Archived: The Limes Care Home

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.

The Limes Care Home is a residential care home providing personal care to 17 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

People were not protected from the risk of abuse. Infection control measures were ineffective and government guidance was not followed or adhered to in order to reduce the risk of possible transmission of COVID-19. There were not enough adequately trained staff to support people safely. Staff were not recruited safely.

Medicines were not managed safely, and little action had been taken since our last inspection to address known issues. Care plans were not updated as people’s needs changed, and people had not been adequately assessed prior to moving into the home. Risk management and oversight remained poor.

Management of the service was inadequate. A large number of people had been admitted into the service unsafely in a short space of time. A number of issues which had been identified to the provider during our last inspection had not been addressed. The provider had no systems and processes in place to assess risk and monitor quality and safety. There was no oversight of the quality of care 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

The last rating for this service was inadequate (published 26 February 2022).

Why we inspected

The inspection was prompted due to concerns regarding people being admitted unsafely to the home, staffing, management, infection control, and how people were safeguarded from the risk of abuse. 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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. 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 and good governance.

Please see the action we have told the provider to take at the end of this report.

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 the 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.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Limes Care Home is a residential care home providing personal care to 10 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 receiving their prescribed medicines unsafely. Risk management was poor and there were insufficient risk reduction measures in place in order to protect people from risk of harm. Infection control measures were ineffective and government guidance was not followed or adhered too in order to reduce the risk of possible transmission of COVID-19. Staff were not recruited safely, and staff training was not always completed in order to care for people safely.

Management of the service remained poor and insufficient improvement had been made in order to improve the quality and safety of care provided. Issues found during our last inspection had not been effectively addressed and people remained at risk of receiving unsafe care. Governance systems were not effective, and action was not taken to address areas of concern. Provider oversight was poor, and they failed to take timely action on known issues.

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.

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 3 September 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to infection control and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained as inadequate, this is based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this 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 in relation to safe care and treatment, safeguarding people from the risk of abuse, staffing, recruitment and management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 the 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.

The Limes Care Home is a Residential Care Home providing personal and nursing care to 10 people aged 65 and over at the time of the inspection. The service can support up to 40 people. The service was purpose built with bedrooms and communal areas split across two floors. Due to the number of people living in the home at the time of the inspection only the ground floor was in use.

People’s experience of using this service and what we found

Risks were not always assessed, identified and managed to meet people’s needs. Medicines were not consistently managed safely. Infection control processes were not following government guidelines to ensure they would be safe and effective.

Staffing levels were not sufficient. There had been a high turnover of staff within a short timeframe. The provider had made limited improvements and lessons learnt were not effective.

Governance and management systems were not always reliable and effective. The service lacked the drive for improvement to address issues and concerns we raised during our last inspection.

There was very little leadership and oversight of the service was poor. There was insufficient risk management and quality monitoring. Auditing was not robust and there were missed opportunities for learning and improving the quality of care.

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 requires improvement (published 10 November 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 27 August 2020 and found concerns with how the provider monitored the quality of the service. The provider completed an action plan after the last inspection, detailing what action they would take to improve and by what date.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care services inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. 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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe, risk management, medicines, staffing numbers, staff recruitment, leadership and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Limes Care Home is a Residential Care Home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

The service was purpose built with bedrooms and communal areas split across two floors. Due to the number of people living in the home at the time of the inspection only the ground floor was in use.

People’s experience of using this service and what we found

Systems and processes to assess and monitor quality were still not effective. Health and safety had not always been kept up to date. This included recording of temperatures and risk assessments. Some audits had not identified issues found, consequently, these had not been fully addressed. Supervision records did not reflect staff training and development needs.

Incidents and accidents were reviewed and monitored, but the investigations did not always identify and mitigate the risk. Risk assessment and safety monitoring records were not always completed in a timely manner. Measures were in place to keep people safe from harm. There was sufficient staff for the number of people living at the home at the time of this inspection. Medication and risk of infection was managed.

We have made a recommendation that management, review all known risks for people.

Staff were recruited safely, but interview questions were not always available to reflect the rational and suitability of the staff member.

Since our last inspection training had improved, but the training style of online training did not meet all staffs training needs. Supervision was completed but did not reflect training and professional development.

We recommend the provider reviewed the supervision process.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published 26 February 2020. The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections. At this inspection some improvements had been made, however further improvement were required to comply with the regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 January 2020. breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

Enforcement

We have identified one breach in relation to good governance. 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.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe, as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service has been in Special Measures since 20 January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

The Limes Care Home is a residential care home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

The service is purpose built with bedrooms and communal areas split across two floors. Due to the number of people living at the home at the time of our inspection only the ground floor was in use.

