This comprehensive inspection took place on 17 and 18 January 2017 and was unannounced. The inspection team consisted of one adult social care inspector. At the time of the inspection, there were 46 people living at the home. Lakeside Nursing and Residential Home is registered to provide personal care and support for up to 50 people. It is situated close to Worthington Lakes and Standish town centre.

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.

People we spoke with who lived at Lakeside Nursing and Residential Home told us they felt safe.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service.

We looked at five staff personnel files and there was evidence of robust recruitment procedures in place.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. Staff told us they had received safeguarding training and we saw training certificates that confirmed this. The home also had a whistleblowing policy in place.

We looked at how the service managed the administration of medicines. At the last inspection on 25 August 2015 there were no ‘when required’ (PRN) protocols in place and no information on medicines recorded in people’s care plans. At this inspection we found that the registered manager had introduced ‘when required’ protocols and detailed information on medicines was now in people’s care plans. We observed staff administering medicines and saw that people were given their medicines as required. Records of medicines administration had been completed consistently and accurately. We saw requirements relating to controlled drugs were being met. We saw medicines were stored safely in a locked medicines trolley in the treatment room which was very clean.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use. We saw that monthly infection control audits were in place and included areas such as beds and mattresses, furniture, bedrooms and the general environment and equipment. There was an up to date a fire policy and procedure. Fire safety and fire risk assessments were in place.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition. Accidents and incidents were recorded correctly and included a record of the accident or incident, a summary chart and action plan.

There was a staff supervision schedule in place, which identified meetings during the year and staff were subject to a formal induction process and probationary period. Comprehensive staff training records were in place and staff had completed training in a variety of other areas relative to their job role.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the authorisations. Staff had received training in the MCA and DoLS and most were able to explain the principles of this legislation to us. Staff were aware of how to seek consent from people before providing care or support.

Special diets were catered for, food allergies were recorded and people had nutrition and hydration care plans in place. People who used the service also commented positively about the food.

We saw staff showed patience and encouragement when supporting people.

People’s relatives told us they felt staff were caring when assisting their relative. Staff spoken to had a good under

This inspection took place on 25 August 2015 and was unannounced. We carried out an unannounced comprehensive inspection of this service on 16 January 2015. Breaches of the legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found the provider had made improvements and was meeting the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lakeside Nursing and Residential Home on our website at www.cqc.org.uk

Lakeside Nursing and Residential Home is a care home that provides accommodation for up to 50 older people. At the time of our visit there were 47 people living at the home. It is located close to Worthington Lakes and Standish town centre, and is set in extensive grounds. The home has three floors and there is a passenger lift to all levels. The majority of rooms are for single use and some rooms have an en-suite toilet. There are two large lounges, a dining room and a conservatory on the ground floor.

There was a registered manager in post at the time of our visit. 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 last inspection on 16 January 2015 we found medicines were not always being managed safely and this was a breach of the regulations. The provider had put in place new procedures to help ensure thickeners were used safely. This included an audit of thickeners and clear recording of the consistency that fluids should be thickened to. A new audit of medicines had been introduced that had been completed on a regular basis.

We observed part of the medicines round and saw medicines were administered safely. The provider had carried out assessments for anyone who wished to self-administer their own medicines to help ensure they were able to do so safely and to minimise any potential risk. We checked records of medicine administration and saw they had been completed accurately.

There were no ‘when required’ (PRN) protocols in place and no information on medicines recorded in people’s care plans. ‘When required’ protocols would provide information on when ‘when required’ medicines should be administered. Staff were aware when and why these medicines should be given and told us people living in the home were able to tell them when they were required. The registered manager told us ‘when required’ protocols and information on medicines in care plans would be introduced. We have made a recommendation in relation to the management of ‘when required’ medicines.

At out inspection on 16 January 2015 we found systems in place were not sufficiently robust to enable the quality and safety of the service to be effectively monitored. The provider had introduced new audits including audits of medicines and controlled drugs. We were told a new audit of care plans additional to the homes main audit was due to be introduced.

We saw audits had identified areas for improvement and that action had been taken to implement those improvements. For example, we saw the medicines audit had identified that staff had not recorded the dose given for variable dose medicines, and we saw a prompt had been put in the medicines file to remind staff to do this. The main audit carried out covered a wide range of areas and had been signed off by the operational manager. Systems were in place to enable the monitoring of training and supervision staff were receiving.

We carried out an unannounced inspection of Lakeside Nursing and Residential Home on 16 January 2015.

Lakeside is a care home that provides accommodation for up to 50 older people. At the time of our visit there were 45 people living at the home. It is located close to Worthington Lakes and Standish town centre, and is set in extensive grounds. The home has three floors and there is a passenger lift to all levels. The majority of rooms are for single use and some rooms have an ensuite toilet. There are two large lounges, a dining room and a conservatory on the ground floor.

At the time of our visit there was a registered manager who had been in post for approximately five months. 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.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. There was one breach in relation to medication and one breach related to the assessment and monitoring of the quality of service provision. You can see what action we told the provider to take at the back of the full version of the report.

Medications were not always stored, recorded and administered safely and in accordance with the medication policy of the home. We also found one person was being administered drink thickener that had been prescribed for another person. The service had not properly assessed risks or recorded preferences related to self-medication. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 as the provider had failed to protect people from the risks associated with the unsafe use and management of medicines.

