Background to this inspection
Updated
20 May 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
The Limes Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Limes Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with seven people who used the service about their experience of the care provided. We spoke with six members of staff including the deputy manager, senior care workers, kitchen staff and care workers. We spoke with three visiting professionals and two relatives about their experience of the care provided at the home.
We reviewed a range of records. This included six people’s care records and multiple medicine records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including training records, policies and procedures were reviewed.
Updated
20 May 2022
About the service
The Limes Care Home is a residential care home providing personal care to 12 people aged 65 and over some of whom were living with dementia at the time of our inspection. The Limes Care Home can support up to 40 people across two floors, due to the number of people using the service only the ground floor was in use.
People’s experience of using this service and what we found
Medicines were not managed safely, and people were at risk of not receiving their prescribed medicines. People were not protected from the risk of harm or abuse. Staff did not know how to report or who to report safeguarding incidents too. Risks had not been assessed and risk reduction measures were either not in place or not followed.
Infection prevention control measures were not in place and did not protect people from risk of harm, lessons were not learnt which resulted in incidents being repeated. Safe recruitment practices were not followed which left people at risk of receiving care from unsuitable people.
People did not have their needs fully assessed and care was not delivered in line with best practice guidance and the law. This left people at risk of receiving unsafe care. People were not offered choice in what they wanted to eat, or drink and risks associated with eating and drinking were not managed safely.
People were not always supported by trained staff. Staff had not received training in areas such as safeguarding and moving and handling. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People did not receive personalised care and support. People were not offered choices in how they wished to spend their time and there were no activities on offer. End of life care plans were not in place and there was in delay in seeking medicines and clinical advice for people receiving end of life care.
People were not provided with consistently kind and caring support, they were not given choices or consulted about their care. Staff did not always support people in a dignified way, and they did not always acknowledge people who required support.
The lack of leadership, management and governance measures meant the service was not well led. This meant people were at risk of receiving care which placed them at risk of harm in an unsafe environment. Lessons were not learnt, and this resulted in repeated incidents which placed people at risk of harm.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update: The last rating for this service was inadequate (published 22 April 2022) and there were multiple breaches of regulations. At this inspection we found improvements had not been made and the provider remained in breach of regulations.
Why we inspected
The inspection was prompted due to concerns about staffing, management, infection control, and how people were safeguarded from the risk of neglect. Due to the increasing concerns a decision was made for us to inspect much sooner than planned and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the full report.
You can see what action we have asked the provider to take at the end of this full report.
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.
Enforcement
We have identified breaches of regulations in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, fit and proper persons employed, person-centred care, nutrition and hydration, dignity and respect and good governance.
We took urgent enforcement action to ensure people were kept safe from harm and suspended the providers registration, all people living at the service moved out of the home following our inspection.
Due to the repeated breaches and failure to make improvements to exit special measures enforcement action was taken against the provider to remove their registration.
Follow up
We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures: The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.