28 December 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 14 and 16 November and was unannounced on the first day. The inspection was carried out by one inspector and an expert by experience. An expert by experience is someone who has personal experience of using this type of service.
Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what it does well and any improvements they plan to make. We reviewed notifications and any other information we received about the service. A notification is information about important events which the provider is required to send us by law. In addition, we requested feedback from the local authority commissioning with experience of the service.
We spoke with the new owner of the service, the registered manager, six members of the care team, the activity coordinator and the chef. In addition, we spoke with 12 people who lived at Lime Tree Court and five relatives. We also spoke with the visiting GP.
We reviewed each person’s medicine record, five care plans, four recruitment files and other documentation relating to the way the service was run.
We observed practice throughout the service and used a Short Observational Framework for Inspecting (SOFI). SOFI is a way of observing care to help us understand the experience of people who were unable to communicate with us.
28 December 2018
This inspection took place on the 14 and 16 November 2018 and was unannounced on the first day. During our last inspection in October 2017 we found the service was in breach of regulations. Care and treatment was not provided in a safe way. Manual handling was not carried out in a safe way to avoid injury to people. Nutritional needs of people were not always met and the service did not have systems in place to monitor care. We found during this inspection the service had made improvements and was now meeting the regulations.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good.
Lime Tree Court is a ‘care home’. 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. The service accommodates 23 people in one adapted building across two separate units, each of which have separate adapted facilities. The units specialise in providing care to people living with dementia. At the time of our inspection there were 19 people using the service. The service changed ownership on 6 June 2018.
The service is required to have a registered manager to manage the service. 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 and relatives gave positive feedback about the service. People told us that they felt safe because steps had been taken to improve the security of the building, doors leading to the stairs were now locked to prevent accidental falls and they were surrounded by caring staff. One person commented “I feel safe because now they lock the stairs off and people can’t get up or fall down them.” A relative said, “The atmosphere makes the place feel safe. Lime Trees has what it takes- not an old peoples’ place it is a home.”
Staff we spoke with understood the importance of treating people as individuals irrespective of their lifestyle or physical and mental abilities. The service had policies and systems to guide staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Robust recruitment procedures meant that only suitable staff were appointed. People were supported by suitable numbers of staff who had received training to enable them to provide high quality care. Medicines were managed appropriately people received their medicines as the prescriber intended.
We saw people had a choice of meals and said they had plenty to eat. Food was sourced locally and was cooked fresh on the premises. People who required specific diets were monitored to ensure they consumed adequate nutrients. Snacks and drinks were available throughout the day.
Activities and social events were available for people to avoid social isolation. Families and friends could visit without restriction.
There was a procedure in place to allow people to make comments or raise an issue. Relatives and people told us they knew how to make a complaint if the need arose. The service had systems and processes in place to record and learn from incidents and accidents that identified trends and helped prevent re-occurrence.
People were able to attend outside healthcare visits to ensure their needs were met. The provider had systems in place to ensure the service offered quality care and support. Where issues were highlighted the service took action to enable improvements to be made.