This inspection took place on the 9, 10 January and 11 February 2019. The inspection was unannounced.

Lakeside Care Centre is 'a care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides nursing care for up to 53 older people. At the time of the inspection there were 45 people living at the service. The home is set in beautiful surroundings overlooking a lake. It is made up of three floors with six bedrooms and the communal lounge and dining room on the ground floor. The remaining bedrooms are situated on the first and second floor. The main kitchen, laundry room and offices are situated on the ground floor.

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

At our previous comprehensive inspection in August 2015 the service was rated as good overall, with a requires improvement rating in the responsive domain. At this inspection we found multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Following this inspection, the service has been rated inadequate.

Some people and relatives were happy with the care provided. However, some people raised concerns about the skills of staff and some relatives and professionals were dissatisfied with the way the home was run and managed.

The delivery of high-quality care was not assured by the leadership, governance or culture in the service. People's records and other records such as staff files were not suitably maintained, accessible and accurate. The service was not effectively managed or audited. The service had systems in place to audit the service but the auditing failed to address the issues we found. There was no external auditing carried out which meant the service was not working to best practice in relation to the delivery of care.

Risks to people and people’s medicines were not appropriately managed. New staff were not inducted and staff were not suitably trained. Their competencies were not properly assessed for their role and tasks they performed. Most staff told us they felt supported but the records did not support that staff had the one to one supervisions recorded on the supervision matrix.

Systems were in place to safeguard people. However, we saw practices and concerns which should have been reported to the local authority safeguarding team to safeguard individuals had not been reported.

People were supported to make day to day choices and decisions. However, the service was not working to the Mental Capacity Act 2005 and procedures were carried out which were not agreed as part of a best interest decision.

Staffing levels varied and some people felt the staffing levels were sufficient. Whilst other people and their relatives told us staff were rushed, call bells were not answered in a timely manner and there was a delay in people being supported with their personal care needs such as toileting and meals.

People had care plans in place but they failed to provide the detail around how person centred care was to be delivered and how people’s communication needs were to be met in line with the Accessible Information Standard. .

Systems were not in place to comply with the Duty of Candour Regulation and the registered manager failed to notify the Commission of issues that they were required to.

People had access to other health professionals to meet their needs however, the service did not always

We read how peoples care was assessed prior to admission. Care plans and risk assessments were in place and reviewed on an on-going basis. We observed how staff cared for people in a respectful way.

We observed people throughout the home, in their own rooms and in the communal areas. People appeared well cared for and told us they were happy with the care they received. We spoke with people who lived in the home. One person told us they “Would not change a thing.” Another person told us “I feel safer here than I did at home.”

We read the staff rota for the two weeks prior to the inspection. We saw that there were sufficient numbers of staff with the right skills and knowledge to meet the needs of the people living in the home.

We read documentation related to staff training and support. Staff were offered core training and induction as new staff members along with a mentor to support them through the induction process. Further training was available to staff as part of their professional development. Staff told us they felt supported by the senior staff and were aware that their practice was observed and monitored. They told us they found the feedback useful to assist them to understand the expectations of their role and provide a good service to people.

Comments from people included ''They're all wonderful here, I'm very happy'' and ''I'm looked after alright here.'' People told us they were usually looked after by the same group of staff, which provided them with consistency of care. Three staff we spoke with said staffing levels were sufficient to meet people's needs.

People’s privacy, dignity and independence were respected at the service. Care plans were person centred to reflect people's wishes and preferences. We saw risks were identified and measures put in place to reduce likelihood of injury or harm. People had access to healthcare professionals to help keep them healthy and well.

Equipment such as hoists and pressure relieving mattresses was provided at the service to meet people's needs. Equipment was serviced to make sure it was safe to use. Staff had been trained in moving and handling techniques to make sure they carried out manoeuvres safely.

We found the service was using robust recruitment processes for the safety and protection of people using the service. However, in one case there was no evidence on the file of the person's continuing entitlement to remain in the country, since they had been appointed.

There was a system in place to listen to any complaints people had. Records were kept of complaints received at the service and how they had been responded to. People we spoke with did not have any complaints about their care.

This unannounced inspection took place on the 26 and 28 August 2015. Lakeside Care Centre provides accommodation and nursing care for up 53 older people. At the time of the inspection there were 47 people living there. The service also provides respite care for people who need support on a short term basis.

During our last inspection in July 2014 we had concerns about the cleanliness of the kitchen, the lack of knowledge of staff regarding the Mental Capacity Act 2005 and the deprivation of liberty safeguards. Further concerns related to the lack of quality assurance feedback and audits which did not identify the areas requiring improvement that we found. During this inspection we found improvements had been made in these areas.

Lakeside Care Centre has an experienced registered manager in place. 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.

People told us they felt safe living in the home. Systems were in place to ensure people’s care was delivered in a safe way, for example all staff had been training in how to safeguard people from abuse.

Care plans and risk assessments were in place to minimise the risk to people when care was being delivered. We have made a recommendation about how the accuracy of care plans could be improved. Staff protected themselves and others from the risk of infection by wearing gloves and aprons when assisting people with personal care and eating and drinking.

Equipment in the home had regular service checks and audits had been completed to ensure the environment and the care provided was safe.

Safe recruitment methods and checks were carried out to ensure as far as possible staff were safe to work within the home. There were sufficient numbers of staff to meet the individual needs of people. Staff had received training and knew how the Mental Capacity Act 2005 was applied to people living in the home. One referral had been made to the local authority for a Deprivation of Liberty Safeguard (DoLS). Staff received training and support, they had supervision with a more senior staff member and their competency was checked by the registered manager and the deputy manager.

People’s nutrition needs were assessed and care plans and risk assessments were in place to ensure the care provided enabled people to be healthy.

People’s chosen lifestyle and interests were maintained and supported by staff that cared for and about them. Staff were kind and gentle and encouraging when speaking to people, they know how to show people respect and the people living in the home told us they valued that. People were encouraged to make decisions and choices about how they spent their time. Care plans reflected people’s choices. A range of activities was available and people told us they enjoyed participating in them.

Residents and relatives meetings were held and questionnaires were sent to people and their relatives to gain feedback on how the home was run. Responses were positive. Staff spoke positively about working in the home, how they cared about the people who lived there and how supportive the management were.

Complaints were dealt with quickly, staff knew how to deal with complaints and people living in the home understood how to make a complaint, although they had not had any reason for doing so.

There was an open and honest culture in the home, with positive attitude to the care being provided and the people living there.