We carried out a review of the data available to us about Limetree Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Limetree Care Home, you can give feedback on this service.
Limetree Care Centre is a nursing home providing personal and nursing care to 87 people aged 65 and over at the time of the inspection. The service can support up to 92 people in one adapted building over three floors.
People’s experience of using this service and what we found
People told us they were happy with the standard of care and support provided at this care home. The service was now adequately staffed and was no longer reliant on any temporary agency staff. This had helped drive up the standard of care provided because most of the staff were now permanent and were therefore more familiar with the needs, wishes and daily routines of people living at the care home. The suitability and fitness of staff to work in an adult social care setting continued to be thoroughly assessed.
People were cared for and supported by staff who knew how to manage risk and keep them safe. The premises were kept hygienically clean and staff followed relevant current best practice guidelines regarding the prevention and control of infection. Safeguarding concerns were appropriately managed and incidents and accidents were regularly audited to minimise repeat incidents. People received their medicines as prescribed.
People were supported to participate in activities that reflected their social interests and to maintain relationships with family and friends to avoid social isolation. People's care plans were person centred, which helped staff provide them with personalised care and support. Staff ensured they communicated and shared information in a way people could easily understand. People’s concerns and complaints were listened to and investigated by the provider. The service had systems in place to support people in line with their wishes when at the end of their life.
The provider recognised the importance of learning lessons when things went wrong and were keen to continuously improve the service. The quality and safety of the service people received was routinely monitored by managers and nursing staff at both a provider and service level. People’s views were sought to drive improvement and the registered manager placed a focus on working in partnership with stakeholders.
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 requires improvement (published 3 October 2019) and there were multiple breaches 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 we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We received concerns in relation to people’s nursing care needs and safety. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.
Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern.
Please see the safe section of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Limetree Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Limetree Care Centre is a nursing home providing personal and nursing care to 90 people at the time of the inspection. The service can support up to 92 people in one adapted building. The home is divided into three floors. The ground floor provided residential care to people living with dementia. The first and second floors provided nursing care to people living with dementia and other nursing needs.
People’s experience of using this service and what we found
People and their relatives told us staff were kind and they received good care from them. There had been significant improvements in the activities provided and people were supported with a range of different activities across the week.
People told us they did not always think there were enough staff. This was confirmed by our analysis of staffing levels which showed there were not always enough staff on duty to meet people’s assessed needs.
People and relatives told us they felt there had been improvements in how the home was managed. While there had been progress in some areas, particularly regarding the response to incidents and accidents, other issues had persisted. Although the provider’s systems had identified inconsistencies in records, and issues with the cleanliness of the service, the actions in place had not been effective at driving improvement.
People received the care they needed to stay safe and well. However, there were inconsistencies in care plans, risk assessments and records of care. While some people had detailed life stories and information about their preferences, this was not easily available to staff, and some people did not have this information in place. Care plans were not in a format that was accessible to people. We have made a recommendation about this.
People’s needs were assessed and reviewed using a range of standardised assessment tools. We identified inconsistencies in how these tools were used. We also found these assessments did not explore people’s religious beliefs, cultural background, sexual and gender identity. We have made a recommendation about ensuring all aspects of people’s lives are explored in assessments.
People were supported to take their medicines by trained staff. The medicines care plans were not in line with best practice and we have made a recommendation about this.
The provider recognised they still had work to do to improve the quality of support they provided to people approaching the last stages of their life. They were working on making improvements in this area.
People and relatives were able to make complaints and told us they felt the manager responded positively and constructively to complaints that had been made.
Staff had received the training they needed to do their jobs. Staff were involved through staff meetings and received regular coaching sessions where appropriate. Staff shared information about people living in the home via handover meetings which helped to minimise the impact of the inconsistent care plans.
People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The provider recognised the systems in the service needed amending to ensure information about restrictions placed on people were easily available to the staff who needed to know.
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 18 September 2018).
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 had been made and some of the breaches had been resolved. However, in other areas not enough improvements had been made and breaches of regulations remained.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to person centred care, staffing and good governance.
Please see the action we have told the provider to take at the end of this report.
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.
