The Limes Retirement Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to Requires Improvement. This meant people’s needs were not always met. The service was in breach of legal regulation in relation to person centered care.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People living at The Limes were at different stages of their dementia ranging from early onset to advanced stages. There had been little improvement on how the service kept up to date and developed positively in this area to ensure the care provided was right and reflected best practice. Although staff had received training in dementia since our previous assessment, they were still not confident on how to support people with advancing dementia. Observation of staff interaction with people found they lacked the skills to communicate, interact, engage with or support people’s interests, especially at times of distress and anxiety.

A lot of work had taken place to revise care plans however, these still needed work to ensure they fully reflected people’s physical, mental, emotional and social needs. Care plans and associated risk assessments still lacked information to ensure staff had access to detailed, accurate and up to date guidance on how to provide the right care and consistent support to keep people safe. For example, care plans still lacked vital information about conditions, such as diabetes, epilepsy, catheter care, dementia and Alzheimer’s to guide staff on how to meet those specific needs to help people stay well and have a meaningful day. Relatives told us although they held power of attorney status for health and welfare for their family members, and were consulted on some decisions about their family members care they were not regularly involved in the person’s care plan or review of this.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People’s care and treatment was not always being managed in a way that was responsive to their needs and coordinated to ensure they had access to the right health professionals in their local communities. Attempts to find a local dentist had not been pursued to ensure people were supported to access routine oral health checks, unless families facilitated this. This resulted in people only being seen when they had a problem, rather than receiving regular check-ups.Issues about people’s capacity to consent to or refuse dental treatment had not been robustly explored through best interest processes to ensure people’s wishes were considered where dental work was needed.Staff had not been trained to support people with daily oral healthcare. People’s care plans had not thoroughly explored where missing teeth, lost crowns or poor hygiene could lead to pain, difficulty eating and sleeping, and other serious health problems.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information about the service was not always clear and transparent. The provider was required under their registration to complete a Statement of Purpose (SoP). This is a legal document required by CQC to outline the providers aims, objectives and the services offered and how they are designed to meet people’s needs. People living in the onsite Cottages, and not in receipt of personal care often used the premises, catering services, bathing facilities and received support from staff. There was no mention in the SoP about people living in the Cottages to inform people and their relatives or how this affected the service people received. For example, the staffing dependency tool had not included staff time for supporting people from the Cottages, which reduced the number of staff available to support people living at the service.

The registered manager confirmed they had no Service User Guide (SUG) in place to tell people moving to the service what to expect, the services available, or how to complain. However, they were developing a welcome pack which would contain this information.

Although there was a range of information on the notice board, including how to complain and to raise safeguarding concerns, this information had not been provided in different formats tailored to meet people’s individual needs, such as large text, easy read, or pictorial. The registered manager told us to help communication; they used a white board to write activities for the week and picture menus. They also had a folder of people’s favourite meals which had been updated from last inspection to include the current people in the service.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

People and their relatives were encouraged to share feedback about their experiences of the service via annual surveys, including how to raise concerns. Feedback had been provided to reflect how the information had been used and addressed, in the form of ‘You said / We did’ posters. However, review of the completed surveys showed not all concerns raised had been acted on, including reports of people wearing other people’s clothes, hearing aids being lost, lack of privacy and staff appearing bored, disinterested and not interacting with people.

Learning from complaints and concerns still needed to improve. Relatives told us complaints were not always responded to, or they were not informed about how their feedback was acted on, or if improvements were made as a result. The complaints folder had 5 complaints which had been made since the previous inspection in August 2024. Whilst action had been taken to contact the person making the complaint, there was no robust investigation completed to understand what went wrong, who was responsible or how to put things right.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Earlier concerns about equity of access in relation to areas of the premises, facilities and equipment had been addressed with the addition of a new wet room increasing the usable facilities for people to access a bath or shower when they wanted. Frail and immobile people who were living in rooms in the older part of the building on the first and ground floor had been moved to more suitable rooms to ensure their safety. The garden had been made safe but was still not being used to its full potential to promote people’s wellbeing and meet their sensory needs.

People did not always have access to healthcare services that met their individual needs and circumstances.Although there was evidence to show people were supported to regularly access healthcare professionals such as the GP, chiropodist and opticians, barriers or difficulties in finding a local dentist for people to access the care and support they needed had not been robustly explored and actioned by the provider or registered manager. Arrangements were in place with the local GP practice to ensure care was always available and staff had support for emergencies out of hours.

People’s personal, cultural, social and religious needs were not necessarily being understood and met. We saw a Jehovah’s witness church member come to speak with all residents in the lounge, no attempt was made to understand if this activity aligned with individuals' belief or religious following. This happened on a regular basis. There was limited access to other relevant local religious groups to meet the needs of people living in the service, including the involvement of other faiths, and participation in religious ceremonies and festivals.

Staff and leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Since our earlier inspection, some progress had been made to ensure equity in people’s experiences whilst living at The Limes. More staff had been recruited to support people to stay safe. Staff had completed additional training in a range of subjects, including equality, diversity and dementia, however, they still lacked insight and confidence to engage appropriately with people who had advancing dementia at times of distress leading to inequality in the care and support they received. The registered manager was unable to show how they proactively sought out ways to address barriers for people to improve their experience and ensure their outcomes were consistently good. For example, they could not demonstrate how they understood, and consistently met, the needs of the people particularly those with advancing dementia and those nearing the end of their end of life. The provider continued to lack systems to check if people’s life and experiences of living in the service could be improved upon in any way and find inequalities in their care. People and their relatives did not always feel listened to, and their concerns were not always acted upon to ensure they benefited from improvements in the service.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People had been supported to make informed choices for emergency care and treatment, including any decisions about do not attempt cardiopulmonary resuscitation (DNACPR) interventions in the future whilst they had capacity to do so. However, people’s end of life care needs had not been assessed, planned for, and recorded. Despite us viewing the care plan and associated records for someone with advanced health needs and deemed to be on end of life care, there was no plan in place or an acknowledgement that the person was coming to the end of their life.

End of life care planning was inconsistent. People’s decisions and what mattered to them most in relation to the end stages of their life had not always been set out in personalised care plans and shared with others who may need to be informed. Where care plans were in place for supporting people at the end the end stage of their life, these were brief. They did not include the persons specific and individual needs, choices and preferences or how staff were to support them. They did not reflect agreed advanced directives, co-ordination of care and arrangements in place for rapid access to support a dignified and pain free death. People, and their relatives had not routinely been included in discussions about important life changes, such as death and dying to ensure they had time to make informed decisions about their preferred end of life care arrangements. Meaningful conversations with people as part of ongoing assessments and reviews would help to prepare a plan for the delivery of end-of-life care. Whilst staff had received eLearning training in end of life care, they did not know how to plan for this need.