Lakeside is a purpose built care home located on Smithybridge Road, leading to Hollingworth Lake. The first floor is accessed by a passenger lift. The home provides accommodation and support for up to 40 people. There were 27 people currently accommodated at the home.

At the last inspection of November 2016 the service required improvement for four breaches of the regulations. Regulation 11 HSCA RA Regulations 2014 Need for consent, Regulation 12 HSCA RA Regulations 2014 Safe care and treatment, Regulation 13 HSCA RA Regulations 2014 Safeguarding service users from abuse and improper treatment and Regulation 17 HSCA RA Regulations 2014 Good governance. The service sent us an action plan to show how they planned to improve the service. We found the service had made the improvements at this inspection.

The service did not have a registered manager. 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. Since the last inspection a person had been registered but had left after a short time. The service were interviewing potential candidates but had not employed anyone at the time of the inspection.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and homely in character. The environment was maintained at a good level and homely in character.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

This was an unannounced inspection, which took place on the 16 and 22 November 2016. The service was last inspected in August 2015 and rated requires improvement. We found action required following a fire risk assessment had not been addressed helping to ensure people were kept safe. The provider was asked to provide further information to show what action they had taken to address the improvements needed. This was not provided. We reviewed what progress had been made during this inspection.

Lakeside is a purpose built care home located on Smithybridge Road, leading to Hollingworth Lake. Accommodation is provided over two floors. The first floor is accessible by passenger lift. There is parking available to the rear of the building and level access. The home provides accommodation and support for up to 40 people. At the time of the inspection there were 32 people living at the home.

It is a condition of the provider’s registration to ensure that a manager carrying on the regulated activity at Lakeside Residential Care Home is registered with the Care Quality Commission (CQC). The provider has failed to comply with this condition since the last inspection in August 2016. A registered manager is a person who has registered with the CQC 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.

During this inspection we spoke with the new manager who had been in post approximately eight weeks. They told us they would be making an application to register. However following our inspection visit we were told a further manager had been appointed. So that the service is offered clear leadership and support the provider must ensure that the manager makes application to register with the CQC without further delay.

We have identified four breaches in regulation. You can see what action we told the provider to take at the back of the full version of the report.

Records did not clearly demonstrate if a person had the capacity to consent to their care and support or that people had been appropriately assessed as lacking capacity before decisions had been made in the person’s best interest. This meant people’s rights were not respected or protected.

People were potentially being unlawfully deprived of their liberty as authorisations had not been sought from the supervisory body (local authority) in a timely manner.

Effective systems to demonstrate the service was regularly monitored and reviewed needed to be embedded so that, where necessary, improvements were made and people received a good quality service.

The management and administration of people’s medicines needed improving to ensure people received their prescribed medicines safely.

People and their relatives were complimentary about the care and support offered by staff. Interactions were seen to be polite and respectful. Social and recreational opportunities were provided to enable people to maintain their independence and encourage their involvement.

Care records provided staff with sufficient information about the care and support people wanted and needed. Senior care staff were reviewing information to ensure records reflected the current and changing needs of people.

A programme of redecoration and refurbishment was in place to enhance the standard of accommodation and facilities provided for people. Checks were made to the premises and servicing of equipment and improvements had been made to help keep people safe in the event of a fire. Hygiene standards had been improved minimising the risks of cross infection.

We found that safe systems were in place with regards to the recruitment of staff. Staff received a programme of induction and training to help ensure they were able to deliver safe and effective care. Staff spoken with confirmed they were supported in carrying out

Lakeside Residential Care Home is a purpose built care home located on Smithybridge Road, leading to Hollingworth Lake. The home provides accommodation and support for up to 40 older people some of whom live with dementia.

This was an unannounced inspection which took place on the 17 August 2015. At the time of our inspection there were 38 people living at the home.

We last inspected Lakeside Residential Care Home in July 2014. We found the provider was not meeting all of the regulations that we reviewed. We found improvements were needed with regards to medication administration, staffing levels, records about care and support people needed and effective quality monitoring systems. The registered manager sent us an action plan telling us what action they were to take to meet the regulations. We looked at what improvements had been made during this inspection. We found systems had been implemented to monitor and review the quality of the service and care records provided good information to guide staff in the care people required. On-going recruitment had taken place to fill staff vacancies and overall the medication system was safe.

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.

The fire risk assessment identified that some areas needing attention had not been signed off as completed. Failing to monitor and mitigate assessed risks may place the health and welfare of people at risk of harm.

We found a breach in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We received a mixed response from people about the meal choices provided. We saw the lunchtime experience was not well organised and did not provide people with a relaxed sociable occasion. We have made a recommendation about the mealtime experience so that this promotes people’s choice, independence and well-being.

Opportunities for people to participate in a range of activities needed enhancing to meet the individual needs of people. We have made a recommendation about the type of opportunities made available to people to promote their well-being and encourage their independence.

Overall the management and administration of people’s prescribed medicines was safe.

People were supported by staff in a dignified and respectful manner promoting their autonomy and involvement. We saw staff assist people in a patient and unhurried manner. People and their visitors told us that staff were kind and considerate and they were always made welcome when visiting the home.

People’s visitors told us that staff had the necessary skills to support people properly. We found staff had been safely recruited and had received on-going training and support essential to their role so they were able to do their job safely and effectively. The registered manager offered support to those staff requiring further personal development and consideration was given to the skill mix of staff so that experienced and new staff were deployed on each shift.

Care records had been reviewed and updated to reflect people’s wishes and preferences about the support they needed. The registered manager was able to demonstrate their understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

Effective systems were in place with regards to the safety checks to the building and emergency equipment, which helped to keep people safe.

