We carried out a review of the data available to us about Limes Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Limes Residential Care Home, you can give feedback on this service.
The Limes Residential Care Home is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection some of whom were living with dementia. The service can support up to 26 people.
People’s experience of using this service and what we found
People were safe living at The Limes. Safeguarding processes were in place to help safeguard people from abuse. Risks associated with people’s care had been assessed and guidance was in place for staff to follow.
People were supported to engage in activities based on their hobbies and interests which had a positive impact on their well-being. Care plans were detailed, person centred and evidenced that people and their relatives were consulted around their care preferences.
People received their medicines, as prescribed. Feedback given to the management team by the inspection team regarding the management of prescribed creams was addressed following the inspection. There were enough staff to support people in a person-centred way.
Improvements made following the last inspection had been sustained and embedded. There were quality monitoring systems and processes in place to identify how the service was performing
and where improvements were required.
Staff received appropriate induction, training and support and applied learning effectively in line with best practice. This led to good outcomes for people and supported a good quality of life.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff were caring and kind. People we spoke with and their relatives confirmed this. Staff provided comfort and support if people became anxious or upset.
Staff supported people to meet their health and nutritional needs. People were supported and encouraged to maintain their independence. Staff worked with health care professionals to maintain people's wellbeing.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 7 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The Limes Residential Care Home 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 Limes Residential Care Home is registered to provide care and accommodation for 26 older people some of whom may have dementia. On the day of inspection, there were 23 people living at the home.
There was a registered manager in place. 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.
When we last inspected the service in February 2017, we identified breaches of regulations relating to the oversight of Deprivation of Liberty Safeguards (DoLS) and storage of people’s confidential information. At that inspection, the service was rated as Requires Improvement overall. At this inspection, the service remains rated Requires Improvement overall.
People were not always receiving individualised care that was responsive to their needs. Some people raised concerns regarding the lack of suitable activities and access to the community. Some care plans did not contain sufficient information about people’s specific care needs.
We found instances of poor infection control practices and unclean areas on the day of the inspection.
Medicines were not always safely managed. Where people required as-required medicines, such as painkillers, guidance was not available to guide staff on when people required these medicines. We found some stock discrepancies with quantities of medicines and what was recorded.
Some risks associated with people’s care and health had not been assessed and guidance had not been provided to staff to keep people safe.
The provider was not always working within the principles of Mental Capacity Act (MCA). Documented consent to care had not always been obtained from the appropriate person. There were no records of capacity assessment or best interest decisions for people who may not have had capacity to make their own decisions about their care.
Although there were quality assurance measures in place to monitor the care provided, the provider and registered manager had not identified and addressed the shortfalls we’ve described above. Therefore, their governance processes were not consistently effective.
Although some people raised concerns regarding the staffing levels, we found that there were sufficient staff on duty on the day of the inspection. We have made a recommendation that the provider continually assesses staffing levels to ensure that there are sufficient staff available to meet people’s changing care needs.
Appropriate checks were in place to ensure staff were safe to work with people using the service. Staff received regular supervision, training and appraisals. Staff told us they felt supported.
People and relatives told us that staff were caring which was confirmed by what we saw. Feedback received from people indicated that they were not involved in planning their care.
People had access to health services and staff were pro-active in ensuring that people’s physical health needs were met.
At this inspection, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to safe care and treatment, premises and equipment, consent to care, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.
The Limes Residential Care Home is registered to provide care and accommodation for 26 older people some of whom may have dementia. Highlands Healthcare Limited is the registered provider of the service since 24 May 2016 and this was the first inspection under their ownership.
There was a registered manager who had worked at the service for a number of years under the both the previous owner and current owner. 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.
On the day of inspection 21 people were living at the home and one of these people was in hospital.
We found two breaches of regulations in good governance and the need for consent. The service had changed ownership but arrangements had not been made for people’s electronic records to be transferred by the new provider in a confidential manner. The computer containing records and the service e-mail account was taken by the previous owner following the change of registration in May 2016. When we inspected in February 2017 the matter had not been addressed as such the management team had not protected people’s confidential information. They did not have access to people’s Deprivation of Liberty Safeguards (DoLS) documents and supporting e-mails. This had resulted in one DoLS not being reviewed in a timely manner and there was no record of people’s mental capacity in terms of their care and treatment or any conditions arising from the DoLS authorisations. The management team had not shown good governance in this respect.
People and relatives spoke positively about the care provided by staff in the service and told us staff were kind. However people had differing views about the staffing levels as some people felt more staff were needed some times. We found that the manager had adjusted staff shift times to provide more staff at busier times in the day and if staff were absent a replacement staff member was called in to cover their shift. There were recruitment systems in place to ensure staff were safe to work with vulnerable people. Staff confirmed they had received supervision and training to support them in their role.
All but one staff member had received safeguarding adults training and all staff spoken with could tell us how they would report suspected abuse appropriately.
There were appropriate systems in place for the safe administration and storage of medicines and the staff member administering medicines was well informed about their use. Medicines were audited on a monthly basis by the registered manager.
We saw evidence that people were supported to access appropriate health and social care services in a timely manner. People’s health records were kept updated and the service provided freshly cooked meals and ensured people remained well hydrated. Staff provided support when appropriate to people to eat their meals whilst continuing to promote their independence.
The service was clean and staff used infection control measures appropriately. The service had decorated the communal areas and put down new flooring that improved the living environment for people. There were some new signs to support people to recognise where they were in the home.
People told us they were supported as they wished to be and people had individual care plans that detailed their support needs and they had been reviewed on a regular basis. However we did not see evidence of people signing their care plans and brought to the registered manager’s attention that it would be easier for people to read typed care plans rather than hand written.
There was a complaints policy and procedure. People and their relatives told us they felt they could complain and raise concerns. People were asked their views in a survey about the service they received. The service manager undertook monthly audits to assure the quality of the service.
We made a recommendation with regard to care plan records being typed to allow them to be shared and read by people and their relatives.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17 Good Governance, and Regulation 11 Need for Consent.
You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.