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Lime Tree Gardens Requires improvement

Reports


Inspection carried out on 17 June 2021

During a routine inspection

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

Inspection carried out on 10 April 2019

During a routine inspection

About the service: Lime Tree Garden is a purpose-built care home for up to 24 adults with mental health needs. On the day of our inspection there were 23 people using the service. The aim of the service is to support people with enduring mental health illness to develop basic life skills so they can live independently in the community.

People’s experience of using this service:

Medicines were not always managed safely. People were supported to take medicines in line with their preferences, but the service’s processes to ensure that medicines were always administered as prescribed were not always effective.

People did not always receive personalised care. Their needs had been assessed by the service prior to receiving services. However, the care plans at times provided insufficient detail for staff to provide personalised, strength-based care and support that was consistent and responsive to people's individual needs. We noted that staff we spoke with had a good understanding of the needs of people they supported.

Staff received a range of training to help them to work with people who used the service. More training was required to guide staff on how to effectively work with people when they exhibited behaviours that challenged the service.

Staff received support in the form of one to one supervision and a yearly appraisal of their personal and professional development goals. However, supervisions were not always regular. Staff also participated in a range of meetings where they could discuss matters relating to caring for people and the service provision.

The service had checks in place but these had not identified shortfalls that were found during inspection. These related to the management of people's medicines, following the principles of the MCA, staff training and effective care planning and records keeping.

DoLS applications had been submitted when required. Improvements were needed in relation to what decisions individual people with no capacity could make and how staff could support them in doing so.

Improvements were needed to ensure that people’s needs had been thoroughly assessed before they were accepted as suitable to live at the service. This was to ensure people’s needs could be met by the service.

Some improvements were needed to how the service managed risk to the health and wellbeing of people using the service and health and safety of the premises. Accidents and incidents had been reviewed to ensure lessons were learnt and the safety of the service improved.

People were encouraged to be involved in planning and reviewing of their care through one to one meetings. However, because the meetings were not always recorded, the provider could not evidence that they had taken place.

External professionals gave positive feedback about the commitment of staff working at the service. They also thought the service was well led. However, they thought further work was needed so the methodology and the recovery approach used by the service was clearly defined and visible when supporting people who used the service.

Safeguarding concerns were managed promptly. Staff had received safeguarding training and were able to recognise when people were at risk of abuse.

Safe recruitment procedures helped to protect people from unsuitable staff. There were appropriate staffing levels to response to people’s need.

The service asked people’s consent before providing care and support to them. However, when people did not have capacity to make decisions, staff did not have enough information on how to support these people with making decisions about their everyday care.

People received support to have a diet that met their needs and preferences. People had access to health professionals when needed.

The accommodation provided people with space they could use to socialise or spend time on their own if they preferred. People could move freely between different parts of the service.

Staff protected people’s priva

Inspection carried out on 10 October 2016

During a routine inspection

This inspection took place on 10 October 2016 and was unannounced. At our last inspection in November 2015 the service was not meeting the standards in relation to the safe management of medicines and the proper assessment of the risks to the health and safety of people using the service. At this inspection we found that the service was now meeting these standards.

Burghley Road is a residential care home for up to 24 adults with a history of alcohol dependence. The home is in Kentish Town in Camden. There were 19 people staying at the home at the time of our visit.

There was a manager for the service, but as they had only recently taken up the post, they were not yet registered with the Care Quality Commission. We were informed that they were currently applying to be registered.

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 told us they felt safe at the home and safe with the staff who supported them. They told us that staff were kind and respectful and they were satisfied with the numbers of staff on duty at the home.

The management and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks should be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. The service was following the appropriate procedures regarding Deprivation of Liberty Safeguards (DoLS) but this was not relevant to the people being supported at the home.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the management of the home.

People confirmed that they were asked about the quality of the service and had made comments about this. Quality assurance systems were in place in order that suggested improvements could be actioned and monitored.

The service had a number of quality and safety audits which were designed to ensure a safe environment was maintained.

Inspection carried out on 10 November 2015

During a routine inspection

This unannounced inspection took place on 10 November 2015. Our previous inspection took place on 9 May 2014 and we found all of the regulations we inspected were met.

Burghley Road is a residential care home for up to 24 adults with a history of alcohol dependence situated in Kentish Town in Camden. There were 22 people staying at the home at the time of our visit.

There was a registered manager was in place at the time of our visit. 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.

During this inspection we found that risk assessments were not always updated appropriately after there had been an incident of threats and violence at the service.

People were permitted to smoke in their bedrooms but a risk assessment had not been completed for each person.

There were issues with regard to the disposal of medicines. We saw how bottles of prescribed eye drop medicines were not used in the correct date order.

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

There were not always adequate formal or informal activities to engage and occupy people. Pathways to move people on appropriately after detox had not been established.

We have made a recommendation about improving engagement with people by offering more formal and informal activities. Also the service should explore ways to work with other agencies to appropriately support people after detox to move on to more suitable accommodation and continue their alcohol reduction.

We made a recommendation in relation to people refusing care and treatment as well as refusing to sign consent forms. This should be clearly recorded on peoples records to evidence the fact. 

There were no call bells or panic alarms located in the corridors, communal areas or medicine room. This meant that staff were unable to call for assistance in an emergency situation.

We have made a recommendation about introducing an emergency communication system to summon assistance if required.

Staff had a good understanding of safeguarding issues and the types of abuse that may occur. They were also able to tell us how to report and record concerns and use the whistle blowing procedures if required.

Safe recruitment procedures were in place that ensured staff were suitable to work with people as staff had undergone the required checks before starting to work at the service.

Staff completed an induction programme and mandatory training in areas such as safeguarding, health and safety and medicines.

