant matters. A business plan was in place and a company representative conducted monthly unannounced inspections of the home, reports of which were kept at Lakeside so that strengths and any areas for development could be identified and addressed as was needed. The home send information to the company each week so that the quality of service can be closely monitored. The home was accredited by an external professional body who audited Lakeside periodically to ensure that the quality of service provided was monitored. The manager had put in place a variety of regular, detailed checks. This enabled her to identify and address any shortfalls within the systems in place at the home and closely monitor the quality of service provided. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. We noted that footrests were now provided for people using wheelchairs so that they were not placed at risk of harm. We also noted that the home was at an acceptable temperature throughout so that people were comfortable. We were told that a new water boiler had been installed since our last visit so the previous problem of very hot water being delivered at the water outlets had been rectified so that people living at the home would not scald themselves. The water outlets checked on the day of our visit were of acceptable temperatures. Systems were in place at the home to ensure that residents finances were adequately protected. The relatives of residents were often responsible for the management of their money. However, personal allowances for some people were retained by the home, where residents were unable or did not wish to manage their own affairs. Clear records were kept of any money or valuables retained at the home on behalf of people living there so that the possibility of any mishandling was reduced. Receipts were retained for any expenditure so that a clear audit trail could be conducted. Care Homes for Older People Page 27 of 31 Evidence: The homes self assessment showed that all systems and equipment within the home had been appropriately checked so that the health and safety of people living there was protected. This was confirmed by examination of a random selection of service certificates. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. A wide range of policies and procedures were in place, which had been reviewed and updated as necessary so that staff were kept up to date with new ways of working. All care staff had completed moving and handling training and most were trained in health and safety issues. We saw two staff members using a hoist to transfer one person living at the home. They did this manoeuvre in a very safe manner and the person being moved was constantly reassured during the procedure. The environment was very well maintained and was free from any hazards, which could pose risks to those living at the home. The training matrix showed that staff had received training in Health and Safety and detailed policies and procedures were in place at the home so that staff were aware of any precautions they should take to protect themselves and the people living at the home from injury. Safety notices were prominently displayed and all fire precautions were followed to ensure that staff knew what they should do in the event of the fire alarm sounding. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 Staff must not be employed to work at the home until all the required checks have been undertaken in order to ensure the safety of the people living at Lakeside. Timescale of 28/12/07 not met. 30/04/2009 2 31 8 A permanent manager must 31/05/2009 be appointed and application made to the CSCI for the person to become registered. Timescale of 31/01/08 not met. Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 13 It is recommended that people living at the home are asked where they would like to visit and from this information regular trips be arranged so that people can maintain community contact. The carpet in the ground floor corridor should be replaced to avoid any injuries from tripping. 2 19 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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