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Inspection Summary


Overall summary & rating

Good

Updated 19 September 2018

This inspection visit took place unannounced on 9 August 2018 and we returned announced on 10 August 2018 to look at the quality assurance systems and to speak with people and staff.

The Limes is a two-storey residential home which provides care to older people including people who are living with dementia. The Limes is registered to provide care for 30 people. At the time of our inspection visit there were 27 people living at the home. Care and support was provided across both floors and each floor had its own communal lounge and dining area.

People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 last inspection we rated the service Good overall, with Well led being rated as ‘Outstanding’ because we found the provider learnt from previous inspections to drive improvements, shared good practice and the culture promoted open and continuous learning. At this inspection we found the service remained overall Good, however ‘in Well led’ we found the governance audit systems had not identified some of the issues we found which affected the standards of the care being provided.

Systems to ensure safe management of medicines were not always followed in line with current guidance and the provider’s own policies. Medicines were not always stored, recorded and given in line with current NICE guidance and staff who administered medicines were not confident or had sufficient knowledge using the electronic medicines management system.

People and relatives were very complimentary and satisfied with the quality of care provided at the home. People felt safe living with other people in the home and they were supported by a consistent, kind and caring staff team.

Staff were available at the times people needed and there were enough staff to respond to people’s needs and requests for assistance. Staff received training so that people's care and support needs were met by staff who knew how to support them. Staff understood their responsibility to safeguard people from harm and report any concerns they had to the management team.

People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. People were treated with respect by staff who addressed them by their preferred names and who supported them in line with their personal preferences and wishes.

No one at the time of our visit received end of life care. The registered manager said care was given so if people wanted, ‘this was a home for life’. Anticipatory and pain relief medicines were arranged and held so if people’s condition quickly deteriorated, their care could remain as pain free and dignified as possible.

The provider worked in partnership with other healthcare professionals to ensure people received effective care that was responsive to their needs. People’s medicines were not always stored and managed safely.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported best practice and decisions were made with family members who had legal authority to do so.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). People's right to make their own decisions about their care, were supported by staff who understood the principles of the Mental Capacity Act 2005.

There wa

Inspection areas

Safe

Requires improvement

Updated 19 September 2018

The service was not consistently safe.

There were enough staff to keep people safe, and the care staff team knew people’s care and support needs. People's risks to their health and wellbeing were assessed and planned for. Systems to ensure safe management of medicines were not always followed in line with current guidance and the provider’s own policies. People felt safe with staff who understood their safeguarding responsibilities. Accidents and incidents were recorded by staff and learning from such events was encouraged and acted upon.

Effective

Good

Updated 19 September 2018

The service remains effective.

Caring

Good

Updated 19 September 2018

The service remains caring.

Responsive

Good

Updated 19 September 2018

The service remains responsive.

Well-led

Good

Updated 19 September 2018

The service is well led.

At the last inspection we rated well led as 'outstanding' because the provider learnt from previous inspections to drive improvements and the culture promoted continuous learning and their audit systems were effective. At this inspection, completed audits did not always identify the issues we found, particularly around care plans and medicines management. Learning from other inspections within the provider’s organisation had not been shared so we found similar issues that affected the quality of care people received.