The Limes

Updated 19 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection visit took place on 9 August 2018 which was unannounced and we returned announced on 10 August 2018. The inspection visits were undertaken by one inspector.

Before our inspection visit, we reviewed the information we held about the service. We looked at information received from the local authority commissioners and the statutory notifications the registered manager had sent us. A statutory notification is information about important events which the provider is required to send to us by law. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority. The commissioners did not share any concerns about the service.

Before the inspection visit, the provider completed a Provider Information Collection (PIC). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIC was comprehensive and we were able to review the information in the PIC during our inspection visits. We found the information in the PIC highlighted what the service did well and how they planned to drive improvements.

To help us understand people’s experiences of the service, we spent time observing and talking with people in the communal areas of the home, or their bedrooms with their permission. This was to see how people spent their time, how staff involved them in how they spent their time, how staff provided their support and what they personally thought about the service they received.

We spoke with four people who lived at The Limes and four visiting relatives. We spoke with the registered manager, three care co-ordinators and three care staff (In the report we refer to these as staff). During our visit we also spoke with the provider’s director of compliance and a director of delivery.

We looked at three people’s care records and other records relevant to their support, such as medicines records, care plans, risk assessments and daily records. This was to see whether the care people received was recorded and delivered according to people’s care plans.

Updated 19 September 2018

This inspection visit took place unannounced on 9 August 2018 and we returned announced on 10 August 2018 to look at the quality assurance systems and to speak with people and staff.

The Limes is a two-storey residential home which provides care to older people including people who are living with dementia. The Limes is registered to provide care for 30 people. At the time of our inspection visit there were 27 people living at the home. Care and support was provided across both floors and each floor had its own communal lounge and dining area.

People in care homes receive accommodation and nursing and/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.

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.

At our last inspection we rated the service Good overall, with Well led being rated as ‘Outstanding’ because we found the provider learnt from previous inspections to drive improvements, shared good practice and the culture promoted open and continuous learning. At this inspection we found the service remained overall Good, however ‘in Well led’ we found the governance audit systems had not identified some of the issues we found which affected the standards of the care being provided.

Systems to ensure safe management of medicines were not always followed in line with current guidance and the provider’s own policies. Medicines were not always stored, recorded and given in line with current NICE guidance and staff who administered medicines were not confident or had sufficient knowledge using the electronic medicines management system.

People and relatives were very complimentary and satisfied with the quality of care provided at the home. People felt safe living with other people in the home and they were supported by a consistent, kind and caring staff team.

Staff were available at the times people needed and there were enough staff to respond to people’s needs and requests for assistance. Staff received training so that people's care and support needs were met by staff who knew how to support them. Staff understood their responsibility to safeguard people from harm and report any concerns they had to the management team.

People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. People were treated with respect by staff who addressed them by their preferred names and who supported them in line with their personal preferences and wishes.

No one at the time of our visit received end of life care. The registered manager said care was given so if people wanted, ‘this was a home for life’. Anticipatory and pain relief medicines were arranged and held so if people’s condition quickly deteriorated, their care could remain as pain free and dignified as possible.

The provider worked in partnership with other healthcare professionals to ensure people received effective care that was responsive to their needs. People’s medicines were not always stored and managed safely.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported best practice and decisions were made with family members who had legal authority to do so.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). People's right to make their own decisions about their care, were supported by staff who understood the principles of the Mental Capacity Act 2005.

There was a strong emphasis on people eating and drinking well. Staff had a good understanding of people’s nutritional risks so they could meet their individual dietary requirements. People told us they enjoyed the food and where people had specific dietary needs, such as soft and pureed foods, vegetarian and culturally, these needs were met.

Staff knew and understood how to limit the risk of cross infection and followed safe infection control practices.

The provider continued to be responsive to people's needs and people were occupied and stimulated with a variety of activities and events. Staff sought information from relatives and extended families so they could get to know people better. Relatives were involved, included and updated whenever changes were identified.

The registered manager promoted a homely atmosphere within the service. People and relatives said, everyone got on well and it was like an extended family. The provider’s governance systems recorded their audits and checks which were comprehensive in not only looking at this service, but how they rated in key areas, across other services within the providers organisation. However, some improvement was required to ensure audits such as care plans, medicines and equipment were more robust so they could identify some of the issues we found.

Further information is in the detailed findings below.