People’s experience of using this service and what we found

People were not always protected from risks associated with their care and support. People remained at risk of falls due to inconsistent risk management. Opportunities to learn from patterns and trends of incidents had been missed. The home was not clean and hygienic, and staff used some unsafe practices that could increase the risk of infection. There were not always enough staff to keep people safe. Further work was required to ensure staff had skills and competency to provide safe and effective care.

Systems to ensure the safety of the home were still not fully effective. Audits had not identified issues, consequently these had not been addressed. Records of care and support were not always accurate or up to date. Personal sensitive information was not stored in line with legal regulations. The provider had not complied with conditions imposed upon their registration.

Since our last inspection, improvements had been made to medicines management systems. This meant people received their medicines safely, as required. Recruitment practices had also improved which meant staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Overall, people had enough to eat and drink, however mealtimes were not always positive experiences. People were supported with their health needs and had access to healthcare services. Overall, the home was adapted to meet people’s needs.

People were supported by staff who were kind and caring. People told us staff consulted with them about their day to day care and said they felt listened to. Staff respected people’s right to privacy.

Although people told us staff understood their support needs, we found there was a risk of inconsistent support, as care plans were not always detailed or up to date. People did not consistently have enough to do with their time. People and their families felt comfortable raising any complaints or concerns. People were given the opportunity to discuss their end of life wishes.

Since our last inspection improvements had been made to better involve people, families and staff in the running of the home. The management team understood their duty to be open and honest with people and worked in partnership with external agencies.

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 (report published 17 July 2019). This service has been rated as requires improvement or inadequate at the past five inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvements been made, however further improvements were required to comply with the regulations.

Why we inspected

This was a planned inspection based on the previous rating. It was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified three breaches in relation to safe care and treatment, staffing and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Requires improvement’. However, we are keeping the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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 the 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.

Since our last inspection, the provider had failed to act to show a sufficient and sustained improvement in the service provided for people. There continued to be a lack of clear quality monitoring processes in place to provide the oversight required to improve the quality of care provided for people.

The lack of up to date clear robust information on people’s care needs continued to impact on the care they received. There remained inconsistency in the assessment of people’s needs and there was a lack of measures in place to mitigate the risks to people’s safety. There was a lack of systems and processes in place to ensure people were protected from the risks of abuse. There continued to be a lack of robust recruitment processes in place. People’s medicines were not always managed effectively, and people were not always protected from the risks of infection due to poor infection prevention practices.

Staff had not always received appropriate training for their roles. People’s nutritional needs were not always managed to provide them with choice and support and their health needs were not always managed effectively.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible: the policies and systems in the service around mental capacity were not used effectively.

People were not always supported to express their views and opinions about their care, and there was a lack of person-centred care. Staff did not always treat people with dignity and respect.

People were not always supported to undertake activities of their choice and they were not supported to make complaints about their care.

There continued to be a lack of oversight of the service by the provider and this affected the governance processes that monitored the quality of the service.

There was a lack of analysis of incidents and accidents to look at trends and reduce risks.

More information is in the detailed findings below. We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around person centred care, governance, safe care and treatment, staff recruitment. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the provider had not notified us of some events at the service.

Rating at last inspection:

The service was rated as Requires Improvement at the last three inspections (reports published September 2016, November 2017 and January 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

About the service: The Limes care home is a residential care home that was providing personal care and accommodation for up to 40 people aged 65 and over. There were 16 people using the service at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection and concerns we received about the care of people at the service. Sufficient improvements had not been made since our last inspection and we found further concerns which means the rating for the service is inadequate. This is the fourth consecutive time this service has failed to obtain a rating of good.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: The service has been placed in special measures and we will continue to work with the provider to ensure improvements are made. We will work with partner agencies and continue to work with the provider to monitor the service, we will visit within six month of this report or sooner if we have further concerns.

Since our last inspection the provider had failed to act to show a sufficient and sustained improvement in the service provided for people. There continued to be a lack of clear quality monitoring processes in place to provide the oversight required to improve the quality of care provided for people.

The lack of up to date clear robust information on people’s care needs impacted on the care they received. The risk assessment tools used to assess risks to people were not utilised effectively to provide guidance for staff on the care people should receive. People’s medicines were not always managed effectively.

There was a lack of analysis of incidents and accidents to look at trends and reduce risks.

People told us they were happy at the service, they felt safe and well cared for. They were treated with dignity and respect.

More information is in the detailed findings below. we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and safe care and treatment. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the provider had not notified us of some events at the service.

