Lime Tree Court Residential Care Home

Lime Tree Court is a residential care home providing personal care to up to 60 people in one adapted building over three floors, each of which has separate adapted facilities. The service provides support to older people, people living with Dementia and sensory impairment and younger adults. At the time of our inspection there were 49 people using the service.

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

People were supported by staff who had received training in how to safeguard people from abuse. Staff reported any concerns and incidents were investigated. Risks to people’s safety were assessed and plans put in place to reduce them. People had their medicines as prescribed.

People were supported by enough staff who had been safely recruited to the service. Where incidents occurred, the provider ensured there was learning in place to prevent these from happening again.

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.

People had their needs assessed and plans put in place to meet them. Staff were trained and had the skills to meet people’s needs. People had meals and drinks which were suitable for their needs and met their preferences.

People were supported by staff with meeting their health needs including having access to other health professionals. The provider had ensured the home was adapted to meet people’s needs and there were processes in place to ensure people received consistent support.

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.

People were supported to receive person-centred care. The provider was meeting their duty of candour. We found the provider had adopted a learning culture and changes were made following learning from events. The provider had oversight of the service through regular checks and audits which were identifying areas for improvement.

People and their relatives were positive about the service and felt involved. Staff told us they were supported and felt listened to by the registered manager.

Rating at last inspection

The last rating for this service was good (14 October 2021)

Why we inspected

We received concerns in relation to the management of medicines and the management of nutrition and hydration risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lime Tree Court is a residential care home that was providing personal care to 48 older people at the time of the inspection, some of whom were living with dementia.

The home accommodates up to 60 people in one adapted building over three floors, each of which has separate adapted facilities.

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

Although people received their medicines as prescribed, we found the overall management of medicines needed to be improved to ensure they were administered and stored safely.

People were protected from the risks of ill-treatment and abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do if they suspected wrongdoing.

The provider had assessed the risks to people associated with their care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

People were supported by enough staff who were available to assist them in a timely way.

People and staff felt the service was well managed. People and staff were given opportunities to share feedback about the service. The registered manager and provider undertook regular auditing to ensure the quality of care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 29 August 2019).

Why we inspected:

We received concerns in relation to the potential lack of timely medical intervention and concerns regarding the safe administration of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection people were at risk of harm from these concerns.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Please see the safe and well-led key questions sections of this full report.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Lime Tree Court is a residential care home that was providing personal care to 52 older people at the time of the inspection, some of whom were living with dementia.

The home accommodates up to 60 people in one adapted building. There are three floors, each of which has separate adapted facilities. One of the floors specialises in providing care to people living with dementia.

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

People told us they felt safe and staff knew how to identify and report concerns relating to people’s safety. Risks were assessed and managed to reduce the risk of avoidable harm. People received support to take their medicines safely. Staff were safely recruited.

Decisions about people’s care and treatment were made in line with law and guidance. 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.

People received sufficient amounts to eat and drink to maintain their health. Staff received training relevant to their role and understood people’s individual needs well.

People were supported by a caring staff team who respected people’s diverse needs. People were supported to maintain their independence where possible and their dignity was valued and respected.

People were supported by a staff team who knew them well and understood their needs and preferences. People and their relatives were involved in the assessment and planning of their care. People were supported to participate in activities and follow their own interests. People knew how to raise a concern if they were unhappy about the service they received.

People, relatives and staff felt the service was well managed. The registered manager and provider had made improvements since the last inspection. People and staff were given opportunities to share feedback about the service. The registered manager and provider undertook regular auditing to ensure the quality of care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 8 August 2018).

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.

Lime Tree Court 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.

Lime Tree Court accommodates 60 older people, who may have a diagnosis of Dementia in one adapted building. At the time of the inspection, there were 49 people living at the home.

There was 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 supported by staff who knew how to manage risks and report concerns to keep people safe. There were sufficient numbers of staff available to support people, infection control procedures were effective and medication was given in a safe way.

Although people’s rights were upheld in relation to Mental Capacity Act , further work was required to ensure that all best interest decisions were specific to the decision that required making and that all people who should be involved in decisions were consulted. People had sufficient amounts to eat and drink and had access to healthcare services where required. The design and decoration of the building met people’s needs.

People were supported by staff who were kind and caring. People were treated with dignity and respect and supported to maintain relationships with those closest to them. Advocacy services were available for people where required.

People were involved in the planning and review of their care and were supported by staff who knew them well. Activities required improvement to ensure that these were available when the activity co-ordinator was not present. Complaints made had been investigated and resolved.

Further work was required on records to ensure these were detailed and accurate. Audits in place to monitor the quality of the service had been effective in identifying areas for improvement. People were given opportunity to feedback on their experience of the service.

Lime Tree Court Residential Care Home provides accommodation and personal care for up to 60 older people. At the time of our inspection, there were 56 people living at the home.

There was a manager registered with us. 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. However we were informed prior to the inspection that the registered manager was no longer working at the location and that a new manager had been recruited. The new manager was present during this inspection.

People felt safe living at the home and were supported by staff who knew how to recognise and report any signs of abuse.Risks to people were assessed and managed to ensure risks were reduced where possible. Medication was administered safely and accurate records of medication given was kept. There were sufficient numbers of staff for people throughout the day although people reported longer waits for support during the night.

