The Limes Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.
At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.
 

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always ensure people were at the centre of their care. People's care plans required more detailed information to enable staff to understand their support needs and relevant risks. For example, records showed people could sometimes need the assistance of 2 or more staff members to support them with emotional distress. However, there was not sufficient information on how these staff members should provide that support. Another person's care plan stated that the service should regularly assess their cognition, but this did not happen.

One person had all items removed from their bedroom apart from a bed and 2 chairs. The bedroom did not have items such as curtains, toilet roll and a door handle for their bathroom. Although care plans stated this had been done for their safety, the provider had failed to supply soft furnishings as stated in their care plan and explore other options, such as using toughened furniture or magnetic or Velcro curtains. Records showed they were at times escorted to their bedroom. This meant they were at risk of being taken to their bedroom with nothing to do .
 

The service did not always show an understanding of people's diverse support needs. Not everyone’s care plans provided information about their diverse backgrounds before living at The Limes Care Home, or their religious and cultural backgrounds. This increased the risk of staff not being able to promote their identity, dignity, values and beliefs.

We observed a person being supported unsafely to use a stair lift, and staff manually supporting their weight on the next set of stairs, increasing the risk of injury to both the person and the staff member . We highlighted this concern to the provider, who told us they would speak to the staff team about the person's needs. When we followed this up with the provider during our final visit, we found they had not yet taken any action. This meant they had not received timely support that was well co-ordinated and responsive to these risks.

However, a relative told us, “There does seem to be enough staff, and they are mostly regulars, so they understand the residents well.”
 

Improvements were required to ensure the service always supplied appropriate information in formats that were tailored to individual needs. For example, visual aids were not being used to support people in making their meal choices during our inspection. While staff relayed available options verbally, we observed people struggling with the staff member's accent, and they were only able to comprehend and choose between chicken and beef, rather than the full dishes, which were shepherd's pie or chicken kievs. A relative told us, “Communication is the biggest problem. Many of the carers do not speak very good English and [relative] finds it hard to understand them.” And “The other day [relative] had a cheese sandwich for lunch when I arrived. I asked [relative] why [they] had not had a hot meal and [relative] said because [they] didn’t understand what they were offering [them], so [relative] chose a cheese sandwich to be safe and knew [they] would like it”

A person's care plan stated that staff should use visual aids and objects of reference to support their communication, but staff could not show us these visual aids and objects of reference. They did, however, tell us they used body language gestures. This meant there was an increased risk that people’s communications needs were not always well assessed or met.

We also observed that staff had a good understanding of how to communicate with people to put them at ease. For example, when a person appeared scared about their mobility-related transfer, the staff member used humour to reassure them.
 

Although the provider did have a system to record and track concerns and complaints, we identified 4 recent complaints made by people or their relatives that had not been appropriately documented or investigated by the provider. This meant there was an increased risk that staff did not always appropriately respond to complaints. Care plans lacked evidence of how people or their relatives had been involved in their development.

However, the provider did have systems in place to gather feedback, such as residents' meetings and feedback forms. A relative told us, “Every other day they will phone and let me know how [relative] is doing. They also send me reports about [relative]. I think what more can I ask?”
 

Although the service had installed ramps, lifts and stair lifts, it was not consistently accessible for all people. For example, one person received unsafe support to use the chair lift. Other areas of the home were not appropriately secure, such as the fire exit next to a person's bedroom and the missing window restrictors we identified. Another person had to use a communal bathroom situated within the main lounge when they often experienced emotional distress around personal care, as staff told us the one in their bedroom was not suitable to meet their needs. This meant people did not always have equitable access to a safe and dignified environment.

Risks relating to burns and scalds was not well managed. This meant increased risks to people's rights to live in a safe care environment. We found evidence that people were being manually lifted or subjected to restrictive practices that had not been adequately assessed by the provider for safety, dignity risks or to provide justification for the necessity. This increased the risk of people not receiving equitable care under the Mental Capacity Act.

Staff and leaders did not effectively review information about people or act to ensure they received equitable outcomes. Safeguarding concerns were not always identified or reported. Documentation regarding instances of emotional distress and the monitoring of individuals' health needs was often incomplete or ineffective. Care plans did not consistently reflect peoples’ individual needs and did not always contain sufficient guidance on how to support them in managing known risks. This meant important information was not always available to ensure people were receiving safe, consistent and fair treatment, especially when they were unable to advocate for themselves. Staff did not always have the necessary skills, competence, and training to support people. Complaints had not always been appropriately documented and investigated, which increased the risk of people not having equitable access to being heard and their care needs understood.

People were not always well supported to plan for important life changes so they could have enough time to make informed decisions about their future, including at the end of their lives. Several people's end-of-life care plans lacked personalisation, instead containing generic information rather than specific details about their wishes, cultural and religious requirements, and personal preferences that needed to be observed at the end of their lives.