Where people’s health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed. People told us and records showed that people had regular access to health care professionals so changes in their health care needs could be addressed. Suitable equipment and aids were provided to meet the assessed needs of people and promote their independence.

The registered manager had a system in place for reporting and responding to any complaints brought to their attention.

We saw systems were in place to monitor, review and assess the quality of service so that people were protected from the risks of unsafe or inappropriate care. CQC had been formally notified of any accidents or incidents involving people, as required by law, to show that people were protected from unsafe care and support.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The manager has been registered with the Care Quality Commission (CQC) since March 2014. It is a condition of the provider’s registration that there should be a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The last inspection of the home was carried out in October 2013. The home was meeting all the assessed standards inspected at that time.

Lakeside Residential Care Home is situated in Smithybridge, close to Hollinworth Lake. The home provides care and accommodation up to 42 people who require assistance with personal care. The home mainly supports older people and people living with dementia. All but four bedrooms are single occupancy. At the time of our inspection there were 35 people living at the home.

Suitable arrangements were not in place to ensure that people received their medication as prescribed. Morning medication took a long time to administer and records were not accurately completed. This did not demonstrate a safe system was in place. This meant there was a breach in Regulation 13.

Sufficient numbers of staff were not always available, providing flexibility in the support people needed. Whilst staff were kind and respectful, people had to wait long periods of time to be supported in meeting their personal care needs ensuring their dignity was maintained. This meant there was a breach in Regulation 22.

Systems were in place to check the quality of the service provided. However, checks were not as effective as they should have been so that improvements enhanced the experiences of people and protected them against unsafe care and support. This meant there was a breach of regulation 10(1)(a)(b)

Individual care records were in place for people living at Lakeside. Records showed that people had regular access to health care professionals so that their health care needs were addressed. Care records were not as up to date as they should have been. This information is important so that staff are provided with clear information about the current and changing needs of people and how they wish to be cared for. This meant there was a breach in Regulation 20

Suitable arrangements were in place to promote and protect the rights of people, particularly where they lacked the ability to make important decisions for themselves. A programme of training and development was in place that staff had the knowledge and skills need to meet the current and changing needs of people.

We saw that mealtime arrangements were not well organised and received conflicting views about the quality of food provided. This was to be explored by the manager so that people’s views were taken into consideration.

Some people told us that opportunities for people to take part in activities both in and away from the home were limited. The registered manager was exploring ways to make improvements promoting people’s autonomy, independence and choice.

People living at the home and their visitors were complimentary about the staff and care and support provided. People told us staff were caring and respectful. All the people we spoke with were confident if they raised any issues or concerns these would be dealt with to their satisfaction.

We found breaches of the health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the management of medicines, accurate and up to date care records to guide staff, staffing arrangements to support people and the monitoring of the quality of service people received. You can see what action we have told the provider to take at the back of the full version of this report.

We saw that people enjoyed a good rapport with staff. People were encouraged to be as independent as possible and where necessary, were assisted in a gentle and unhurried way. People who we spoke with told us, “The staff are generally nice and helpful” and “I always enjoy the food”.

We also spoke with a visiting healthcare professional. They told us; “Overall they [the staff] are excellent” and “Staff address issues in a timely manner so that people have what they need”.

Care records provided detailed information about the individual needs and wishes of people, clearly directing staff in the safe delivery of people’s care and support.

Suitable arrangements were in place to ensure people’s nutritional needs were met.

Further recruitment had taken place so that sufficient numbers of staff were available at all times, ensuring people received consistency and continuity in their care and support.

Arrangements for staff training and development were being developed so that staff had the knowledge and skills needed to meet the varying needs of people living at the home.

Systems to monitor and review the quality of service provided were in place to check that people received a quality service.

The home has been without a registered manager for some considerable time. The management team we spoke with were aware that this must be addressed without further delay.

During our visit we spent sometime speaking with people about their experiences and what is was like to live at Lakeside.

People told us; “They (the staff) are very accommodating and very friendly”, “They look after us well”, “The staff are caring and helpful” and “It’s home from home really”.

One person told us that their visitors were always made welcome and could “come and go anytime”.

People said that refreshments were available throughout the day and that they enjoyed the meals provided.

We also spent time observing how staff provided care and interacted with people. The atmosphere was relaxed and there was a friendly rapport between staff and people living at the home. People were spoken to in a polite and respectful manner and staff were patient when offering assistance.

During our visit we had an opportunity to speak with a number of people who live at the home as well as visitors. Overall people were happy living at Lakeside and felt their care needs were met. However people did comment about the lack of activities and variety to their day. One person said; “You never see staff sitting down and talking to residents”.

Staff were seen to talk politely and sensitively with people. Staff sat with those people requiring assistance and offering encouragement with their meal. People were seen to be enjoying the food.

From our observations we found that routines were flexible with people rising at different times, people had been assisted in caring for their appearance, were nicely dressed and their hair was tidy.

Comments from people included; “The staff are very kind and helpful”, “They make a real effort when it is someone’s birthday” and “I can chose when I want to go to bed”.

People told us that the atmosphere at the home had also improved over recent weeks and that staff seemed happier.

One person told us, “I have nothing but praise for the acting manager, she has clear boundaries and she will sort things out that the staff are not doing or doing wrong. She is very approachable and easy to get on with”.

During our visit we also spoke with the visiting district nurses. They told us that as far as they were aware staff followed instructions that were left in relation to the care of people. They felt that there was good communication with the staff and had no issues with this home.