We carried out a review of the data available to us about London Care (Lime Tree House) 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 London Care (Lime Tree House), you can give feedback on this service.
London Care (Lime Tree House) is an extra care service. People using the service lived in rented flats in a purpose-built building. At the time of our inspection there were 38 people receiving personal care at this service.
The service includes the Southwark Night Owl service. This provides care and support to people living in their own homes in the London Borough of Southwark who require support with personal care tasks at night. There were 8 people using this service at the time of this inspection.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service
People told us they were happy with the service they received from the provider. A person told us “The staff are caring and do a good job with a smile.” People were safeguarded from abuse and poor treatment and there were suitable processes to respond to safeguarding concerns.
The provider had improved the delivery of the night owl service. People told us that staff arrived on time and were reliable. There was now a system in place to ensure that calls took place as planned at night. Staffing levels were sufficient to meet people’s needs and staff were safely recruited. Medicines were safely managed, with appropriate checks to ensure that people received their medicines as planned.
The provider had put measures in place to protect people from the COVID-19 pandemic. This included ensuring staff used personal protective equipment correctly and had training in this, and there was enhanced cleaning within the service. Staff and residents were tested regularly and were supported to be vaccinated against the disease. Risks to people’s wellbeing were assessed and the provider took appropriate measures to mitigate these risks.
People told us they knew how to make complaints and ask for changes to their service, and the provider checked that complaints were addressed in line with their complaints policy.
There were improved systems of governance. A monitoring system was used to ensure complaints, incidents and accidents were responded to appropriately. There were regular checks on the quality of people’s care, including checking records of care and medicines management and speaking with people about the quality of their service. Staff understood their responsibilities and key duties were allocated and checked. Managers acted promptly to address staff concerns and support the staff team.
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 9 December 2019).
Why we inspected
We carried out an unannounced comprehensive inspection of this service between 26 September and 7 October 2019. Breaches of legal requirements were found and we issued a warning notice regarding good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and the handling of complaints.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London Care (Lime Tree House) on our website at www.cqc.org.uk.
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.
London Care (Lime Tree House) is an extra care service. People using the service lived in rented flats in a purpose-built building. At the time of our inspection there were 38 people receiving personal care at this service.
The service includes the Southwark Night Owl service. This provides care and support to people living in their own homes in the London Borough of Southwark who require support with personal care tasks at night. There were 15 people using this service.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service
There were substantial differences in the quality of care between the two services provided from this location.
People told us they were treated with kindness and compassion by their care workers. People living at Lime Tree House praised the service provided. One person told us, “It’s a lovely home.” People were treated with dignity and their privacy was promoted.
People being supported by the night owl service were placed at risk of missed visits. This was due to a lack of monitoring systems and failing to mitigate the risks from missed visits when care workers had been unable to attend. Risks to people’s wellbeing were otherwise assessed and staff took the right action to address these. Staffing levels were planned to meet people’s needs but there were times the night owl service had been unable to meet these.
Medicines were safely managed and there were measures to protect people from cross infection.
People’s needs and wishes for their care had been assessed and people told us their needs were met in the extra care service; but there were times that staffing had affected this on the night owl service. People in Lime Tree House had access to activities and were protected from social isolation. Processes were in place to address complaints and concerns about the service but there were times when these were not followed in the night owl service.
Managers in the extra care service had appropriate systems to engage with people who used the service and the staff team. There were regular checks and audits to ensure people received high quality care. There was less oversight by managers in the night owl service and care workers told us issues were not addressed promptly.
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.
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 26 October 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 some improvements had been made but was still not meeting some regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified two breaches in relation to how the service monitors visits and risks to people using the service and the handling of complaints. Please see the action we have told the provider to take at the end of this report. We issued a warning notice regarding one of these breaches; the provider is required to comply with this by 1 February 2020.
Follow up
We will request an action plan for 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.
‘London Care (Lime Tree House)’ is an extra care service, which provides care and support to people who live in their own homes. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support services.
At the time of our inspection the service was providing care to 34 people who lived on site. The provider also manages the Night Owl service from this location. This service supports people who live in their own homes and require personal care during the night. There were 16 people using the Night Owl service.
The service had a registered manager. A registered manager is a person who has registered with CQC 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. The provider had taken over the management of the service from another provider in February 2018. We found that several aspects of the transition process were badly managed.
The provider told us that the previous care provider had taken all risk assessments and care plans which were required to run the service. Since taking over the Night Owl service the provider had failed to complete assessments, care plans and risk assessments for all but two people. Care workers were relying on information provided by the local authority, but had not checked whether this information was in date. At times people’s timings and care needs had changed but this was not reflected in a care plan. At times people had needs relating to skin integrity or being supported to walk but the provider had not carried out risk assessments about these tasks, and so lacked a risk management plan. As there were no care plans to consent to, the provider had not obtained consent to care or checked whether people had the capacity to do so. This situation had arisen because there was not a clear line of management responsibility for the Night Owl service, and a single dedicated manager had only been allocated the week before our inspection.
At our request, the provider carried out these assessments after the inspection and provided evidence that they had done so.
There was no system in place to monitor, log and investigate incidents. Medicines were not safely managed as systems of audit had been devised but had not yet been implemented. This meant that where there were gaps in the recording of medicines these were not always followed up. Risk management plans for medicines were not always consistent about the level of support people required, and lacked detail on what medicines people took and the risks associated with these.
The staff team and manager had transferred to the new provider. As part of this the provider had checked that staff were suitable for their roles by carrying out appropriate pre-employment checks. There were systems in place to check care workers had the right skills to carry out their roles such as training and assessments of staff knowledge and competency. Within the extra care service there were plans in place to assess and manage risks to people who used the service.
We found breaches of regulations relating to safe care and treatment and the management of medicines, good governance, consent to care and person-centred care. You can see what action we told the provider to take at the back of the full version of this report.