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Archived: The Limes Care Home Inadequate

Reports


Inspection carried out on 8 November 2016

During a routine inspection

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 carried out on 28 September 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 16 April 2015. Breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection on 16 April 2015 we found that the provider was not meeting the standards of care we expect in relation to ensuring that appropriate arrangements for the management of medicines are in place. Care and treatment was not provided in a manner which mitigated risks and systems and processes were not in place for the monitoring and improvement of the service.

We undertook this focused inspection on 28 September 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. During this inspection on the 28 September 2015 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Limes Care Home on our website at www.cqc.org.uk.

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 30 people living at the home.

At the time of our 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.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. The provider had systems and processes in place to assess risks and keep people safe.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The management and administration of medicines was in line with national guidance.

Arrangements were in place to monitor the quality of the service and make changes to the service in order to improve care. People, staff and relatives felt able to raise issues and were confident that they would be addressed.

Inspection carried out on 16 April 2015

During a routine inspection

This inspection took place on 16 April 2015 and was unannounced.

The Limes provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 30 people who require personal and nursing care. At the time of our inspection there were 26 people living at the home.

At the time of our 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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People told us that they felt safe and well cared for. When we spoke with staff they were able to tell us about how to keep people safe. However, medicines were not administered correctly and infection control risks were not consistently managed. People were at risk of cross infection.

We saw that staff obtained people’s consent before providing care to them. However, the provider did not act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). 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.

We found that people’s health care needs were assessed, and care planned to meet those needs. However, we identified concerns about how care was delivered to maintain people’s health. People had access to other healthcare professionals such as a dietician and GP however on some occasions we found that appropriate referrals had not been made.

Staff were kind to people when they were providing support, however, we observed some occasions when people were not treated appropriately. Staff had a good understanding of people’s needs. People had access to activities and excursions to local facilities however there was little opportunity for them to pursue personal interests.

People were not always supported to eat enough to keep them healthy. People were offered drinks throughout the day but did not have open access to drinks during the day. People did not have choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. Staff told us that they felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. They said they would feel comfortable raising issues with the registered manager. The complaints process was openly in view however, it was only available in written format, therefore not everyone was able to access this.

Audits were carried out on a regular basis, however they were not always effective and did not consistently address the issues which were identified . Accidents and incidents were recorded and reviewed to ensure trends and patterns were identified, however, actions were not always in place to limit the reoccurrence of these.

During a check to make sure that the improvements required had been made

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service safe?

During our inspection on 20 May 2014, where people did not have the capacity to consent, the provider had not acted inaccordance with legal requirements. It was not clear in the records whether people had capacity to consent to care.

The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) are laws which protect people who are unable to make decisions for themselves.

The provider sent us an action plan which told us how they planned to address the concerns.

During our review on 31 July 2014, we found that the provider now had a process in place where people's capacity to consent had been reviewed. The provider had also taken action and amended a care plan audit which included when people's capacity to consent to care had been undertaken and if and when they were due for review.

Inspection carried out on 20 May 2014

During a routine inspection

The summary is based on our observations during the inspection, speaking with people who used the service, and the staff who supported them. We spoke with two staff members, three relatives and two people who used the service. We also looked at five care records in detail and other documentation.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We observed care and saw how members of staff treated people. We saw care was delivered well and in a respectful way. We saw that staff were kind and attentive and encouraged people to participate in their care. Staff also showed patience and

gave encouragement when they supported people.

During our inspection we observed staff spoke with people on an individual basis and understood their particular needs. For example, we observed when staff provided care to people they chatted with them about things which were important to them such as their family.

We observed when staff supported people they did so at people's own pace and encouraged people to participate in their care. For example, when they supported people to move they asked them if they were okay and explained what they were doing whilst supporting them.

Is the service responsive?

We saw that people's individual physical, mental and social care and support needs were assessed and met. We saw evidence that care plans had been recently reviewed.

During our inspection we saw staff gave people choices and asked them what they would like to do before assisting them. For example, when offering drinks people were given choices about what drink they would like and if they would like a biscuit with their drink.

We observed staff obtained people's consent before they carried out any care. For example, staff asked people if they wanted support with a task and where they would like to eat their meal at lunchtime.

Is the service safe?

Risk assessments regarding people's individual care needs, for example falls and mobility were carried out and measures were in place to minimise these risks. The service had risk assessments in place for areas such as falls and skin care.

The home had policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves.

However, where people did not have the capacity to consent, the provider had not acted in accordance with legal requirements. It was not clear in the records whether people had capacity to consent to care.

At the time of our inspection there was no one who was considered to be deprived of their liberty.

