Archived: The Lakes Care Centre

The Lakes Care Centre is a care home. It is registered to provide personal and nursing care for up to 77 people aged 65 and over, across 3 units. At the time of our inspection 1 unit was closed. 1 unit provides nursing care and residential care, whilst the other unit provides residential care. At the time of our inspection there were 46 people using the service.

People’s experience of using this service and what we found

Medicines were not always managed safely. We found significant improvements of the premises had been made, however all required checks, repairs and maintenance to the buildings were not yet fully completed. Systems in place for the monitoring and oversight of the service were not yet fully embedded.

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.

Risks to individuals were identified and well managed. There were sufficient staff deployed to meet people’s needs and all required pre employment checks were being undertaken. Staff had received training and knew how to identify and report safeguarding concerns. Systems in place helped to protect people from the risks associated with Covid-19 and other infectious diseases. There were no restrictions on people having visitors to the home.

Staff received appropriate training and supervision. People’s nutritional needs were being met. People told us the food had improved. We saw drinks were readily available for people. The kitchen was awarded a 5-star food hygiene rating by the food standards agency.

People were treated with dignity and respect. Staff supported people with patience and compassion. People spoke positively about the staff. One person said, “The staff are brilliant. They go beyond the call of duty.”

Care records were person-centred. They gave detailed information about what was important to and for the person. There had been improvements in activities on offer, both within the home and wider community. People spoke very positively about the activities on offer. The was a system in place for managing and responding to complaints. Advanced decisions about resuscitation and end of life care plans were in place where required.

People and their relatives were positive about the recent changes, and how the home was now run and organised. Staff spoke very positively about the improvements the consultants had put in place and the difference this had made.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 17 November 2022). At this inspection we found the provider remained in breach of regulations. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

This service has been in Special Measures since 15 February 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lakes Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines, premises and governance at this inspection. We took enforcement action and placed conditions on the providers registration.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Lakes Care Centre is a care home. It is registered to provide personal and nursing care for up to 77 people aged 65 and over, across three units. One unit provides nursing care, whilst the other two units provide residential care. All units have single bedrooms and there are a range of communal spaces.

People’s experience of using this service and what we found

Medicines were not being safely handled. Risks were not being fully assessed and necessary action to mitigate risks was not being taken. There was not always enough staff, and robust recruitment processes were not always being followed. Improvements to infection control practices were noted but further work was needed to ensure processes and good practice were being consistently followed. Lessons were not always being quickly and effectively learnt.

People were not always given the right support with food and drink. The meals being served had improved, but further work was required to improve choice. Not all staff had completed the necessary training but felt supported in their role. Various areas of the home were not suitable, and the registered manager took immediate action to remove people from one area of the home due to concerns regarding fire safety, following our first day of inspection. We found repeat issues regarding protecting people from the risk of hot surfaces, and security around the premises. The provider and registered manager had not identified these shortfalls despite systems for checks being in place. Health care input was not always being followed-up in a timely way.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support good practice.

Systems had been implemented to support oversight in the home but were not being carried out effectively. Regular checks of the environment had not identified shortfalls found, and care plan audits had not identified inconsistencies and inaccuracies within people’s care records. A new management team were in place since our last inspection, but little progress had been made to improve the quality of the service. The provider did not have robust systems in place to assess the effectiveness of action they had taken to improve the service. The provider was holding meetings with families and although communications had improved it was not evident that all families were clear, and up to date about changes happening in the home.

People were not always well treated, and they did not always get the care and support needed in a timely way. People’s dignity was not always considered and there was no consistent approach to promoting independence and allowing people privacy. Some staff were caring and knew people, but we did not always see positive interactions between staff and people.

People were not always receiving person-centred care, or care that was appropriate for their needs. A programme of activities was in place, but people still told us they were bored. People were often left sat in front of the television, with limited task-based interactions with staff, for most of the day. End of life care plans were in place, but further work was required to ensure these were proactively completed in a person-centred and detailed way. End of life decisions were not always subject to review if people showed signs of improvement.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 15 February 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve and worked closely with commissioning services. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the full report.

