Lime Tree Gardens

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 78 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place for learning lessons when things went wrong. Accidents and incidents were reviewed and action taken to reduce the risk of further similar accidents occurring. Lessons were shared with the staff team through team meetings handovers and key worker meetings. Appropriate polices offered guidance to support a leaning culture, for example, in relation to complaints and safeguarding adults.

The registered manager understood their responsibility under the duty of candour responsibilities and were able to demonstrate this.

The service always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The provider had arranged an onsite clinical team as part of the local hospital trust, the team included a general trained nurse, a clinical lead nurse, an occupational therapist and a consultant. The team were available to the people supported and the staff team where they had concerns for peoples physical or mental health.

The teams worked closely to ensure people’s supported needs were reviewed with the overall aim to reduce hospital admissions. The model has been reviewed and proven that hospital admissions for people have decreased.

The teams met weekly for clinical reviews with the overall aim to improve people’s quality of life. They referred people’s physical health needs to relevant professionals when needed. We spoke to 2 of the professional team on the day of our inspection, they said, “Lines of communication are very good, once a month we have a physical health meeting with the local hospital team to review people as needed, “We know the people well and they know they can come to us anytime to support their needs.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

There was an open culture at the service in which people were comfortable and at ease with each other and with the staff team. A relative told us, “They look after [family member] well. When I go and see [family member] I always observe the way they treat them, and I don’t have any concerns.”

Staff received relevant training to safeguard people from abuse and knew how to raise and report concerns when needed. A staff member told us, “I am obligated to report anything I believe to be a safeguarding with the registered manager and the clinical team.”

The service was working within the principles of the Mental Capacity Act (2005). Appropriate legal authorisations were in place to deprive people of their liberty where this was deemed necessary to ensure their safety.

The provider had a safeguarding adult’s policy. This made clear their responsibility to report allegations of abuse to the local authority and CQC. Where there had been allegations of abuse, these had been dealt with in line with the policy.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Systems were in place to ensure risks people might face were routinely assessed, monitored and reviewed. People’s care records contained detailed information for staff to follow to ensure risks to people were mitigated, so people remained safe when taking part in activities and events of their choice.

Staff were fully aware of the potential risks to people and the steps they needed to take to reduce or safely manage them. Throughout our site visits we observed staff were visibly present, attentive and aware of people’s whereabouts in the home and any changes that might indicate they needed additional support.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety checks on the premises were up to date at the time of our inspection, including those related to fire safety and legionella and gas safety. People’s risk assessments covered the physical environment. The premises were generally well maintained, although there were some minor issues that needed to be addressed. The registered manager was aware of these and could tell us the provider’s plan of action to repair these. The provider had a plan for the premises communal and dining areas to be repainted which was required.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were involved in champion roles, this meant that staff got to lead on areas they wanted to learn more about, for example one staff member was the champion for medicines, another staff member was responsible for activities for people involving people in the process. This approach meant staff were invested int their roles to ensure the best outcomes for people, this was then discussed with the registered manager during supervisions to ensure they had the tools and training needed to carry out their roles effectively.

Staffing levels meant people were supported to pursue their interests and hobbies when they wished. People discussed the activities they would like to do during meetings. The activities included various classes at a local community hub and indoor activities such as karaoke, bingo.

The staff recruitment process was thorough, and records demonstrated it was followed, and regularly reviewed. Staff received comprehensive training that was based on the Skills for Care common induction standards. They form part of the Care Certificate which is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social sectors. Disciplinary and capability processes were fair and regularly reviewed to ensure there was no disadvantage based on any specific protected equality characteristics. The processes enabled staff to receive appropriate, comprehensive training that was relevant to their role and enabled them to meet people’s needs.

Supervision records confirmed that staff had regular 1-to-1 meetings with management to support professional development and identify further learning needs. Systems monitored training and supervision, ensuring staff remained up to date and equipped to deliver safe, effective, and person-centred care. 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The premises were visibly clean on the day of our inspection and cleaning schedules were in place. This helped ensure the premises were routinely kept clean. Staff wore personal protective equipment when providing support with personal care and had undertaken training on infection control. There was an infection control policy to help guide good practice in this area

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

The provider had recently changed to an electronic medicines management system.

People received their medicines as prescribed. There were no errors identified in the medicines check we completed. Risk assessments were completed to determine the level of support each person required, and this was reviewed regularly to promote independence.

The registered manager had a staff member assigned who was the medicine champion, they were very knowledgeable. They understood the complexities of certain medicines and associated contraindications.

Staff were trained and assessed as competent to manage and administer medicines. Medicines were stored securely and at the correct temperature which was checked daily. The provider had a medicines room which was accessible for people to come to for their medicines, we observed medicine administration on the day of our assessment, staff were attentive and supportive to people whilst they received their medicines.

People had regular medicines review meetings with the onsite clinical team, this meant that peoples medicines were reviewed holistically and regularly which supported people’s needs.

The registered manager audited medicines regularly to ensure they had management oversight.