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Inspection Summary

Overall summary & rating


Updated 30 September 2016

This comprehensive inspection took place on 23 August 2016 and was unannounced. The inspection team consisted of two adult social care inspectors. At the time of the inspection, there were 30 people living at the home. Lime House is registered to provide personal care and support for up to 32 people. The home is part of Nugent Care and the head office is based in Liverpool. The home has a main house connected by link corridor to a lodge. Most rooms were for one person and there were also up to four shared rooms. There was a choice of several lounge and sitting areas throughout the home.

At the last inspection on 29 August 2014 we found the service to be compliant with all regulations we assessed at that time.

There was a registered manager in post. 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 we spoke with said they felt safe living at Lime House. There were systems in place to protect people from abuse. There was an up to date safeguarding policy in place, which referenced legislation and local protocols.

The service had a robust recruitment procedure in place. Appropriate checks were carried out before staff began working at the home to ensure they were fit to work with vulnerable adults.

There were sufficient numbers of staff working at the home to meet people’s needs. All of the people spoken with including people living at the home, staff and visiting relatives told us they felt staffing levels were sufficient.

We looked at a sample of Medication Administration Records (MAR’s) and observed medicines administration during the day and saw that MAR’s were signed by staff when people received their medication, as required. We saw requirements relating to controlled drugs were being met. A medicines stock control form was used for each person receiving assistance with medicines. People living at the home told us they had no concerns about receiving their medicines.

We saw that care plan documentation contained risks assessments which covered Waterlow, pressure sores, moving and handling, nutrition, bathing and falls/mobility. Each risk assessment had a corresponding ‘risk plan’ which detailed how the risk was managed and any control measures that were in place.

The home was clean and tidy with no pervasive malodours present.

There was a staff induction programme in place which staff undertook when they first started working at the home and this was aligned with the requirements of the care certificate. Staff told us they received supervision as part of their work and we looked at a sample of records which demonstrated these took place.

The registered manager demonstrated effective systems to manage DoLS applications.

During the inspection we observed staff seeking consent from people before providing assistance, such as asking people if they would like to take their medication.

We observed people were treated with kindness and dignity during the inspection. Each person we spoke with said they liked living at Lime House and were happy with the care they received.

We saw that people had specific nutrition care plans in place and where required, risk assessments had also been implemented if people were at risk with regards to their nutrition.

There was a four week rolling menu in place, which was available in the dining room. Special diets were catered for, food allergies were recorded and information on different diet types.

In care plans we saw people had access to a range of different service including district nurses, podiatrists, doctors, advanced nurse practitioners, GP’s and opticians.

We saw that adaptations had been made to make the environment suitable for people living with dementia.

We found the service aimed to embed equality and human rights though good person-centred care planning. The people we talked with spoke highly of the staff who cared for them.

We observed staff were patient, respectful and friendly towards the people who lived in the home. Staff said they liked working at the home.

The service used an electronic care planning system called ‘CareSys’ with hard copy paper files also being in place. We saw detailed personal profiles in the care records.

People’s care files identified that individuals and their relatives were involved in the planning of their care, and personal preferences were discussed.

We saw people had a choice of activities to stimulate them.

Our observations and discussions indicated people who used the service expressed their views and were involved in making decisions about their activities.

The home had procedures in place to receive and respond to complaints.

Residents and relatives meetings were held regularly and information from these meetings was used to inform the delivery of the service.

We saw a variety of positive comments about the home received from visiting professionals. The service worked in partnership with a wide variety of organisations and professionals.

The service undertook a range of audits, which were completed according to different schedules.

Observations of staff practice were regularly carried out and quality assurance audits were also carried out monthly at provider level.

There was a full range of policies and procedures in place which were available in paper copy format and electronically.

The service had a business continuity plan that was recently reviewed and audited in August 2016.

The local authority had also carried out an audit in March 2016 and the home had achieved a 97% compliance rating.

Inspection areas



Updated 30 September 2016

The service was safe. Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service and there was evidence of robust recruitment procedures.

People we spoke with who lived at Lime House told us they felt safe.

Records of medicines administration had been completed consistently and accurately. Accidents and incidents were recorded correctly.



Updated 30 September 2016

The service was effective. Staff were subject to a formal induction process and probationary period and there was a staff supervision schedule in place.

Staff were aware of how to seek consent from people before providing care or support.

There were adaptions to the environment to assist people living with a dementia.



Updated 30 September 2016

The service was caring. Staff spoken to had a good understanding of how to ensure dignity and respect and staff showed patience and encouragement when supporting people.

We heard lots of laughter between staff and people and there was a positive atmosphere within the home.

The service involved families when developing care plans or carrying out assessments.



Updated 30 September 2016

The service was responsive. Care files were well organised and contained information that covered a range of health and social care support needs.

Each person had a detailed care pathway, an assessment of possible risks and a description of the person’s needs for support and treatment.

The home had procedures in place to receive and respond to complaints.



Updated 30 September 2016

The service was well-led.

There was a registered manager in post.

There were a variety of systems in place which helped the service to monitor the quality of care provided and the service undertook a range of audits.

Surveys were carried out and information was used to improve the quality of service.