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Limewood Nursing and Residential Home Good

Reports


Inspection carried out on 10 September 2018

During a routine inspection

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 improveme

Inspection carried out on 24 May 2017

During a routine inspection

This inspection took place on 23 and 24 May 2017, and was unannounced. At our last inspection in December 2015 we found that the service required improvement in two domains, responsive and well led. At this inspection we found that some improvements had been made however further improvements are needed to ensure the service provides a consistently good service for people.

Limewood Nursing and Residential home provides support and care for up to 59 people, some of whom may be living with dementia. At the time of this inspection 53 people used the service.

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.

Risks to people's health and wellbeing were identified and assessed, however they were not always reviewed or updated in a timely way. Staff were available to meet people's care and support needs, however there were occasions when some units were left without a staff presence.

People were supported to access other healthcare professionals to maintain and improve their health and wellbeing. However records were not always updated in a timely way to ensure healthcare needs were consistently met.

Staff had training opportunities to acquire the knowledge and skills necessary to meet people's individual care and support needs. Recruitment and vetting procedures were in place that ensured appropriate people were employed.

People felt safe living in the home and staff were aware of how to safeguard them from the risk of potential abuse. Staff were aware of the action they should take where they had concerns regarding the safety of people. Appropriate action was taken when allegations of abuse and concerns with people's safety were identified.

People’s medicines and nutritional needs were managed well.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA and Deprivation of Liberty Safeguards (DoLS) when they provided support.

Staff showed care and kindness towards people and people were encouraged to make day to day decisions about their care and support. People were supported to maintain their independence.

There was a range of daily activities arranged for people to enjoy either in a group setting or on an individual basis.

The provider had a complaints procedure and people knew how and who to complain to.

Systems were in place to monitor the quality and safety of the service and changes had been made to the internal management structure of the service. Further improvements were needed to ensure staff deliver a safe and effective service for people.

Inspection carried out on 7 July 2015

During a routine inspection

This inspection took place on 7 July 2015 and was unannounced.

The service provides accommodation with nursing care for up to 59 people, there were 40 people using the service when we inspected. They offer residential, nursing and respite care. People who used the service may be living with dementia and/or have physical or sensory disabilities. The service is divided into clusters of eight bedrooms. Each cluster has its own open plan living area, kitchen, dining area, quiet room and assisted bathroom.

The registered manager left the service on 10 June 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The deputy manager was acting into the role of manager.

People were not always supported to be involved in the planning of their own care and staff were not clear how they knew who to consult with when people were unable to be involved. This meant that people’s voice may not be heard. Some people were not supported to follow their interests and participate in social activities. There was little planned activity at the home and the ‘reality high street’ was not used to its potential.

People were protected from avoidable harm and abuse. People felt safe and staff knew what to do if they suspected abuse, we saw that local procedures had been followed when needed. People's risk was assessed and reviewed and measures were in place to reduce risks. There were sufficient numbers of staff to keep people safe and meet their needs. Agency staff were used to ensure sufficient staffing levels, these were usually regular agency staff that had been to the service before. The provider was recruiting more permanent staff. Medicines were safely stored and administered so that people received their medicines when needed.

We are required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DOLS are for people who are unable to make a decision about where or how they are supported and they need someone else to make this decision for them. All people who permanently lived at the service were referred for a DoLS assessment because the exit doors were locked, this meant their rights were respected. We had not been notified of people who had a DOLS assessment and this is a requirement of registration.

Staff received training to help them deliver effective care to people. People were supported to eat and drink enough to maintain a balanced diet and support with eating and drinking was provided when needed. People were supported to have access to healthcare services.

People were treated with kindness and compassion and their privacy and dignity was respected. Some people received personalised care to meet their specific needs. Staff felt supported by the manager. Relatives felt the manager was approachable and people knew how to complain. The manager completed quality checks and regularly reviewed incidents to look for trends. Actions were put into place to make improvements following these checks. Feedback was gathered from people and their relatives and a relative’s forum was being developed.