Background to this inspection
Updated
3 August 2021
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 Care Act 2014.
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, a pharmacist inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience had personal experience of mental health.
Service and service type
Lime Tree Gardens is a care home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they 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 the information we held about the service. This information included any statutory notifications that the provider had sent to the CQC. Statutory notifications include information about important events which the provider is required to send us by law. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with members of the management team including the registered manager and two deputy managers. We also spoke with four care staff, five people who used the service and two external healthcare professionals who worked with the service regularly. We looked at records which included care records for five people, medicines records for a further five people, and other records relating to the management of the service, such as health and safety checks, team meeting minutes, medicines and the home's and the provider's audits.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, staff recruitment, supervision and quality assurance records. We spoke with four family members of people who used the service. We received feedback from two other professionals who are in regular contact the service.
Updated
3 August 2021
About the service
Lime Tree Garden is a purpose-built care home for up to 24 adults with mental health needs. The aim of the service is to support people with enduring mental health illness to develop basic life skills so they can live supported in the community. On the day of our inspection there were 19 people using the service.
People’s experience of using this service and what we found
The service needed to improve how they managed and monitored people's medicines. This related to the storage of medicines, medicines administration practice when people were away from the service, and monitoring medicines administration records.
The service had made improvements since our last inspection. Apart from issues related to the management of medicines, the service provided effective care to people helping them to meet their mental and physical health needs.
The provider assessed and analysed risks to people's health and wellbeing. Care documentation provided staff with information on how to manage and minimise these risks. Safe infection prevention and control practices helped to protect people from the risk of infection, including Covid-19.
Staff understood their role in safeguarding people from abuse. The provider's recruitment practice ensured suitable staff supported people. Although recent high staff turnover, there were enough staff deployed during each shift to support people.
Staff had the training to help them to support people effectively. This included the mandatory training and specialist workshops on working with people with physical and enduring mental health illnesses. Staff could access ongoing support from a clinical team of mental health professionals to understand people's needs better and respond to them promptly.
People had access to healthcare professionals, and staff supported people to ensure people's physical health was well looked after.
People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible and their best interests; the policies and systems in the service supported this practice.
People and relatives told us the staff at Lime Tree Gardens were kind and caring, and their support helped people improve. Staff encouraged people's independence and ensured that people received dignified care which met their preferences.
People had care plans which guided staff on how to support people. People and relatives told us people participated in care planning and reviewing of their care. Overall, people and relatives thought the staff were meeting people's needs.
The service had a new management team who started to make improvements within the service. The feedback they received was positive. All stakeholders said the service was well managed, staff had skills to support people effectively, and people's wellbeing was improving.
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 17 June 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 we found improvements had been made and further improvement were needed. The provider was no longer in breach of regulations 9 and 18. However the provider was still in breach of regulation 12.
Why we inspected
We undertook this inspection to check if the service had followed their action plan and to confirm they now met legal requirements.
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 safe and well-led sections of this full report.
Enforcement
We have identified breaches in relation to management of medicines.
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.