Limetrees

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.

This is the first assessment for this newly registered service that registered with us in 2023. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 needs were not consistently or thoroughly assessed, and records did not always reflect a clear, up-to-date understanding of individuals’ care and support requirements. Some care plans were incomplete, inconsistent, or lacking detail, particularly in areas such as clinical conditions, dietary needs, and mental capacity.

We found conflicting information around mental capacity and DoLS, and unclear guidance for staff on how to meet people’s needs safely. This increased the risk of care not always being delivered in line with people’s preferences or best interests.

There was also limited evidence assessments were regularly reviewed or updated to reflect changes in people’s needs. In some cases, monitoring information, such as fluid intake or risk changes, was recorded but not clearly used to inform care planning or next steps.

Some relatives told us about being involved in initial assessments. One relative told us, “We spent two or three hours developing her care plan,”. Relatives consistently told us they felt staff understood their family member’s needs well.

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, teams, and external services generally worked well together to support people’s care, with positive feedback from both relatives and professionals about communication and coordination. Relatives consistently told us they felt informed and involved, with one stating, “We are kept well informed,” and another sharing, “I can raise anything.”

There was evidence of effective partnership working with external professionals. A visiting professional told us staff were “friendly, competent and no major concerns, they escalate when needed,” indicating staff recognised when to seek additional support and worked appropriately with other services to meet people’s needs.

Staff interactions observed during the inspection showed a team approach to supporting people, with staff communicating with each other and supporting shared tasks throughout the day. While some inconsistencies were observed, there was an overall culture of staff working together to provide care.

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, teams, and external services generally worked well together to support people’s care, with positive feedback from both relatives and professionals about communication and coordination. Relatives consistently told us they felt informed and involved, with one stating, “We are kept well informed,” and another sharing, “I can raise anything.”

There was evidence of effective partnership working with external professionals. A visiting professional told us staff were “friendly, competent and no major concerns, they escalate when needed,” indicating staff recognised when to seek additional support and worked appropriately with other services to meet people’s needs.

Staff interactions observed during the inspection showed a team approach to supporting people, with staff communicating with each other and supporting shared tasks throughout the day. While some inconsistencies were observed, there was an overall culture of staff working together to provide care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Support for people to live healthier lives was variable and not consistently delivered or evidenced. While some monitoring systems were in place, such as fluid charts and health observations, these did not always demonstrate clear follow-up or action when concerns were identified. This meant opportunities to promote and maintain people’s health were not always fully maximised.

We found examples where people’s health needs were being monitored, and staff were seen to escalate concerns appropriately in some cases. We mostly received positive feedback from people and relatives around the quality of the meals. Relatives we spoke with, told us people’s dietary needs were generally supported. One relative told us, “[Person] loves their food,” a further relative told us, “[Person] is now eating well, they have gained weight.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There was evidence systems were in place to monitor care and drive improvements, and leaders had begun to strengthen oversight across the service. Audits, checks, and monitoring tools were being used, and staff demonstrated awareness of their role in identifying areas for improvement.

We saw examples of monitoring supporting care delivery, including the use of charts and records to track people’s needs, and staff escalating concerns when required. A visiting professional told us staff were competent and no major concerns, they had no concerns to escalate when needed,” Staff responded appropriately to changes in people’s health.

Relatives were positive about the outcomes for their family members, one relative told us, “[Person] is in the best place,”

While there were further opportunities to strengthen consistency, particularly in how audits were completed and actions followed through, there was a clear foundation in place for monitoring and improving outcomes, with increasing oversight and a willingness from leaders and staff to identify and address areas for improvement.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Assessment and recording of consent, including mental capacity, was not consistent or clearly evidenced, which meant it was not always clear how decisions about care and treatment were being made. Records showed inconsistencies in mental capacity assessments, and documentation did not always demonstrate how decisions reflected people’s level of understanding or how they had been supported to make their own choices. This increased the risk of decision-making not always being fully informed or clearly recorded.

Care records did not always clearly evidence how consent had been obtained or reviewed, including where more formal decision-making processes may have been required. This limited assurance all decisions were being made in line with the person’s best interests at the centre of the decision.

We observed interactions where staff took a respectful and person-centred approach, regularly asking for permission before providing care. One resident said, “They are very careful about your dignity and ask in such a lovely way,”