Limetree Care Centre is a nursing home providing care and support over three floors for up to 92 older people, some of whom were living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
At the previous inspection in April 2017 the home was rated "Good" in all areas. However, we received information of concern from relatives and other agencies that the service had begun to show signs of poor management, leadership and governance and was not always able to ensure delivery of high-quality, person-centred care for people, which prompted this inspection. We found that on this inspection the service did not meet some of the required standards relating to safety, providing effective and responsive care and in the management and leadership of the service.
The service did not have a registered manager in post at the time of the inspection. A new manager had been recruited and was going through the process of registering with the Commission. 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.
There were not always sufficient numbers of suitably qualified and experienced staff to provide the necessary care and treatment to people.
People's health and nutrition were not always monitored effectively. Fluid and nutrition charts were of variable quality, as were records of people's weight changes.
People did not always receive personalised care that was responsive to their needs. Care plans did not fully reflect people's interests and background. The quality of and frequency of activities was variable and staff did not spend much time in meaningful interaction with people.
The service was not always well-led by a consistently good management team. The service had a high number of incidents and accidents and was engaged in an improvement programme with the local authority. This, together with the areas of concern identified during this inspection meant that the service was not always able to ensure delivery of high-quality, person-centred care for people.
The service carried out suitable pre-employment checks to ensure safe care for people.
Staff knew their responsibilities to protect people from potential harm and abuse and how to report this.
There was a garden which people and relatives commented positively about, and which we saw was being well used on the hot summer day.
Staff we spoke with confirmed that they had attended Mental Capacity Act (MCA) training and were able to tell us about the principles of the MCA, acting in people’s best interests and how they applied these in their work with people.
People at the home were treated in a kind and compassionate manner which respected their privacy and afforded them dignity. Relatives spoke positively about the staff. Relatives also commented that they could visit at any time and that they could trust the staff.
Staff addressed people according to people’s wishes. We observed staff treating people with kindness and compassion, speaking quietly and gently to people and it was clear that staff knew people well. We saw notices on doors when personal care was being given, which ensured people’s privacy.
The service had a complaints policy and procedure. The policy included timescales for responding to complaints and details of how people could escalate their complaint if they were not satisfied with the initial response from the service. People using the service and their relatives told us they knew how to complain if they needed to. People told us that since the new manager had arrived they could speak to her and that they felt things had changed for the better in regard to open communication.
The provider had already begun to act on the above issues. A new management team had been recently brought into place and the manager was going through the process to be registered by CQC.
A team of external support for the service was already active, working with the manager and staff with the aim of improving things.
The work carried out to date by the senior leadership and management team received positive comments from people, relatives and staff. Staff told us they felt the changes being introduced were positive and it made them focus on their job better.
Records and information were securely stored, and there were plans on how to evacuate people in case of an emergency.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.
At our last inspection in January 2015 the service was rated as 'Good’. At this inspection we found the service remained Good.
The service had a registered manager at the time of the inspection. 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 continued to be kept safe by staff who were trained to protect them from abuse. Staff reduced people’s risks of avoidable harm by assessing their risks and developing plans to mitigate them. Staff were deployed in sufficient numbers to ensure people’s safety and the provider used appropriate vetting and selection methods to recruit staff. People received their medicines safely and the service good infection control practices were in evidence.
The service continued to be effective. Staff were trained, knowledgeable, supervised and skilled. The service understood its legal responsibilities under the Mental Capacity Act and Deprivation of Liberties Safeguards and supported people in accordance with them. People ate well and their nutrition and hydration were monitored. People were supported to stay healthy and were supported to access healthcare services whenever necessary.
People and relatives told us that the staff continued to be kind and caring. People were supported to maintain the relationships that mattered most to them. Staff protected people’s confidentiality and supported people to maintain their independence. People were supported with tenderness and compassion at the end of their lives enabling them to die with dignity and pain free.
The provider continued to be responsive to people’s needs by embracing the use of technology. Assessments were highly detailed and resulted in referrals to healthcare professionals when specialist input was required. The provider was imaginative in the activities it offered to people and responsive in supporting people to pursue their interests. The provider actively gathered people’s views and acted decisively on the feedback they received.