Rating at last inspection:

The service was rated as Requires Improvement at the last two inspections (reports published September 2016 and November 2017).

About the service: The Limes care home is a residential care home that was providing personal care and accommodation for up to 40 people aged 65 and over. There were 16 people using the service at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection. sufficient improvements had not been made since out last inspection which means the rating remains at requires improvement. This is the third consecutive time this service has been rated requires improvement.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

The Limes Care Home provides accommodation and care for up to 40 older people. There were 16 people receiving care at the time of our visit. The service was last inspected July 2016 and the rating for that inspection was Requires Improvement.

There was a manager registered with the Care Quality Commission (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 about how the service is run.

People were supported by staff that knew how to recognise when people were at risk of harm.

Assessments of the risks to people’s safety were in place and regularly reviewed, but themes and trends were not monitored or analysed.

There were enough experienced staff to keep people safe and to meet their needs. Safe recruitment processes were in place. However, no record was made during interviewing of staff to demonstrate interviews had taken place. People were protected from the risk associated with the management of medicines, but this was not always monitored robustly.

Staff did not receive sufficient training or regular supervision. The principles of the Mental Capacity Act 2005 (MCA) were considered when supporting people. People were supported and encouraged to follow a healthy and balanced diet. People’s day to day health needs were met effectively by the staff.

People and their families had a good relationship with the staff who cared for and supported them. People were treated with respect and dignity. People were involved with decisions made about their care and support. Information was available for people if they wished to speak with an independent advocate. People were supported to live as independently as possible.

People knew how to raise concerns or complaints and were encouraged to do so if needed. We could not tell if the service was following the provider’s procedures to ensure any complaints or concerns were dealt with in a timely manner, as there were none recorded.

People and staff spoke highly of the registered manager and the service provided. A number of systems were in place that enabled people, staff and relatives to give their views about the service. Robust quality assurance processes were not in place or consistently being applied. Some policies and procedures were out of date.

The provider had not displayed their rating prominently in the home.

We found breaches to the regulations. You can see what action we told the provider to take at the back of the full version of the report.

The Limes Care Home provides accommodation to older people. It is registered for a maximum of 40 people. There were 21 people receiving care and support at the home at the time of our visit.

On the day of our inspection 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.

People felt safe and the home offered a safe environment for people to live. People were supported by staff who understood how to protect and keep people safe. Appropriate processes were in place to support staff to report allegations of abuse if required. Risk assessments were in place to identify and reduce the risk to people’s safety. Sufficient numbers of staff were in place to keep people safe and the provider followed safe recruitment processes. Medicines were stored and handled safely.

People were supported by staff who had completed an induction and relevant training to help them carry out their role. Staff were knowledgeable about the people they cared for and how to best meet their needs.

People’s rights were protected under the Mental Capacity Act 2005. People were supported to have sufficient to eat and drink, but did not always have a good experience at lunch time. People received effective care relevant to their needs. They had access to relevant health care professionals to maintain their health and wellbeing.

People were cared for by kind and compassionate staff. Staff interacted with people in a caring and friendly manner. People were able to contribute to their care and support. People’s privacy and dignity was protected. Arrangements were in place to share information to support people with independent advocates if and when required.

Care plans were personalised to meet people’s relevant needs and what was important to them, but contained limited information. The staff did not always encouraged people to participate in activities that were available in the home. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were complimentary about the management team. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. The service was led by a registered manager who had a clear understanding of their role and how to improve the lives of people at the service.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if the person needed to be supported in this way. One person told us that their meal was, "Always nice".

Appropriate actions had been taken to make sure that people were safe from infection or to resolve infection prevention and control issues when they were identified.

Staff rotas and training information showed there were enough staff members and that training had not been kept up to date. People using the service said there were always enough staff available to meet their needs.

The service had a policy and procedure to guide people in how to make a complaint. No complaints had been made in the 12 months prior to this inspection.

People expressed their views and were involved in making decisions about their care and treatment. One person said, "They know my routines now and they always help me to do what I want to. Coming here was the best move I ever made."

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The people we spoke with who used the service said they were very comfortable at the home. One told us, "I've got all I need here." Another said, "Everything is as it should be here." We observed a senior care worker administering medication and saw that each person received what they needed and as it was prescribed by a doctor.

People who used the service described the staff as, "Marvellous" and "very good". We saw the staff worked together when helping people to move around the premises. We found there were enough qualified, skilled and experienced staff to meet people's needs and no one had long to wait for assistance from staff.

The provider visited daily and questionnaires were used to help the manager and provider to regularly assess and monitor the quality of service that people received.