Lime Lodge

Updated 11 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors completed a site visit.

Service and service type

Lime Lodge 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.

Registered Manager

A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. However, the provider had recruited a new manager after the inspection and they were in the process of applying to become the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We also contacted Healthwatch for feedback about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.

During the inspection

We spent time observing care and support in the communal areas. We spoke with one person who used the service and one relative. We spoke with the manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with four care staff. We reviewed a range of records. This included five people's care records and multiple medication records. We looked at two staff files in relation to recruitment. We looked at a variety of records relating to the management of the service, including the staff rota, audits and checks. We also reviewed the internal and external environment.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who liaise with the service.

Updated 11 May 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Lime Lodge is registered to accommodate up to nine people in one adapted building. People living at the service had a learning disability and / or autism. At the time of our inspection, seven people were living at the service. Accommodation is provided over two floors and within the grounds of the service.

People’s experience of using this service and what we found

Right Support

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support the best practice.

Improvements were required in how people were involved in their care and treatment that maximised their choice, control, and independence. People’s independence was not always sufficiently promoted and there were limited opportunities to engage in meaningful activities based on people’s interest and hobbies.

Risk assessments and support plans review and monitoring needed improvement. Risks in relation to the environment and infection prevention control had not been fully assessed and mitigated.

Medicines management processes did not follow best practice guidance.

People who lacked capacity to make certain decisions for themselves or had fluctuating capacity did not have their mental capacity assessments regularly reviewed to ensure the decisions made by staff on their behalf were in line with the law and supported by effective staff training and supervision.

The examples of menus we saw did not consistently promote healthy, varied diet. We did not find evidence of staff supporting people to be involved in preparing and cooking their own meals in their preferred way. Access to the kitchen was restricted by a pad lock which did not promote people’s independence. People’s cultural preferences in regard to diet were respected.

People were referred to health care professionals to support their wellbeing, however the updates and guidance from the professionals was not always recorded and we could not be assured if all the staff were aware of the guidance.

The interior and decoration of the service was not fully adapted in line with good practice to meet people’s sensory needs. People’s care and support was not always provided in a clean and hygienic environment. People personalised their rooms and were included in decisions relating to their own room’s decoration.

Right Care

There was a risk people may not receive consistent safe care because their support plans and risk assessments had not always been developed or were not up to date.

Staff did not ensure all people had up-to-date care and support assessments, including medical, psychological, functional, communication, preferences and skills. People, those important to them and staff, did not review plans regularly together. There was a lack of clear pathways to future goals and aspirations, including skills teaching in people’s support plans.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity.

Staff understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse.

Right Culture

The provider did not frequently check staff’s competency to ensure they understood and applied training and best practice. The provider's systems and processes used to monitor quality and safety were not fully effective. The provider's internal governance, systems and processes had not fully identified the shortfalls we found. There was no ongoing action plan to drive improvements. The provider had limited oversight and monitoring of the service.

Prior to our inspection, following a whistleblowing concern, we had contacted the provider and established that some staff did not complete mandatory training. This meant people were at risk of being supported by staff without the essential skills and qualifications. The provider addressed it immediately and at the time of our inspection all staff had received the mandatory training. People were supported by staff who had received basic mandatory training, however this did not include training in the wide range of strengths and impairments people with a learning disability and or autistic people may have, mental health needs, communication tools, positive behaviour support, trauma-informed care, human rights and all restrictive interventions.

Safe staff recruitment checks were completed before staff commenced their employment.

Staff were positive about the support and leadership of the provider. An external professional and relatives gave overall positive feedback about the service.

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 15 July 2021) and there were breaches of regulation. At this inspection we found the provider remained in breach of two regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about medicines, training, infection control and management of the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the overall oversight of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lime Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safety, need for consent and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.