• Care Home
  • Care home

Archived: The Limes Residential Care Home

Overall: Requires improvement read more about inspection ratings

11-15 Fenstanton Avenue, London, N12 9HA (020) 8446 6609

Provided and run by:
Mr Munundev Gunputh

Important: The provider of this service changed. See new profile

All Inspections

5 January 2016

During an inspection looking at part of the service

The Inspection took place on 5 January 2016 and was unannounced. At our last inspection on 6 February 2015 we rated the service as Requires Improvement. We found breaches in four regulations relating to staffing, maintenance of equipment, person centred care and medicines administration. There were concerns about the number of adequately trained staff, there was poor management of the prevention of falls and care staff did not maintain equipment. There was a lack of meaningful person centred activities.

The Limes Residential Care Home is a residential care home providing accommodation with personal care for up to 25 elderly people with dementia. At the time of our visit there were 20 people using the service, two of the people were in hospital.

The service had a registered manager. 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.

We found that the provider undertook staff recruitment checks to ensure candidates were safe to employ. Staff received three days induction training and regular supervision sessions. The registered manager now kept a falls matrix and recorded falls and the cause. We saw referrals to the falls clinics. The service risk assessed and identified risks but did not always give staff clear guidelines to manage the risks. Care plans were detailed for some areas of people’s support but lacked detail in moving and handling and managing people’s behavior.

The environment still was not accessible to people with cognitive impairments. The service had made attempts to sign post uneven floors and orientate people to their rooms but the measures taken were not effective. The environment was not safe as there was broken furniture and environmental hazards that were not being addressed appropriately.

People required greater assessment and attention paid to their adaptive equipment as care staff did not use specific equipment designed for the individual person.

The registered manager had arranged two new activity sessions that people have enjoyed. However were not activities on a regular basis throughout the week to keep people engaged and active.

People we spoke with and relatives spoke highly of the care staff and we saw some caring interaction by the care staff who know peoples likes and dislikes. People who use the service said they felt comfortable complaining to the registered manager who kept a record of complaints made.

The registered manager undertook audits but they were not successful in addressing the environmental issues.

We found overall 2 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We made a recommendation about more frequent auditing of the environment.

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

6 February 2015

During a routine inspection

This unannounced inspection took place on 6 February 2015. The Limes provides accommodation and personal care to older people. The home is registered to accommodate 26 people. There were 19 people living at the home at the time of the inspection, two of whom were in hospital temporarily.

The home had a registered manager. 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 last inspection was 6 February 2014 where we found a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2010 due to a failure to implement safe staff recruitment practices to ensure new staff were suitable people to work in a care home.

We found this had improved at this inspection.

There was mixed feedback from people living in the home. The majority of people said they felt safe and well looked after at The Limes.

Staff were kind and supportive to people. One person told us, “The staff are very pleasant and helpful.” Staff supported people with personal care, to eat and drink enough and helped them to maintain their health. Staff felt supported and received supervision from the registered manager to help them learn and improve in their job. There were some opportunities for people living in the home to take part in activities but these were limited and not always age appropriate. Three people told us there was not enough to do to fill their time.

The service did not protect people enough from the risks of falling over. The layout of the building and the way staff were based in the lounge meant that some people were at high risk of falls when they left the lounge area. The design of the building limited the homeliness of the environment and the choice of places for people to spend their time. Most people sat in a line in a narrow lounge area. Those who preferred to stay in their room were able to do so.

Medicines were not always managed properly as the records did not always give enough detail to prevent unsafe practices, for example there was no up to date written guidance for how frequently one person could have pain medicines. The registered manager did resolve this straightaway when we brought this to his attention after this inspection.

Some equipment such as the cooker, fridge, some shower facilities and first aid kits were not clean and well maintained. Staff had not received all the training they needed and the training records were not up to date.

At this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

We have also made recommendations about improving the menu, seeking advice on falls prevention and providing training to staff for providing good care to people at the end of their life.

