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Archived: The Limes Residential Home Requires improvement


Inspection carried out on 16 August 2016

During a routine inspection

This inspection was unannounced and took place on 16 August 2016.

The Limes Residential Home is registered to provide personal care and accommodation to up to 19 people. The home specialises in the care of older people. The home is arranged over four floors with a small passenger lift which is not able to accommodate a wheelchair. The home is therefore only suitable for people who have reasonable levels of mobility. At the time of this inspection there were 13 people living at the home.

The last inspection of the home was carried out in August 2014.No concerns were identified at that inspection.

There is a registered manager in post. 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.

People were very happy with the care and support they received at the home and with the staff who supported them. However we found that some improvements were needed to ensure there was on-going maintenance and redecoration to improve the environment for people.

People were at risk of not receiving care and support which was reflective of current good practice or legislation because many of the policies and procedures were out of date. We recommend the provider seeks advice and support to up-date and amend their policies and procedures.

People were extremely complimentary about the staff who supported them. Staff were kind and caring and welcomed visitors into the home. There were sufficient numbers of staff to ensure people received physical and social support. People had confidence in the staff and thought they were well trained. Staff were happy with the training they received and felt they had the skills and knowledge to meet people’s needs.

People were able to make choices about all aspects of their day to day lives and were involved in the planning of their care. People were supported to take part in activities at the home and to access community facilities.

Risks of abuse to people were minimised because there was a robust recruitment procedure and staff knew how to recognise and report abuse. People felt safe at the home. One person said “Safe as houses here. Nothing to worry about.”

People had access to healthcare professionals to meet their individual needs. One person said “They always get a doctor if you need one.” Medicines were administered safely by staff who had received training to carry out the task.

People thought the management in the home were open and approachable and said they would be comfortable to make a complaint if they were unhappy with any aspect of their care. When complaints were made these were investigated and responded to.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 1 August 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The staff we spoke with were knowledgeable and aware of their responsibilities under the Mental Capacity Act. We observed that best interest assessments had been conducted for people who lacked the capacity to make decisions about certain aspects of their care.

People told us they felt safe in the home, comments included; "I feel very safe here" and "We get lots of choices"

People had been cared for in an environment that was safe and clean; one person told us "Everything is very very clean here". Equipment at the home had been well maintained and serviced regularly. Provider support was available on a daily basis.

Policies and procedures were in place, risk assessments had been conducted for all people living in the home. Staff we spoke with were confident the training they had received as part of induction and mandatory training helped them to care for people living in the home.

Is the service effective?

The care plans and risk assessments we looked at suggested the care people received was safe and planned in accordance with individual preferences. People told us that they were happy with the care they received. It was clear from what we saw and from speaking with staff that they understood people’s care needs and that they knew them well.

One person told us "The staff are very good". Staff had received training to meet the needs of people living in the home. Another person told us "I know that we have care plans and if we can we sign them"

Is the service caring?

We observed staff treating people with respect and courtesy. Staff were kind and attentive. We observed people being given time to do things and supported to maintain maximum independence. People told us "They look after me very well" and "We are treated with respect"

Visiting family members told us, "I find my relative so much better since they have been here, I think the staff are very nice and we are made to feel very welcome" We observed affectionate and caring interactions between staff and people living in the home.

Is the service responsive?

Care plans that we looked at detailed people's interests, dislikes, preferences and personal history. We observed the minutes of a resident's meeting that detailed a persons request during a resident's meeting to have seating available whilst waiting for the lift. We observed that a chair had been positioned for the person concerned. This demonstrated a responsive service that actively seeks people's views and opinions and responds to them.

Is the service well-led?

A manager was in place who was registered with the Care Quality Commission. Staff told us they had regular training, supervision and appraisals. We observed a variety of policies and protocols to ensure the safety of people living in the home. Quality assurance processes were in place and up to date.

Resident's meetings were held three monthly so people had an opportunity to suggest change or request various activities. People were encouraged and supported to maintain previous outside interests. One person told us "I go to the local church"

Staff told us communication was good among the staff team and they all felt well supported by management.

Inspection carried out on 21 January 2014

During a routine inspection

There were 15 people living at the home at the time of our inspection. One person was an inpatient at a local hospital.

We spoke to nine people who all told us that the staff were very kind to them and always asked them what they wanted to do when seeking their consent. One person said "I am very happy here and really enjoy the activities and the food is really good".

We reviewed six care plans and noted that they were centred around each person's individual care needs. We saw detailed risk assessments that ensured that the care and support that was delivered was safe.

We observed that systems and processes were in place to ensure that medical and non-medical equipment was safe and fit for purpose for people, visitors and staff at the home. People had mobility assessments to ensure that the appropriate medical equipment was made available to them and they were supported in its use.

We observed throughout the inspection that staff cared and supported people with kindness and dignity at all times. We noted that staff were well supported and attended supervision, appraisal and in service training.

We noted that surveys had been completed by people living at the home, relatives, carers, and visiting professionals. Everyone commented on how pleased they were with the standard of care and how each person's needs were being met. One person said "I have been here a long time and I am cared for so well".

During a check to make sure that the improvements required had been made

We found the provider had taken action to ensure its premises were safe to use and adequately maintained.

The provider had employed an external company to service the main electrics and work had been completed where faults had been found. The guttering had been cleaned to reduce the cause of damp and mould in people’s bedrooms. They had also arranged for the rooms affected by damp to be redecorated. The disabled access to the home had been levelled and a temporary ramp had been purchased to improve access for people.

Inspection carried out on 5 September 2012

During a themed inspection looking at Dignity and Nutrition

We carried out an unannounced inspection on 5 September 2012. On the day of our visit there were 15 people living at The Limes Residential Home. We spoke with eight people living at the home, seven staff members, which included the registered and deputy manager and cook and looked at eight peoples care files.

Comments included: “It’s lovely here”; “the staff are really nice and helpful”; “we are involved in planning our care.”

People told us what it was like to live at the home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional.

Some of the people who used the service at The Limes Residential Home had a dementia and therefore were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

Inspection carried out on 5 September 2012

During an inspection in response to concerns

This inspection was carried out as part of a themed dignity and nutrition inspection. During the themed inspection we found there were significant concerns about how the home was maintained and the suitability of some of its premises for the people who lived in the home. The outcomes reviewed through the dignity and nutrition themed inspection will be detailed in another report and the concerns identified covering the additional outcome will be in this report.