People were supported by staff who had received training and had the skills and knowledge required to support people effectively. There were effective communication systems in place to ensure that staff had the information they required to support people. The oversight and application of the Mental Capacity Act [MCA] and Deprivation of Liberties Safeguards [DoLS] was in need of review at the home. Staff understanding of DoLS was variable. Staff established consent from people before providing care. People had their dietary needs met and were supported during mealtimes as required. People had access to healthcare services when this was needed.

People felt that although staff were caring, they did not spend enough time with them in order to build a caring relationship. Staff ensured that people were treated with dignity and respect and that people’s independence was encouraged where possible. People had been encouraged to maintain relationships with people close to them and had access to advocacy services should they require this.

People’s care needs had been assessed prior to them moving into the home and these needs were reviewed regularly. People did not feel there were sufficient activities available to them to keep them occupied during the day. People knew how to make complaints and there was a system in place to ensure complaints made were investigated.

A new manager had been recruited and people reported that this has had a positive effect on the service. Audits had not been completed consistently and had not identified some of the issues we found during the inspection. Notifications about people who were subject to a Deprivation of liberty safeguard had not been sent to us as required by law. Feedback was gathered from people through resident, relative and staff meetings.

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.

Lime Tree Court Residential Care Home is registered to provide accommodation and personal care to a maximum of 60 older people who may have Dementia or sensory impairments. At the time of the inspection there were 60 people living at the home.

The home had 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 told us they felt safe at the home. Staff had an understanding of how to identify and report abuse and had a good understanding of how to manage risks to keep people safe.

We saw there were sufficient numbers of staff on duty to support people. We saw that staff had undergone checks prior to starting work to ensure they were suitable to care for people. Staff had appropriate training and support to enable them to meet people’s needs.

We saw that people were supported with their medication in a safe way. Staff had training before being able to handle medication and checks were completed in order to ensure people had received their medication as required.

People were supported to make their own decisions and had their rights upheld in line with the Mental Capacity Act 2005.

People were given choices at mealtimes and were supported to have enough food and drink. There was a system in place to ensure any changes to what people wanted to eat was reflected in the menu.

People’s health needs were met as they were supported to access a range of healthcare support when required.

Staff had a kind and caring approach and treated people with dignity and privacy. Staff supported people to maintain their independence where possible.

People and their relatives were involved in the assessment and review of their care. People were supported by staff who had a good knowledge of people’s needs.

People were supported to take part in activities that reflected their personal interests. Activities were adapted to suit people’s preferences.

People and their relatives were aware of how to make complaints. Complaints made had been investigated fully by the registered manager. People were supported to give feedback on the service via resident meetings and questionnaires.

The registered manager completed monthly audits to monitor the quality of the care provided.

At the time of our inspection, 59 people were using the service. We spoke with eight people who used the service and two relatives during our visit. People told us they were happy with the care they received and shared no concerns with us.

We spoke with the registered manager and seven members of staff. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Prior to our inspection, we spoke with two social care professionals and reviewed information we held about the service.

The premises comprised of three floors where people lived and spent their time. We observed how people were supported on all three floors of the home and how staff spoke with people.

We looked at five people's care records to see if they were accurate and up to date.

Below is a summary of what we found. The summary describes what we observed, the records we looked and what the staff told us.

Based on the information we received we asked if this service was safe?

Is the service safe?

We saw that systems were in place to manage and monitor how the staffing was provided to ensure people received the agreed level of support. The staff we spoke with told us there was generally enough staff on duty to meet people's needs. People we spoke with told us that staff were always available and they never had to wait long if they needed any support.

There was positive interaction between staff and people who used the service. Staff spoke to people in a friendly and respectful manner and responded promptly to any requests for assistance. The staff knew how people wanted to be supported and information was available to ensure people's needs were met safely.

At the time of our inspection there were 60 people living at the home. We spoke with five people, three members of staff, the deputy manager and the manager. We looked at eight people's care records.

Records reflected the support people received and important information relating to their health. However, we found one example of a record which did not fully reflect a person's health condition. This meant staff did not have the information they required about their condition in order to support them safely.

We found appropriate systems were in place which ensured the management of medicines for the people who used the service were safe.

At the time of our inspection there were 57 people living at the home. We spoke with seven people, three relatives, four members of staff and the manager. We looked at seven people's care records and 10 people's Medical Administration Records (MAR), which showed what medicines had been administered to people.

People and their representatives were positive about the care they received. One person told us, 'It's always been very good for me'. We found improvements in care had been made since our last inspection.

We found that medicines were not always being stored safely. We found examples of people not receiving the medicines they needed in order to support their health which put their wellbeing at risk.

We found that the premises were appropriately maintained and the provider responded to resolve issues in a timely way. One person told us, 'I had a problem with the overflow from upstairs. Staff fixed it promptly'.

We found that records did not always provide staff with the latest guidance on how people should be supported. We saw that some records, such as repositioning charts, were not always appropriately completed which meant that it was not possible to determine whether people had received the support they required.

We found that people were supported in making day to day decisions about the care they received. People's preferences were respected and promoted. One relative told us, 'They do listen'.

People did not always receive the care detailed in their care plan. People, staff and visitors told us there were not always enough staff to support people.

Records of medication were not always correctly completed by staff. We found gaps in some people's medication administration records, which meant that people could not always be sure they had received their medications.

We found that staff were recruited in a safe way and correct checks were carried out to ensure their suitability to care for people. One person told us, 'They know what they are doing'.

The service maintained a number of audits to ensure the quality and safety of care. People's views about their care were obtained by the provider.