6 February 2014

During a routine inspection

We spoke with six people who used the service. Although most said they were happy with the food, some felt this could be improved. Comments included, 'food is rubbish, don't have a good cook. I was told before coming here that I would get fresh curry every day.' Another person said the food was, 'very pleasant.' One person commented, 'you take what you get.' We spoke with three relatives who told us they felt the food was fine.

We observed some good interactions by staff, but noted that one staff member feeding one person appeared rushed and did not communicate with the person. One person told us that staff were, 'ok, depends on how you talk to them,' another said staff were 'alright.' A relative describe some staff as, 'lovely, they offer you drink and biscuits,' whilst other staff were less approachable and 'didn't make eye contact.'

We saw from the menu that people received a well-balanced meal of vegetables and protein. However we were concerned about the condition of the kitchen area where food had been prepared and some food items were out of date. We contacted the Environmental Health Food Standard Agency (FSA) who visited the day after our inspection and made a second visit on 10 February 2014 and were satisfied with the action the provider had taken.

The service worked in cooperation with other healthcare professionals to meet the individual needs of the people they cared for. However, the provider did not always follow their own policy and procedures in relation to staff obtaining suitable information about staff's previous employment.

16 April 2013

During an inspection looking at part of the service

We previously inspected The Limes residential care home on 13 December 2012 and found non compliance in areas of care and treatment, staff support and records. We carried out a compliance review to check compliance against the action plan produced by the manager had been implemented.

During this visit we found that the service had made several improvements. We spoke with a healthcare professional who told us that people were well cared for by staff and they acted on recommendations made in terms of appropriate healthcare for people. 'Shining example of good care,' said the healthcare professional. We spoke with two of the twelve people sat in the lounge. 'Very looked after,' said one person when asked how they were looked after by staff. 'Well cared for and the food is very good,' said another. We spoke with a relative who told us, 'I am satisfied with the quality of care given to my relative.'

Staff were supported by their managers and received appropriate training to meet the needs of the people they cared for. Records relating to people who use the service were kept securely and could be located promptly when needed.

13 December 2012

During a routine inspection

There were 21 people in residence at the time of our visit and we spent sometime talking to some, including their relatives for views about the service. We spoke with three relatives who told us that staff were very good and helpful. They felt staff treated people with dignity and respect, and they spoke of staff as being 'nice and friendly.'

People's privacy and dignity were respected in the manner staff spoke and interacted with them. We observed staff speaking to people in a caring and calm manner. Staff were able to give us examples of how they treated people with dignity and respect such as ensuring the door was closed when assisting with personal care and knocking before entering people's rooms.

There were systems in place to ensure that people were protected from abuse and that they received the care they needed. Systems were in place to monitor and to make improvements to the quality of care and support provided to people by the home. However, we were concerned that staff had not received regular supervision and records for people using the service were not up to date.

11 October 2011

During a routine inspection

People told us that they had very good first impressions of the care home and said that it was 'better than expected. My daughter made a good choice'. We were told that 'I have been very happy here. I am glad of the company' and 'I would rather be here than on my own at home'.

People told us about how care was provided and said 'they ask first. I'm not rushed. In the mornings they ask me if I need any help'. They confirmed that they were able to make choices and that their privacy and dignity was respected. They told us that members of staff listened to what people using the service said and that they could always talk with staff that were 'friendly'. Most people that we spoke with were not aware of having a care plan. However, they confirmed that they were satisfied with the care provided. They told us 'I get the support I need'. On the whole they liked the meals served in the home. One person said 'I eat everything they give me. It's like home cooking'.

People confirmed that they felt safe and comfortable with members of staff and with the other people living in the home. When asked who they would speak to if they had any concerns or worries, they told us that they would speak to the manager or that they would 'go to the office, they listen'.

We asked people if there were enough members of staff on duty to support them. They thought that there were and said 'they come quickly if you ring the bell' and if they had rung the bell the staff had told them not to worry 'that's what we are there for'. They described the staff as 'very kind' and told us that staff 'know what they are doing'. They told us that they received 'very good quality care' and were 'quite content'. One person said that 'if there is anything I don't like I can talk to someone and they will put it right'.