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

People did not always receive safe care. During our visit we found concerns regarding how people’s medicines were stored, managed and administered to people. People’s risks were not always assessed and reviewed appropriately. We found that identified improvements within the service have not always been sustained.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their families told us they could raise concerns about their care and discuss areas that needed to be improved . However,any improvements had not always been sustained for a longer period of time. One family member told us,"They will do things when you ask them to do, but then you come back, and things are as they were and you have to ask again." Another person told us:" I am here a lot and see things that shouldn’t happen but I don’t think it is my place to tell you as I’m only a friend and it is for a relative to bring things like that up."

Most of the staff told us they felt they could raise concerns. However some, staff told us that they were worried to speak up. One member of staff commented,"There are staff who have been here a long time and it is difficult to say anything. I don’t want to say anything just in case this affects my job."

There were processes in place to support a learning culture such as policies and procedures. However, these were not always followed meaning that people’s risk was not always effectively managed and mitigated. For example we saw records of the complaints log, as well as evidence of positive feedback, but it was not clear how this was used to support learning and improvement.

We received mixed feedback from people. One person told us:” I feel safe here so far. Another person told us,"I had a fall and hurt my shoulder. It’s bruised on my back. I told them but not much was done about it. It does feel to be getting worse. Staff said,it's only bruised and I haven't see the doctor." We saw written feedback from one person, "’m often encouraged to sit straight down when standing despite being sat all day."One relative told us,: “I feel mum is safe here, a lot safer than at home.”. Another relative said," I do feel I have to come in to check if things are ok.”

Staff overall had a good understanding of people’s individual risks. For example we saw a staff member reacting quickly when one person started eating food that could potentially cause a choking incident. However staff did not always support people in a person centred way or recognise their individual communication needs. One staff member told us,"I have never done care before, the way some people behave is difficult to manage. Sometimes it is very hard."

Staff did not always promote people’s independence and support people to take positive risks. We saw people who wanted to stand up and mobilise but were told by staff to” Sit down, you will fall”, or “Sit down, where are you going?.” Staff did not always assess and manage risks appropriately. We saw cabinets containing people’s medicines left with the keys in and the medicines trolley left unattended at times , rooms with “keep closed" signs left open, and one occasion where a faulty pull cord was left in a communal bathroom.

Risks involving people were not always identified, assessed and reviewed in a timely manner. For example, we found that people’s care plans did not always include up to date information regarding people’s special diet and there was contradictory information for example the summary of care needs was not always updated to reflect a person’s, change of needs. We also found that people who were at risk of pressure sores were not always supported to change their position and minimise the risk of developing pressures sores or exacerbating existing ones.

We have received mixed feedback from people regarding the staffing. One person told us,"If you need help they get to you as quickly as they can but sometimes there is a bit of a wait as a lot of us live here." Another person told us:” It depends how busy they are how quick the help comes.” One relative told us:” They seem to be a regular team of staff and I know quite a few of them now, there aren’t many new faces.” Another relative told us,"There isn’t always a senior at night, or one senior is trying to deal with both units. Sometimes they seem to ask normal staff to do a senior role."People were overall complimentary about staff. One person told us,"The girls who help me are lovely.” Another person told us:” The staff are quite nice, there seem to be enough most of the time.” Although during the inspection the staffing levels seemed adequate people and their relatives did comment that this was the exception rather than the rule and that often, staffing levels weren’t quite as good.

Staff told us there was not always enough staff to meet people needs. For example one staff member told us,"There should be more staff on the unit."Another staff member told us,"There isn’t enough staff.”

During our visit we observed that staff were well-intentioned towards people. However staff appeared to be rushed in the support provided to people and did not have enough time to spend supporting people beyond their basic needs. During busy times such as mealtimes not all of the people were receiving the support they needed. We saw people with food left in front them not receiving the assistance required. We observed people being left for long period of time on their own without any support or interaction from staff.

There were processes in place to support effective staffing. However not all of the processes were effective. Staff records overall demonstrated suitable recruitment practices. There was evidence of references being sought prior to employment and gaps in employment were explored. There was evidence of completed DBS checks however not all of the DBS checks had been reviewed. Staff were provided with training. However, most of the training was delivered online and there were not many opportunities for face to face sessions. There was evidence that staff training compliance was monitored but no evidence of what actions were taken as a result of non-compliance identified. Not all of the staff had their training up to date and this included senior staff responsible for the line management of care workers or administering medicines to people. There was very little evidence that staff competencies were periodically checked and assessed. We observed improvements were needed to staff’s understanding of person-centred care, dementia care and moving and handling. There was no evidence that staff received periodical supervisions. There was no evidence of staff appraisals taking place.

People did not always receive medicines in a safe way.One person did not receive their strong painkiller on the morning of our visit until we noticed this and brought it to the attention of staff at lunchtime. The senior carer administering medicines had signed the MAR to say they had administered the medicine (which was a controlled drug). This person was given other prescribed medicines (from a pharmacy labelled monitored dose pack) without a record of administration being made. These medicines were not entered on the person’s MAR. We saw errors in the records of administration of painkillers to other people. The exact times of administration and whether the medicine was effective (if prescribed ‘when required’) were not always recorded which meant that people’s pain was not managed safely. Guidelines for staff on when to give painkillers prescribed ‘when required’ (prn protocols) lacked the necessary detail. We saw one person’s tablet had been left on the table where they were eating breakfast. The senior carer administering medicines told us they had put it there. Relatives who other inspectors met during the inspection said staff sometimes left tablets on tables. The medicine trolley was sometimes left unlocked and unattended in the dining room during the medicine ‘round’. One relative told us:,"It is trial and error on her meds at the moment. It’s hit and miss if she gets them sometimes especially at night as there are less staff and if she refuses, they sometimes don’t have time to get back to her.”Another relative told us,"I’ve noticed that sometimes they will give him his tea time and nighttime medication at the same time."

Everyone living at the home was registered with the same GP. The GP attended the home every week and care staff provided a list of names of people they wanted the GP to review. The GP said that many patients at the home had only registered with the practice recently, but they currently had no concerns to share with CQC. Senior staff we spoke to lacked understanding of good practice requirements for administering medicines and the importance of a robust process for managing controlled drugs.

Access to treatment rooms was restricted only by a keycode and there was no procedure for changing the code to increase security. Not all medicines inside the room were locked away. Some cupboards (not British Standard medicine cupboards) containing medicines were unlocked These security arrangements had not been risk assessed. The temperature of medicines fridges was not adequately monitored to ensure that insulin and other medicines requiring storage between 2 and 8 degrees Celsius remained safe to use. On Derwent unit the medicines trolley was sometimes left unlocked when unattended during the medicine round. However, cupboards for storing controlled drugs met legal requirements. The home had a medicine policy. However the review date was June 2023. Staff on duty at the time of the inspection could not show us any medicine audits. We found a discrepancy in the controlled drugs (CD) register, where one transdermal patch was unaccounted for. This person did not have a transdermal patch application record to ensure the patch was applied safely One person’s painkiller, stored by the home and to be administered by community nurses, had not been entered in the CD register. Staff we spoke to were unaware they should keep a record of this medicine.