About the service: The Lakes is a provides residential care for up to 47 older people living with dementia. There were 43 people receiving care at the time of the inspection.People’s experience of using this service:
¿ The provider failed to have sufficient oversight of the home as there were failings in the quality and safety of people’s care.
¿ People were not protected from the risks of abuse as staff and the registered manager had failed to recognise or report allegations of abuse, unexplained injuries and poor moving and handling; they had not alerted the relevant authorities.
¿ Staff did not consistently ensure people were supported to eat their meals. People were at risk of losing weight and dehydration.
¿ The provider did not employ enough staff to meet peoples’ needs; they relied heavily on agency care staff. Recruitment of staff was on-going.
¿ People’s experience of care differed depending upon how many permanent staff were on duty. People living with dementia did not always respond well to agency staff as they did not know them well. Permanent staff showed kindness in the way they spoke and reacted to people’s anxiety.
¿ The provider failed to ensure agency staff had a suitable induction to the service, employment checks, training and competencies required to carry out their roles. Both agency and permanent staff had not always received the training and supervision they required to provide care that met people’s needs.
¿ Staff were not adequately deployed to meet people’s needs. People’s dignity was not always maintained as their personal care was not always carried out in a timely way.
¿ The provider was not working within the principles of the MCA. They had not identified people who required a Deprivation of Liberty Safeguards (DoLS) assessment or made the appropriate applications.
¿ Staff did not always have information about people’s needs as people’s risk assessments and care plans did not always reflected their current needs. The registered manager had started to update the care plans.
¿ People did not always receive their medicines in a safe way. Staff did not always follow the provider’s medicines policy.
¿ People living with dementia had access to substances that are hazardous to health as toiletries including denture cleaner was readily accessible in people’s rooms.
¿ People did not receive care that reflected their personal preferences such as diet, bedding and clothing. The registered manager recently introduced deployment of staff that reflected people’s preference for female care staff.
¿ People had not had the opportunity to express their preferences or wishes for their end of life care.
¿ People had not been supported to express their views about their care or be involved in creating their care plans. However, the registered manager had recently written to relatives to invite them to people’s reviews.
¿ People and their relatives had not been asked for their feedback. People did not have any involvement in the running of the home.
¿ People’s verbal complaints were not recorded or responded to. The registered manager did not always follow the provider’s complaints procedure.
¿ The provider did not have adequate systems to assess, monitor, evaluate and make changes to improve the service. The provider failed to have systems in place to evaluate the quality and effectiveness of deployment of staff.
¿ The home was purpose built to meet the needs of people living with dementia. However, not all areas of the home were adequately used for the purpose they were intended.
¿ People were supported to access planned healthcare. Staff were prompt in referring people to their GP when they showed signs of ill health. Staff followed infection control procedures.
Why we inspected: We brought forward a planned inspection as we had received information of concern from families, staff and the local authority.
Enforcement: The provider was in breach of 10 regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 and two regulations of Care Quality Commission (Registration) Regulations 2009.
Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals are added to reports after any concerns found in inspections and appeals have been concluded.
Follow up: We will continue to monitor the service and work with partner agencies. The provider will be instructed to provide action plans and reports.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.
Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
For more details, please see the full report which is on the CQC website at www.cqc.org.