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Archived: The Limes Care Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 8 December 2016

This inspection took place on 8 November 2016 and was unannounced. The Limes Care Home provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 25 people living at the home.

There was not a registered manager in post. An application for the current manager to become the registered manager had been made to CQC. 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.

At this inspection we found that the provider had failed to ensure that previous improvements had been sustained. We found that there were five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. You can see what action we have taken at the back of the full version of this report.

On the day of our inspection people were not cared for safely. Staff knew how to safeguard people against abuse however staff did not have the appropriate competencies and skills to provide safe care. Staff did not respond appropriately and in good time to people's changing needs.

Medicines were not managed appropriately and safely. People did not always get their medicines as prescribed. The management of infection prevention and control did not mitigate the risk of cross infection.

Staff did not follow care plans when delivering care. Staff did not respond in an appropriate manner to people and did not always provide emotional support to people. Staff were not consistently kind to people when they were providing support. People did not have their privacy and dignity considered. Staff were able to tell us about people’s needs but we did not see care being provided in a way that met their needs.

We found that people’s health care needs were assessed however care was not planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. However we observed medical assistance was not always provided in a timely manner.

Staff did not always provide care according to their training. Staff were provided with training on core areas but had not received training in areas specific to the needs of people who lived at the home such as care of people with dementia. The provider had a training plan in place and staff had received supervision.

The provider did not always act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

People did not have their nutritional needs met. People had their nutritional needs assessed but were not always supported with their meals to keep them healthy. Where people had special dietary requirements we saw that these were not consistently provided for. People had choices at mealtimes.

People had access to limited activities. Signage in the home was poor and not provided in a manner which assisted people with dementia to orientate themselves.

Records were not accurate and did not include a record of the care and treatment provided to the service user and of decisions taken in relation to that care. Care plans were not updated consistently and did not reflect the care people required.

Systems were not in place to adequately assess, monitor and improve the quality and safety of the services. Audits were in p

Inspection areas

Safe

Inadequate

Updated 8 December 2016

The service was not safe.

Risk assessments were not updated and consistent.

Medicines were not administered safely.

Care was not provided as detailed in the care records. People were at risk of developing pressure sores, choking and having falls.

There were sufficient staff to provide care but staff did not respond to people appropriately.

Staff were aware of how to keep people safe from abuse.

Effective

Inadequate

Updated 8 December 2016

The service was not effective.

The provider did not act in accordance with the Mental Capacity Act 2005.

People did not have their nutritional needs met. People were not always supported with their meals.

Staff did not have the knowledge and skills to carry out their roles and responsibilities effectively.

Staff did not recognise the need for people to have access to urgent medical support.

Caring

Requires improvement

Updated 8 December 2016

The service was not consistently caring

Staff did not always respond to people’s emotional needs.

Staff did not respond to people in a kind manner.

People did not have their dignity maintained.

Responsive

Requires improvement

Updated 8 December 2016

The service was not consistently responsive.

Care records did not reflect the care people required. People and relatives were unaware of their care plans.

People had access to activities.

The complaints procedure was on display and people knew how to make a complaint.

Well-led

Inadequate

Updated 8 December 2016

The service was not well led.

The systems and processes in place to check the quality of care and improve the service were not always effective. The provider did not have adequate systems in place to ensure that the service was well-led.

A registered manager was not in post.

The provider had not acted as required by the CQC in displaying their rating on their website.

Staff felt able to raise concerns.