Records showed that staff had received one to one supervision monthly unless they were on holiday or absent from work. There was also evidence of regular annual appraisals.

People currently staying at the home were not subject to a Deprivation of Liberty Safeguards (DoLS) authorisation to deprive them of their liberty to receive care and treatment. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005.

Staff showed dignity and respect as well as demonstrating an understanding of people’s individual needs. They had a good understanding of equality and diversity issues and were able to tell us how they ensured people’s cultures, beliefs and the way they wished to live their lives were recognised and supported.

Staff knew how to support people to make a formal complaint and they told us that most issues were resolved effectively before they got to a formal stage.

There was effective communication between all staff members including the managers. Staff received daily verbal handover and we saw evidence of regular staff meetings that also covered more strategic issues such as policy briefings, staffing issues an updates.

Audits and quality monitoring visit took place regularly. Quarterly audits of support plans, including risk assessments and reviews were undertaken. A traffic light system was used as quality grading to prompt action and ensure compliance.

Inspection carried out on 9 May 2014

During an inspection in response to concerns

This inspection was a carried out as a responsive follow up to a recent serious occurrence at the service.

You can see our judgements on the front page of this report.

At this inspection we sought to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, a visitor and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff we spoke with demonstrated awareness of the different types of possible abuse and all were confident about reporting concerns should they need to.

Is the service effective?

We viewed the records of five people using the service and saw each person�s records contained an assessment of needs completed with the person as well as an assessment by the referring local authority.

Is the service responsive?

Most of the comments people made were complimentary although the provider may wish to note that someone told us �90% of the time I am treated with respect�, another person said �some staff knock on my door all of the time, others only some of the time�.

Is the service well-led?

We were informed by the manager that a recent survey of people using the service had been completed.

Inspection carried out on 28 November 2013

During an inspection looking at part of the service

This report is a follow up to our reports published in April and September 2013. We had inspected this provider on 5 and 10 April 2013, when we noted some issues which had a minor and moderate impact on people using the service. We followed up with another visit on 24 July 2013 when we judged that the provider had not taken sufficient steps to ensure that people experience care and support that met their needs. In addition the provider did not ensure that people who use the service were always protected against the risks associated with medicines. We set compliance actions requiring the provider to take steps to comply with Regulations 9 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We made a further visit on 28 November 2013 when we judged that the provider had now taken sufficient action to ensure that people experience care and support that met their needs. The provider had also improved medication management and we noted that people were protected against the risks associated with medicines.

Inspection carried out on 24 July 2013

During an inspection looking at part of the service

In this report the name of Mr. Bauer appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

This report is a follow up to our report published in April 2013. We had inspected this provider on 5 and 10 April 2013, when we noted some issues which had a moderate and minor impact on people using the service. These related to standards regarding respecting and involving people, their care and welfare, management of medicines, and monitoring the quality of the service. We set compliance actions requiring the provider to take steps to comply with Regulations 9, 10, 13, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We made a further visit on 24 July 2013 when we found that the provider had taken sufficient action to ensure dignity and independence of the people.

We also found that the provider had a working system in place to regularly assess and monitor the quality of service that people received.

Whilst there had been some significant improvements in care provided to people who use the service and medication management there were still some outstanding concerns. We judged that the provider had not taken sufficient steps to ensure that people experience care and support that met their needs. People were not always protected against the risks associated with medicines.

Inspection carried out on 5, 10 April 2013

During an inspection looking at part of the service

People using the service told us that staff were supportive, one person said that �they are helpful, 88% of them". Another person confirmed that "most of them are OK" and that they were �very helpful.�

People using the service told us that staff had not always acted on what they promised. This related to the purchase of some equipment and the redecoration of one of the rooms.

During our visit we observed some poor interaction between staff and people who use the service. Staff did not always talk about people in a respectful way and there were minimal opportunities for positive interactions between people who use the service and care workers.

People told us that their care needs were met and we saw that care plans were up to date. We noted that risk assessments were not sufficiently detailed. The provider had developed improvement plans to allow people greater involvement in suggesting and participating in activities, but the plans had not been fully implemented.

We raised concerns regarding administration of medication as we noted discrepancies in records and the medication stock kept at the home.

Since our previous visit the provider had made some improvements relating to staffing levels and additional staff were employed to ensure people�s care needs were met.

The provider did not have effective systems in place to assess and monitor quality of the service.

Inspection carried out on 28 November 2012

During a routine inspection

We inspected the home on the 28th November 2012, when we looked at records of people living at the home, staff files and other records relating to the service. We spoke with the acting manager and their deputy and interviewed three care workers. We observed care being provided and spoke with six people using the service.

Most people we spoke with were happy with the care being provided. One person said of the home �it�s good,� but that there was �not much going on.� We did not see any structured activities taking place. The need for more activities to be provided at the home had recently been noted by one of the local authorities commissioning the care. Because of this, the provider was actively working with people at the home to identify and introduce more activities which the people would enjoy and benefit from.

People said that at times there was not enough staff to meet their needs. Staff members we interviewed also expressed concerns over staffing levels and the impact this had on the care being provided.

The atmosphere at the home was quite calm and relaxed. We saw that staff members were friendly and confident in their interaction with people and the support they provided.

Inspection carried out on 18 October 2011

During a routine inspection

People told us that they felt treated with respect and were able to choose how they spent their time. We saw that people could express their wishes and have their needs met. They said that they usually knew what was happening in the service.

People said that they liked the food on offer, the choices and the quality. They told us that they felt safe and protected by service. They said that they were well cared for.

People told us that they felt treated with respect and were able to choose how they spent their time. We saw that people could express their wishes and have their needs met. They said that they usually knew what was happening in the service.

People said that they liked the food on offer, the choices and the quality. They told us that they felt safe and protected by service. They said that they were well cared for.

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