The service continued to be well led. Robust audits were in place to ensure people received high quality care. The provider’s partnership working including supporting the apprenticeships of local college students and piloting research with a university hospital. Communication throughout the service was effective ensuring that all staff were fully aware and had the most up to date information to deliver people’s care. Staff commended the support they received from the registered manager.
This unannounced inspection took place on 16 January 2015. The last inspection of Limetree Care Centre took place on 17 October 2013 and it met all the regulations inspected then.
Limetree Care Centre provides accommodation and personal care to 92 older people, some of whom had dementia. There were 91 people using the service at the time of this inspection.
The service had a registered manager who had been in post since 2010. 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.
The service was safe. People received care and support in a safe way. Medicines were kept securely and people received their medicines as prescribed. The service identified risks to people and had appropriate management plan in place to ensure people were safe as possible. People consented to the care and support they received. The service met the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).
There were sufficient staff available to meet people’s needs. People told us staff were kind and caring. We observed that people were treated with dignity and respect by the staff. People were supported to communicate their views about how they wanted to be cared for. People told us they enjoyed the choice of food that was available to them at the service and it met their nutritional needs.
Staff were trained to provide good care to the people they looked after. Staff received the support and supervision to carry out their duties effectively. Staff had had good knowledge and awareness of how to meet the needs of people with dementia.
The service had received an award in recognition of staff skills in providing care to people in the final years of life. Health professionals told us the service communicated well with them to ensure people received appropriate care and treatment.
People had their individual needs assessed and their care planned in a way that met their needs. People received care that reflected their preferences and choices. Reviews were held with people and their relatives to ensure people’s support reflected their current needs.
People were asked for their views and their feedback that was used to develop the service. The registered manager responded appropriately to complaints about the service. Regular checks on were undertaken to ensure the service was of good quality and met people’s needs.
We found the care planning to be systematic and detailed with evidence of people contributing to their care plans. We saw that staff dealt with an emergency and made prompt arrangements for the transfer of the person to hospital.
The staff we spoke to had access to a wide range of training and the provider monitored the access to training ensuring that statutory training was completed.
The majority of the people we spoke to were happy with the service and felt able to raise their concerns with the staff or the Manager. There was evidence that the complaints were fully investigated and that change to practice took place as a result of complaints.
The inspection team was led by a CQC inspector and a colleague, joined by a practicing professional and an Expert by Experience, people who have experience of using services and who can provide that perspective.
We used a number of different methods to help us understand the experiences of people using the service. A number of the people who lived at this care home had complex needs, which meant they were not always able to communicate verbally with us in a meaningful way. During the morning and at lunch we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
People told us that they were always given a choice of what to eat and that they had plenty to drink. People enjoyed mealtimes, they were able to choose to have them in own rooms or in the lounge or dining room.
People felt safe living at the home; they liked having familiar staff, who they found kind and gentle, look after them.
A person spoken with said 'the staff are all nice. They are down to earth and we have a laugh as well. I watch them and think to myself- they are so patient and good!"
A relative told us that they were pleased with the care their grandparent was receiving and confirmed they had been involved in planning their care.
People told us that they found the home was a nice place to live, but that they would rather be in their own homes if their health was better. One person was in a jovial mood and enjoyed having people around, she said, "I have plenty of neighbours to talk to and am never lonely here". Another person described the flexible environment, she said "I can do what I want, when I want, how I want".
We found that the environment was calm, with people engaging with staff and in activities. Snacks and drinks were available and encouraged throughout the day, these ensured that people who become restless at mealtimes had access to finger foods throughout the day.
We felt the sense of warmth displayed from staff. They behaved in a kind and respectful manner, and took the time to explain as they assisted people with tasks.
Mealtimes were special and made as pleasurable and relaxed as possible, with all nursing and care staff present to assist people with meals.
Some people were not able to give us information about the care they received; however our observations were that their social, emotional and healthcare needs were promoted.
Relatives were generally positive about the service. One person said that his uncle had much improved since moving to the home in recent months. He said that the care and treatment has contributed to his overall well being.