Enforcement

We have identified breaches in relation to how people are treated, and given personalised care suitable to their needs; how the service meets the requirements of the mental capacity act; how risk and medicines are managed within the service; how people are supported with what they eat and drink; how the premises is safely managed; staffing and recruitment of staff; and how the service is managed and improvements made.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Lakes Care Centre is a care home. It is registered to provide personal and nursing care for up to 77 people aged 65 and over across three units. One unit provides nursing care whilst the other two units provide residential care. All units have single bedrooms, and there are a range of communal spaces.

People’s experience of using this service and what we found

People were not always safe as action was not taken to consistently identify, assess and mitigate risk. This included both individual risks and needs, and environmental risks. Systems for supporting people with their medicines were not safe and people did not always have the medicines they needed. Accurate medicines records were not being consistently maintained. There was not always enough staff to meet people’s needs and good infection prevention and control procedures were not always being followed. Systems to learn lessons were not always effective.

The service had not taken reasonable action to make enough improvements since the last inspection. Enforcement action and recommendations from the last inspection had not been addressed and there were multiple repeat breaches of regulation. We were not assured that the provider was able to identify, address and sustain improvements. Record keeping and systems of checks were not consistent to ensure good governance. Lessons were not being effectively learnt to mitigate future risk of avoidable harm for people. The service was working with the local authority and clinical commissioning group to make improvements across the service following recent concerns.

Peoples’ care needs were not consistently assessed and did not always contain detailed person-centred or accurate information. People were not always supported to eat suitable healthy and balanced diets and many people told us they were unhappy with the quality of food. Staff felt well supported in their role, but relevant training was not consistently completed, and assessments of staff’s knowledge and competency was not always in place. There had been limited improvements to the environment since our last inspection. People were referred to relevant health care services when needs were identified.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Records regarding the assessment of decision specific mental capacity and best interest decisions were not consistently recorded and there were not sufficient systems for oversight in place.

The provider did not demonstrate that people were well cared for through taking effective and timely action, such as addressing shortfalls from previous inspections, issues within the environments and acting on the feedback of people, for example regarding food and activities. People spoke positively about the care team and we saw staff were generally kind and caring although staff were often task focused. Records did not consistently reflect people’s preferences or how to promote independence and we saw examples where people’s dignity and privacy was not respected.

People did not always receive person-centred care and care records did not consistently reflect individual’s needs and preferences. People told us they were bored and there were not enough activity coordinators to provide personalised activities which were socially and culturally relevant to people. The service had begun work to develop advanced care plans with people but, at the time of the inspection, people’s records did not capture their end of life care wishes.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 August 2021) and there were multiple breaches of regulation. The provider did not return a completed action plan after the last inspection to show what they would do and by when to improve as requested. At this inspection we found the necessary improvements had not been made and the provider was in continued breaches of multiple regulations and breach of additional regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, the quality of care being provided, staffing levels and systems of oversight at the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to the management of people’s medicines, the assessment and management of individual and environmental risk, developing and delivering individual plans of care, having enough staff to meet people’s needs, oversight and governance of the service at this inspection. We found new breaches in relation to providing suitable healthy and balanced diets, ensuring the environment is suitable for people’s needs, and care and treatment provided with the consent of the relevant people and in accordance to the Mental capacity act (2005).

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe., and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Lakes Care Centre is a care home. It is registered to provide personal and nursing care for up to 77 people aged 65 and over across three units. The Derwent unit provides nursing care whilst the other two units, known as the Coniston unit and Kendal unit provide residential care. All units have single bedrooms, and there are a range of communal spaces. At the time of the inspection 67 people were receiving support at The Lakes Care Centre.

People’s experience of using this service and what we found

The provider had not implemented an action plan in response to the last inspection and limited progress had been made to drive improvements. There were inconsistencies in how checks and audits of the quality of service were completed. Staff meetings had recently been reintroduced following the Covid-19 pandemic. The new management team were committed to ensuring improvements and developing new processes to ensure the good quality of the service.

People were not always supported with their medicines in line with best practice. We found inconsistencies in how risk was recorded, and within the programme of checks made regarding the safety of the premises. There was not always enough staff to support people. The home was clean, although many areas required redecoration. A new management team were in place and in the process of identifying and implementing improvements within the home. They ensured concerns were investigated when raised and were implementing measures to ensure lessons learnt were shared across the service.

Care records did not always consistently and accurately reflect people’s needs and preferences, and people told us that choice was not always promoted. We have made a recommendation about improvements to how people are supported at mealtimes. We have made a recommendation about ensuring staff have the training and support they need to be competent to undertake their role. The home needed redecoration and we have made a recommendation about ensuring best practice guidance is considered when making improvements across the home.

