Archived: The Limes

The Limes care home provides accommodation for a maximum of 30 people. It provides intermediate care (rehabilitation) for 28 people, which is shared with Salford Primary Care Trust and staffed by a Multi-Disciplinary Team. The home also provides two respite beds for people who require short term placements.

The provider, which is called Aspire for Intelligent Care and Support C.I.C Ltd, is a new employee owned social enterprise and is a ‘community interest company,’ which registered with CQC in June 2015.The service had up until that point been operated by Salford City Council. The ‘community interest company’ structure is intended to ensure that assets are kept within the company and activities are carried out to benefit the local community. Though Aspire is a new provider, the service is run by the same management and staff team, who were previously employees of the local authority. All staff had the opportunity to purchase a one pound share that had no monetary value, but entitled them to vote at the annual general meeting and to have an input into how their company was run.

There was a 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.

We found the management and administration of medication was not safe.

We reviewed 13 medication administration records (MAR) and found six did not have people’s allergies recorded. Not having allergies recorded increases the risk of medicines being given to someone with an allergy.

Minimum and maximum fridge temperatures were not recorded everyday as per national guidance.

We checked the Controlled Drugs (CD) cabinet and register and found concerns with how CDs were being recorded, checked and how they were being returned to the pharmacy for disposal.

Medicines were not always administered as prescribed. One person was not given a medicine to thin their blood on one day and a tablet to help their bones for two days as the medicines were not available in the home to give and staff could not explain the reason for this. Another person who was taking a medicine for Parkinson’s disease that needed to be administered at specific times did not receive it at the required time on six occasions.

The medicines policy had not been updated since 2005, and medicine audits had not been completed since September 2015. An up-to-date medicine policy ensures that staff have the most recent guidance and medicine audits highlight areas for improvement.

This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of safe care and treatment. The service had not protected people against the risks associated with the safe management of medication.

The Limes care home provides accommodation for a maximum of 30 people. It provides intermediate care (rehabilitation) for 28 people, which is shared with Salford Primary Care Trust and staffed by a Multi-Disciplinary Team. The home also provides two respite beds for people who require short term placements.

The provider, which is called Aspire for Intelligent Care and Support C.I.C Ltd, is a new employee owned social enterprise and is a ‘community interest company,’ which registered with CQC in June 2015. The service had up until that point been operated by Salford City Council. The ‘community interest company’ structure is intended to ensure that assets are kept within the company and activities are carried out to benefit the local community. Though Aspire is a new provider, the service is run by the same management team and staff, who were previously employees of the local authority. All staff had the opportunity to purchase a one pound share that had no monetary value, but allowed them to vote at the annual general meeting and have input into how their company was run.

There was a 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.

This service and provider have not been previously been inspected by the Care Quality Commission (CQC).

We found the home relied heavily on the clinical assessments that had been undertaken by the healthcare teams such as the MDT or visiting health professionals. These included risk assessments such skin integrity, falls risk and nutritional. Staff were able to confirm that risk assessments had been undertaken and confirmed that these were discussed and documented at handovers. We found no evidence in any of the care files we looked at that risk assessments had been undertaken by the home and there was only very limited written guidance available for staff on how to manage risk for individual people around falls.

Overall after discussions with both the visiting health professional and the MDT team members, we were satisfied that the management of risk was safe, however this was not accurately reflected in care files. Records relating to risk assessments and involving the MDT and District Nurse Team were held separately. We found the MDT, District Nurses and the home were all involved in caring for people who used the service. MDT and District Nurses carried out their own assessments, but the documentation of how it was improving the outcome for individuals was not captured.

This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 3), in relation to good governance. We found the service had failed to maintain accurate and complete contemporaneous records for people who used the service.

We spoke with staff to see what supervision, annual appraisals and support they received. Supervisions and appraisals enabled managers to assess the development needs of their staff and to address training and personal needs in a timely manner. Whilst some staff acknowledged receiving supervision and confirmed that support was always available, a number of staff stated they had not received supervision consistently and could not remember whether they had received an annual appraisal.

One manager told us that each assistant managers had been allocated staff to undertake supervision with and they were currently aiming to undertake this every three months. From speaking to staff and looking at supervision records, this was not currently happening.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because the provider could not demonstrate the appropriate support and professional development of all staff.

We found there were no management systems in place to review the quality of care files and ensure accurate and complete contemporaneous records were maintained for people who used the service. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service failed to assess and monitor the quality of service provision effectively.

People we spoke with consistently told us that they felt the home provided a safe and secure environment.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse.

We looked at how the service ensured there were sufficient numbers of staff on duty to meet people’s needs and keep them safe. During our visit we found there were sufficient numbers of staff on duty during the day to support people who used the service.

We found people were protected against the risks associated with medicines, because the provider had appropriate arrangements in place to manage medicines safely.

The environment within the home was generally clean, but there were areas where the décor appeared to be old and in need of redecoration.

Staff we spoke with confirmed they received an induction when they started working at the home, which included an introduction to the workplace, working systems, policies and procedures, training and development requirements.

Throughout our inspection, we observed staff seeking consent from people before delivering any care or treatment such as medication, support with mobilising, personal hygiene or support with eating.

We have made a recommendation about suitable environments for people living with dementia.

People we spoke with were complimentary about their overall impression with the care and support provided at the home. People who lived at the home described staff as caring and spoke positively about them.

Health professionals we spoke with during the inspection including the members of the Intermediate Care Team or visiting Health professionals told us that the home responded professionally, efficiently and with good effect for people who used the service.

We found that the service routinely listened to people to address any concerns or complaints. We found the provider had effective systems in place to record, respond to and investigate any complaints made about the service.

Staff told us they enjoyed working at home and that managers were approachable and listened to any concerns they had.

We looked at the minutes from various team meetings including staff and senior team leaders. We saw topics of discussion included rotas, professional boundaries, meal times, medication and falls management.