Lime House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of a legal regulation in relation to person-centred care.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s care plans were not always up to dateand information was inconsistent. For example, 1 person’s care plan said they needed repositioning every 2 hours, however repositioning logs were not in place. The registered manager advised the person’s needs had changed and they no longer required repositioning, however, there were no records to confirm this, and no specific date could be provided to us. Another person required support with repositioning, however there was no reference to this in their care plan.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

There was limited evidence that people were involved in their care planning and reviews. People told us they wanted more showers than they received because the service did not have enough staff to meet their showering needs. People told us there was limited opportunities to engage in activities and they would like more. This was a breach of regulation 9 (Person-centred Care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s nutritional needs were met. Staff knew about people’s dietary needs. We observed staff supporting people with their meals and drinks as required. One person told us, “I enjoy most of the food, the chef is very good.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked closely with external professionals to make sure people received joined up care. Healthcare professionals told us staff always provided the information they needed about people’s health care needs. One healthcare professional said, “As a team we go into Lime House regularly and we haven’t had any issues. Staff have always been helpful and take our advice.”

The registered manager had systems in place to ensure information was shared with team members such as during shift handovers and team meetings. Information was also made available to healthcare partners when needed, for example paramedics when people required an ambulance, or on admission to hospital.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We were not assured people’s personal care needs, repositioning needs and oral care needs were met as the provider had failed to ensure systems were sufficient to identify shortfalls in care records and take action to improve them.

Malnutrition Universal Screening Tool (MUST) scores were not always calculated on a monthly basis as some people weights had not been recorded consistently. MUST isa screening tool to identify adults who are malnourished or at risk of malnutrition.

People were not supported to take part in meaningful activities which can support their physical and mental health and well-being. This contributed to the breach of regulation 9 (Person-centred Care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff supported people to access healthcare services when they needed them.

The provider did not always consistently improve people’s care and treatment. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider failed to assess, monitor and mitigate the risks relating to the health, safety and welfare of people and there was limited evidence of a structured approach to monitoring outcomes or evaluating the impact of care.

The provider did not use recognised tools or frameworks to measure progress or outcomes.People’s care plans contained details of expected outcomes, however these outcomes were not monitored or adapted when people’s needs changed. There were limited goals or targets in care plans, and there was limited evidence of people being supported to achieve personal aspirations. This contributed to the breach of regulation 9 (Person-centred Care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Information about people’s cognition were recorded in their care plans. Concerns about people’s mental capacity were escalated to the local authority and health care professionals.

Staff received training in the MCA and deprivation of people's liberty (DoLS). Staff understood consent, the principles of decision-making, mental capacity and DoLS. One staff member told us, “MCA is whether someone has the mental ability to make their own decisions.”

Measures were in place to ensure people received the support in the least restrictive way possible. Care records contained the relevant level of information in relation to people's capacity, any DoLS authorisations and systems were in place to ensure consent to care was obtained.