People were not consistently supported to have maximum choice and control of their lives and the systems in the service did not consistently support people in the least restrictive way possible and in their best interests. The policies and systems in the service did not consistently support good practice and records required improvement.

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

Rating at last inspection

The last rating for this service was requires improvement (published 31 December 2020).

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of people’s health conditions. This inspection examined those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the management of people’s medicine and risk; how people’s care needs and preferences were assessed and care planned for, staffing levels within the service and the oversight and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Lakes Care Centre is a care home. It is registered to provide personal and nursing care for up to 77 people aged 65 and over within three units. The Derwent unit provides nursing care whilst the other two units, known as the Coniston unit and Kendal unit provide residential care. All units have single bedrooms, some of which are en-suite, and a range of communal spaces, including adapted bathrooms, lounge and dining areas and secure outside gardens. At the time of the inspection 53 people were receiving support at The Lakes Care Centre.

People’s experience of using this service and what we found

People’s medicines were not always being safely managed and record keeping in this area was not robust. The home was clean and tidy and staff had access to plenty of personal protective equipment (PPE). Safe recruitment processes were being followed and staff felt supported and well trained to undertake their role.

There were systems for oversight and governance. However, these were not always sufficiently robust or undertaken frequently enough to identify issues in a timely way. The registered manager was committed to learning and following the inspection took steps to address the shortfalls found. The registered manager maintained regular contact with families and families felt they were kept informed and updated of any changes happening within the home. Staff felt the home was well run and everyone was committed to achieving positive outcomes for people.

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

Rating at last inspection

The last rating for this service was requires improvement (published 10 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced Comprehensive inspection of this service on 05 and 07 February 2019. Breaches of legal requirements were 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 and Good governance.

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 remained the same. 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 The Lakes Care Centre on our website at www.cqc.org.uk.

Enforcement

We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how medicines are being managed and how the home ensures they have sufficient oversight and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Medicines were not always being managed in line with current best practice.

Systems of governance and oversight were not sufficiently robust to have identified the issues we found in relation to the management of medicines.

The service had appropriate checks and maintenance to ensure the service and equipment was safe for the people living at The Lakes Care Centre.

Staff were safely recruited and received the training and support they needed to undertake their role.

People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

There was a wide range of opportunities for people to engage in activities and follow hobbies and interests.

People were very positive about the staff and told us that their privacy and dignity was promoted.

The service had good community links and had a number of initiatives with local churches and schools.

Care records contained information about people's needs and risks. Preferences and choices were considered and reflected within records and work was ongoing to improve the new electronic system.

Environmental and individual risk assessments were in place. Risks considered included falls, malnutrition and choking risks.

More information is in the full report.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. (16 January 2018). At that inspection we inspected the domains of safe and well led, both were rated as requires improvement. Following this inspection, the ratings for these domains remain unchanged.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

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 is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

The Lakes Care Centre is registered with the Care Quality Commission to provide nursing and residential care for up to 77 older people. There are three Suites, the Derwent, the Kendal and the Coniston Suites. The Derwent Suite provides nursing care for up to 37 people. The Kendal Suite provides residential care for up to 15 people and The Coniston Suite provides care for up to 25 people with dementia related needs.

This inspection took place on 19 October 2017 and was unannounced.

This inspection was prompted by receipt of a Regulation 28 Coroner’s Report received on the ninth October 2017 informing of an incident that took place on 24 May 2017 following which a person using the service later died in hospital. Regulation 28 reports are issued by Coroners when the Coroner remains concerned that similar incidents could reoccur.

Information shared with the Care Quality Commission about the incident indicated potential concerns about the management or risk of falls and the subsequent investigation of falls by the registered provider.

The concerns raised form part of the two domains; is the service safe and is the service well led. Our findings are reported under these domains.

You can read the report form our last comprehensive inspection, by selecting the ‘all reports’ link for ‘The Lakes Care Centre’ on our website at www.cqc.org.uk.

At the time of our inspection, 74 people were using the service, 36 on the Derwent Suite, and 14 on the Kendal Suite and 24 on the Coniston Suite.

There was a registered manager in place and they were available throughout this inspection. 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.

Care records, risk assessments and systems were in place to help and support staff to minimise the risk to people of having falls.