We saw that the service made frequent referrals to specialists when a health need was identified and we found evidence of effective nursing care having been delivered to people. However, we found one case where a referral had not been made to an eating and drinking specialist as would have been expected. We raised this with the nurse and a referral was made whilst we were still on site.

People living at Lakeside and their relatives spoke positively about the care and support they received. Staff and families both felt like they had developed good relationships with one another. People told us they felt their independence and privacy was respected and that they were confident that any concerns they might raise would be acted upon.

The manager had been at the service for around five months and was in the process of modernising systems and improving the quality assurance processes in the home. We found a nutritional risk assessment had been incorrectly calculated on several occasions and this had not been picked up before our visit. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 as the provider did not have effective systems in place to monitor the quality of service delivery.

Staff and families were positive about the leadership of the home and the changes being made.

We saw that meetings were held with residents, families and staff and we were told people were confident that any issues raised would be dealt with.

Staff had undertaken training essential to perform their role and additional specialist training had been carried out in order to provide effective support to people with specific needs. The service had also been responsive to people’s changing health needs by carrying out assessment and purchasing required equipment such as profiling beds.

Some people living at Lakeside were found to show signs of having dementia. Improvements were required to make the environment more dementia friendly and support the independence of people who may have dementia living in the home. We have made a recommendation about ‘dementia friendly’ environments.

We saw a range of activities took place at Lakeside, including activities to involve people cared for in bed or with symptoms of dementia. People said they looked forward to the activities and staff had a positive attitude toward supporting people with activity and occupation. We saw that the home had undertaken a number of activities in support of charities and people told us they were proud of their achievements and contributions.

We visited Lakeside as we had concerns reported to us about some of the systems used at the home when caring for people. This related to the way that people’s continence problems were managed and the way that their medicines were given. We looked at both areas of care and found that the service was meeting the expected standards.

We spoke with four people who lived at the home and one visitor. They were full of praise for the staff. One person told us “Nothing is too much trouble for the staff.” The comments we heard from other people included “We are looked after very well here”; “The food is very good. I always eat what I am given.”; “I have no concerns about the staff or the way that I am treated here”; “The staff are great” and “There are no problems with my medicines”

Before our inspection there had been a safeguarding incident that was investigated by the local authority. We visited to check that actions had been taken to reduce the likelihood of the same incident from happening again. We found that staff had received appropriate training and that people were protected from the risk of abuse because there were appropriate arrangements in place to identify the possibility of abuse and prevent abuse from happening.

People were seen to be supported by staff to make choices about where they spent their day. Some people were in the main lounge, some in the activities lounge and some had chosen to stay in their own rooms.

People spoken with said that they could do whatever they liked and could have meals in their bedrooms if they wanted to. One person said " I like to be by myself and staff understand this."

Comments such as "this is a really nice place to live " it is not home but the next best thing” and "it is a lovely place I have no complaints" were made. Relatives spoken with said " the home is great, really well run" and " good home no concerns at all "

We spoke with the people who used the service. One person told us that the food was " very good food” and “ the food is great I have put on weight since I came in here.” Another told us "the food is nice." A relative spoken with said " my relative always eats everything and says it is very good "

During our inspection we spoke with five people living at Lakeside Nursing Home and one visitor. People told us that they were happy living there and they thought that they were well looked after. One person told us “It is much better here than the care home where I was before.” Another person said “I am well looked after here. The staff are so nice and the food is very good.”

We found the people were well cared for and that their individual preferences were respected. One person told us “I can get up when I like. They take you to bed but it is still up to you – sometimes I go to bed and watch television.”

Most people told us that they felt safe and that they had no concerns about the staff or their care. One visitor told us "My relative is well looked after here. The matron runs a tight ship." Another person told us that they would rather be at home but as this was not possible "it is all right here."

We found that staff were happy working at Lakeside and that they had received relevant training in areas such as safeguarding, infection control and dementia. They told us that they were supported in their role and that the manager was approachable.

We saw that there were appropriate systems in place to monitor the quality of care that people received and the manager responded to comments and suggestions made by people, their relatives and members of staff.

People told us that they were content and happy living at Lakeside care home and confirmed that they were treated with dignity and respect.

Comments included:

“I have choice about what I do everyday. I need help to go to bed but they always wait until I’m ready – when I’m watching television they will wait until I’ve finished before asking if I’m ready to go.”

People said that there was plenty of interesting things to do and good food to eat, and they felt that their health and social welfare were taken care of.

Comments included:

“She’s doing fine, she’s so much better than when she came in.”

“Staff are very pleasant and helpful and there’s plenty to do and there’s a very good activities officer.”

“I can’t fault the meals there’s plenty of choice and they know what I don’t like.”

People said that senior staff were approachable and knowledgeable and that care staff were kind and friendly.

Comments included:

“Staff are smashing, very pleasant, she’s kept in good health and if there’s anything at all they keep me informed”

“I’m quite satisfied that it’s where I have to stay and I get on well with staff.”

People felt that they were listened to and could raise concerns if they had them.

Comments included:

“Matron is wonderful I would talk to her.”

“If I had a complaint I would talk to my named nurse.”

And

“I know there are procedures- one is formal and the other for minor matters.”