Background to this inspection
Updated
17 October 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.
The inspection took place on 10 September 2018 and was unannounced. The inspection team consisted of two inspectors; one assistant inspector; a specialist advisor who was a nurse with experience of providing nursing care to older people and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection visit, we checked the information we held about the service and provider. The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service such as what the service does well and any improvements that they plan to make.
We reviewed other information we held about the service such as notifications. A notification tells us information about important events that by law the provider is required to inform us about. For example; safeguarding concerns, serious injuries and deaths that had occurred at the service. We also considered information we had received from other sources including the public, Healthwatch and commissioners of the service. Healthwatch are the independent national champion for people who use health and social care services. We used this information to help us plan our inspection.
We spoke with four people who used the service and three visiting relatives. We did this to gain people's views about the care and to check that standards of care were being met. We also spoke with 15 members of care staff, two nurses and the activities coordinator. We spoke with the deputy manager, the registered manager and the quality and compliance manager to help us to understand how the service was managed.
Some people who used the service were not able to speak with us about their care experiences so we observed how the staff interacted with people in communal areas and we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We looked at the care records of eight people who used the service, to see if their records were accurate and up to date. We also looked at records relating to the management of the service. These included six staff files, training records, incident reports, medicines administration records and quality assurance records.
Updated
17 October 2018
This inspection took place on 10 September 2018 and was unannounced.
At the last inspection in 2017 we rated the service as requires improvement. At this inspection we found that many improvements had been made, although some improvements were still required to ensure that medicines were consistently safely managed and all people’s risk management plans contained accurate and up to date information.
Limewood Nursing and Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Limewood Nursing and Residential Home accommodates up to 59 people over seven ‘clusters’. At the time of the inspection, the service supported 57 people.
Limewood nursing and residential home was specifically designed by a team of clinical specialists, architects and designers at the University of Sterling who have been promoting the importance of the design for people living with dementia. The home has seven ‘clusters’ which are spread across three floors. On the ground floor, there is a high street which was made to replicate the town of Stafford and includes a pub, a picture house, a hairdressing salon and a large area for social activities.
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.
Some improvements were required to ensure that medicines were consistently managed safely to ensure that people received their medicines as prescribed. Risk assessments were in place and most were very detailed and specific to each person, to provide staff with the information they need to manage people’s risks. However, we have a made a recommendation about ensuring consistency for all risk management plans.
People were protected from the risk of harm and staff were trained to recognise the signs of abuse. There were enough suitably skilled staff to meet people’s needs. People were protected from the risk of infection by robust prevention and control measures. Reflective practice and analysis meant lessons were learned when things went wrong.
People’s needs were suitably assessed before the moved to the service and staff were inducted and trained. People had their nutritional needs met and there were systems in place to ensure people received consistent care and support. People were supported to have healthier lifestyles by having timely access to healthcare services and professionals. People had their consent sought in line with the principles of the Mental Capacity Act 2005. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
People received support that was delivered in a caring and compassionate way and people were treated with dignity and respect. People, where possible were consulted about how their care was provided and people’s care was regularly reviewed and adapted in accordance with their needs.
The service delivered care that was person centred. Staff knew people very well and they had access to activities. The provider had plans in place to further improve the provision of activities for people. There was a complaints procedure available to people and their relatives and people were supported at the end of their life to have a dignified and comfortable death.
People, relatives and staff felt the management team were approachable and supportive. There were opportunities for all to be involved in the development of the service and feedback was used to make improvements. The registered manager and provider had effective systems in place to monitor the quality and safety of the service and had plans in place to make improvements where these were required.
The service worked in partnership with other organisations to improve outcomes for people. They participated in innovative partnership working schemes to help improve the services provided.