Staff had received the moving and handling training they needed to help make sure people were supported safely when mobilising.

During this inspection we found two breaches of regulation. These breaches related to none notification to the Care Quality Commission of the serious injury of a person who used the service and action had yet to take place to minimise the risk of falls to people using the service, especially at mealtimes.

You can see what action we have told the provider to take at the back of the report. We are currently considering our options in relation to enforcement in relation to some breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

The Lakes Care Centre consisted of three separate suites. The Derwent Suite providing nursing care for up to 37 people. The Kendal Suite providing residential care for up to 15 people and The Coniston Suite providing care for up to 25 people with dementia related needs. The home is registered to provide nursing and residential care and accommodation for up to 77 people and at the time of this inspection there was a total of 77 people using the service. One person was in hospital.

Accommodation comprises of all single rooms some of which have en-suite facilities. Each suite had a communal lounge and dining room and access to a safe, enclosed outdoor space.

At the time of our inspection a registered manager was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that the legal requirements that had been made at the inspections conducted in February and August 2015 had been satisfactorily addressed.

People living in the home told us they were happy with their care and liked the staff that supported and looked after them and felt safe when their care was being delivered.

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care.

Care plans were person centred and included risk assessments that provided staff with instructions to follow when supporting people with their care needs. Care records showed they were reviewed and any changes were recorded.

Records looked at and talking with staff and the management team demonstrated that staff had been recruited to the service safely, appropriately trained and supported. Staffing levels were observed to be sufficient to meet the needs of people who lived at the home.

Medicines management were found to be safe. Nurses and senior care staff responsible for the administration of medicines had received appropriate training. All medicines and controlled drugs were safely kept with appropriate arrangements for storing in place.

People using the service had access to healthcare professionals and their healthcare needs were met.

Staff spoken with and records seen confirmed training had been provided. Staff were knowledgeable about the support needs of people living in the home.

Systems were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff spoken with and records seen demonstrated that staff understood their responsibilities in keeping people safe and to report unsafe care or abusive practices.

During our walk round of the service we found all areas to be clean, tidy and appropriately maintained.

People who used the service and their relatives knew how to raise a concern or make a complaint.

A range of activities were available and people were encouraged to participate in those activities that interested them.

The registered manager and senior management team used a variety of methods to assess and monitor the quality of the service. This included regular audits of the service and meetings held to seek the views of people using the service, their relatives and the staff team.

We spoke with people who lived in the home and those who were able to express their views told us that they were satisfied with the care and support they received from staff. The care plans we observed identified assessment and risk recorded to promote people's safety and welfare.

People told us the staff 'Are very good' and 'If I want something they sort it out for me.' They said it was 'Friendly here.'

We found that staff were aware of the importance of gaining consent from people who use the service and that the service user had a right to withdraw that consent. Staff had received safeguarding of vulnerable adults training.

We found that there was a complaints system in place which had been used effectively and information was available to service users, their relatives and staff on what to do in the event of making a complaint.

Staff working at The Lakes said they enjoyed their work. Comments included 'I like working here and feel valued as an employee' and 'It's like a little family, I have never enjoyed working somewhere so much.' The staff felt they received appropriate training to do their job and were supervised by senior staff.

We talked to relatives during the visit. The relatives we spoke with were happy with The Lakes. They felt they had been consulted in their relatives care. Comments included 'It's brilliant here, it's a caring, nurturing place', 'The unit manager is like a guardian angel', 'They (service users) are attended to in every way' and, ' So caring and very homely, I wouldn't change anything.'

One person said: 'I'm very happy here, when I'm poorly I get all the attention in the world.' Another said: "I'm being well looked after, very comfortable." Another comment was: 'I think the care is excellent.'

Another resident said: "I like it here. They (the staff) are very good. They know what to do and how to help me. It's nice living here, I can look out of the window and see the trees and watch the birds."

We found that The Lakes Care Centre treated its residents with respect and maintained their independence. The standard of care was generally high, and when problems had occurred action had been taken swiftly to deal with the cause.

We found that residents were protected because the staff were well trained to deal with issues of safeguarding and abuse.

We looked at a recent recruitment process and found that The Lakes Care Centre had followed all the necessary steps to ensure that competent staff of good character were recruited.

We found that The Lakes Care Centre had good systems in place to monitor quality and to address any issues that came to light.