The service was safe, clean and hygienic. We saw that regular checks were made on the cleanliness of the building. We observed some refurbishment had taken place since our previous inspection.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members. One relative told us that their relation had improved since coming to the home.

We observed care plans had been updated to reflect people's changing needs and where people had short term needs due to illness care plans were in place to ensure these were met.

We observed staff responded to people's needs and requests in a timely manner.

Is the service well led?

Staff said that they felt supported and trained to safely do their job. They told us they felt able to raise issues with the managers and had opportunity to do so at staff meetings and supervision sessions.

Quality assurance arrangements and checks were in place and people were listened to. Surveys had been carried out with relatives and people who lived at the home.

We saw evidence learning took place following incidents. Processes were in place to monitor incidents and accidents in order to prevent them occurring again. Audits had been carried out and action plans put in place to ensure the continual improvement of the service were undertaken.

During a check to make sure that the improvements required had been made

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Inspection carried out on 29 July 2013

During a routine inspection

During our visit we spoke with three people who lived at the home, one relative, a visiting professional and a staff member. We also looked at records and observed care. Overall we observed people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people and interacted with them positively. We saw staff supported people to move at their own pace and safely.

We spoke with a relative. They told us the staff were, "Very,very good."

People told us the staff were caring and looked after them well. One person said, "It’s not home but people (staff) are very caring.”

We looked at how people's nutritional needs were met and found people received effective nutritional support, to meet their assessed needs. People told us the food was good and we saw people were able to choose their meals.

When we spoke with staff they told us they had received training to enable them to provide appropriate care to people.

We found gaps in the records we looked at which meant people were at risk of receiving inappropriate care.

Inspection carried out on 14 February 2013

During an inspection to make sure that the improvements required had been made

We did not speak to people about their care during this visit.

At our last inspection on 4 October 2012 we issued a compliance action, as we were concerned there were not sufficient numbers of suitably qualified, skilled and experienced persons available in order to safeguard the health, safety and welfare of people.

During this visit we spoke with the registered manager and a member of care staff. We also looked at a range of documentation.

We found additional staff had been recruited to to support care staff during the busy periods,for example mornings and evenings. These were new roles and the staff were called 'hostesses'. The provider had also employed staff to carry out cleaning and laundry services. When we spoke with a staff member they told us, "The staffing is better." They said they thought the new roles worked well and they were working as a team to support people.

When we looked at the staffing rotas we saw they were as the manager had told us and incuded the additional staff.

Inspection carried out on 4 October 2012

During an inspection to make sure that the improvements required had been made

We did not speak to people about their care during this visit.

At our last inspection of The Limes on 4 July 2012 we issued a compliance action, as we were concerned staff were not receiving appropriate support to enable them to carry out their role. We were concerned that at this time no member of staff had received an appraisal.

Following this visit we received an action plan from the provider to address the issues. In the action plan the provider said they would provide all current staff with an appraisal by September 2012.

During this visit we spoke with the registered manager by telephone, relatives and three care workers. We checked a range of documentation and checked on the progress the manager had outlined at the meeting. We requested additional information which we have received.

We found all staff had received an appraisal by 30th September 2012. .

We spoke with staff and they told us they had found the appraisal process useful.

We did not intend to follow up on outcome 13 but during our visit we spoke to staff and relatives who raised concerns about staffing numbers. We also observed incidents where people did not receive their care in a timely manner.

Inspection carried out on 3 July 2012

During a routine inspection

As part of our inspection we spoke with a number of people who used the service.

People told us that they liked living at the home.

One person told us, “I love it here.”

People said they could usually get help when they needed it. One person said that staff, “Come as soon as they can.”

A relative said the home had always been a happy friendly place but now it was better organised.

They also told us they felt able to raise issues with the staff and managers.

People said that the food was good and were given a choice of meal at mealtimes.

Inspection carried out on 6 January 2011

During an inspection in response to concerns

On the day of our visit we spoke to a number of staff and people who use the service. We received many positive comments from people who felt respected and involved. One person said "I feel well looked after”. Another person told us "staff look after us lovely, they treat us very well and we like it hear”, They also said "there is a good choice of food and it’s always lovely." We were told that staff treat people with respect and they had a lovely Christmas.

People who use the service told us there are a lot of activities to choose from and there is always something to do. One person told us, “the staff helps me to have a shave and I could have a bath when they want one”.

A number of people who use the service told us, "the laundry is OK; we always get our own clothes back no problems”. People also said that they have their own clothes and choose what they want to wear; there was no problem with the laundry the clothes which are returned belong to them.

We were told by a person that uses the service, "the staff are wonderful”. Another person said, "staff are excellent, kind and caring. There were enough staff but they were very busy."

Reports under our old system of regulation (including those from before CQC was created)