CQC report explained · a nursing home
What the CQC found at Lake View Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some environmental and equipment risks were not identified, including unlocked rooms, incomplete fire safety checks and an unserviced hoist. Medicines, staffing, safeguarding and infection control were otherwise generally managed well.
- Effective?
- Requires improvement
- People received assessments, personalised care and support with food, training and healthcare. However, Mental Capacity Act assessments were inconsistent and some relatives were not involved in care planning.
- Caring?
- Good
- Inspectors saw staff treating people with patience and kindness. Staff respected privacy and dignity, encouraged independence and listened to people’s views.
- Responsive?
- Good
- Care plans reflected people’s preferences, and staff supported activities, family relationships and communication. The home planned to provide more community activities and a sensory room.
- Well-led?
- Requires improvement
- Managers were approachable and staff felt supported, but audits and governance systems did not reliably identify risks or missing assessments. This led to a breach of Regulation 17.
What inspectors found, March 2023
Lake View Nursing Home was rated Requires Improvement; inspectors found kind, responsive care but weaknesses in safety, consent and management systems.
This was the home’s first inspection since it registered. Inspectors visited without notice on 20 and 22 December 2022 and 5 January 2023. They spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment and management records.
The home was rated Good for Caring and Responsive. People were treated kindly and with dignity. Staff knew people’s preferences, supported activities and helped people keep in touch with relatives. Medicines were managed safely, staffing levels were considered sufficient, and staff had training and induction.
The home was rated Requires Improvement for Safe, Effective and Well-led. Inspectors found incomplete fire safety checks, an unserviced hoist, unlocked rooms containing potentially harmful items, and missing risk assessments for some health conditions. Mental Capacity Act assessments were inconsistent, and management audits had not found all the problems.
The provider acted quickly on some issues during the inspection. CQC found a breach of Regulation 17 on good governance and asked for an action plan. CQC said it would monitor progress with the local authority and use further information to decide when to inspect again.
Kind and respectful staff
People and relatives described staff as patient, kind and professional. Inspectors saw staff protecting privacy, dignity and independence.
“We saw people were treated with patience and kindness by the staff who supported them.” from the report
Medicines managed well
Medicines were administered and recorded correctly. Regular audits found errors and the home acted on them quickly.
“Medicines were administered in line with people's prescriptions and recorded appropriately on a Medication Administration Record (MAR).” from the report
Enough trained staff
Inspectors found enough suitably trained staff, with safe recruitment checks in place. Agency staff also received induction and training.
“People were supported by enough staff who were suitably trained.” from the report
Personalised activities and care
Care plans included people’s likes and dislikes. Staff supported activities in the home and helped people maintain family relationships.
“People's care plans were person-centred and included people's likes and dislikes.” from the report
Management checks missed risks
seriousAudits did not identify all safety problems, including an unserviced hoist and missing health risk assessments. This was a legal breach.
“Effective quality assurance systems were not in place to mitigate risk of harm to people in the care home.” from the report
Fire safety checks
seriousSome fire safety checks had not been completed because the person responsible was unavailable. There was no backup plan for completing them.
“There was no contingency plan for weekly fire safety checks to be completed in the absence of the person allocated to complete them.” from the report
Missing health risk assessments
needs fixingRisk assessments for conditions such as diabetes and epilepsy were not always in place. This could make it harder for unfamiliar staff to recognise problems quickly.
“Some risk assessments were in place, however, there was a lack of risk assessments for more specific health conditions, for example diabetes and epilepsy risk assessments.” from the report
Mental capacity assessments
needs fixingThe quality of Mental Capacity Act assessments was inconsistent. Some were not specific to the decision being made, so the provider could not be sure decisions were assessed lawfully and in people’s best interests.
“Some MCA assessments were not decision specific.” from the report
Mixed involvement in care planning
minorSome relatives said they had not been involved in their family member’s care plan, although others said they took part in reviews.
“We haven't been involved in [person's] care plan.” from the report
- 01Have all fire safety checks been completed, and what backup arrangements are now in place if the responsible person is absent?
- 02Have all lifting and other care equipment been serviced, and how are servicing dates checked?
- 03Which risk assessments have been added for conditions such as diabetes and epilepsy?
- 04How are Mental Capacity Act assessments now checked to ensure they are specific to each decision and include best-interest decisions where needed?
- 05How will you make sure relatives are invited to take part in care plan reviews?
This was an unannounced first full inspection covering all five key questions and infection prevention and control. This explanation was written from the published report of 8 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Lake View Nursing Home
Each visit the CQC has published, newest first, back to the day the home was registered.
- March 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2022
Registered with the Care Quality Commission on 17 August 2022.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
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What to check when you visit
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Most charge £980 to £1,190 a week. 93 can care for a couple. 9 years' experience on average.
“She's shown compassion, patience and a level of understanding that no other carer has given.”
“She maintained a great environment for mum both with the tidiness and cleanliness of the house and Mum and with her caring and understanding attitude.”
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