Limegrove

Updated 14 April 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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. 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

The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Limegrove is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 3 March 2022 and ended on 8 March 2022. We visited the service on 3 March 2022 to carry out the inspection. On 8 March 2022, telephone calls were made to relatives to obtain their feedback on the care their loved on received at Limegrove.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

We used all this information to plan our inspection.

During the inspection

During the inspection, we spoke with seven people, one visitor and one health professional about their experience of the care at Limegrove. We also spoke with eight care staff, which included the registered manager as well as the registered provider’s district manager. We reviewed the care plans for six people, as well as observing medicines practices and reviewing medicines records. In addition, we checked four staff recruitment files as well as other documentation in relation to the running of the service, such as complaints, audits and meeting minutes.

After the inspection

We spoke with three relatives to gain their feedback on the care their loved one was receiving at Limegrove. We also asked the registered manager to send us staff rotas, audits and training and supervision information.

Updated 14 April 2022

About the service

Limegrove is a residential care home providing accommodation and personal care for up to a maximum of 55 older people, some of whom may be living with dementia or other age-related conditions. The service is divided into five living areas over three floors. Each living area has its own lounge and dining room. At the time of inspection, 41 people were living at Limegrove.

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

Although some people told us staff responded to them in a timely manner when they required support and our observations supported this, staff told us they felt rushed and did not have time to spend with people. Staff rotas showed staffing levels fell below the amount they should be on several occasions. Although call bell audits demonstrated people’s bells were responded to in a timely manner, there was a risk that people may not receive prompt care from staff and staffing levels may be unsafe.

Risks to people had not always been identified or recorded in a way that may assist staff to provide responsive care. This meant people may be at risk of harm. In addition, some incidents of potential abuse had taken place, but these had not always been reported to CQC in line with requirements.

Although there were governance arrangements and systems at Limegrove these were not always effective in identifying shortfalls or areas requiring improvement. Such as care records or actions from audits. Staff told us, that despite a clearly recognised structure in place, they did not always feel supported or valued.

The registered manager was aware that work was needed to improve activities for people in order to help ensure they were not socially isolated. Our observations on the day were that little was going on and some people told us they would like to see more happen within the service. People said they spent their time in a variety of ways and the registered manager was working hard to reinstate activities following a recent COVID-19 outbreak.

People told us they were happy living at Limegrove. They said staff were kind and caring towards them and showed them respect. We observed this during our visit. People were enabled to make choices around how they wish their care and to retain their independence as much as possible.

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 see a healthcare professional when needed and they were provided with sufficient food and drink to help ensure they maintained a healthy weight. People received the medicines they required.

People lived in a service that was well maintained and homely and they were cared for by staff who had received sufficient training and supervision for their role. Staff knew people well and read people’s care plans to help ensure they provided person-centred, individualised care. People said they spent their time in a variety of ways and the registered manager was working hard to reinstate activities following a recent COVID-19 outbreak.

People knew how to make a complaint and felt comfortable doing so. Where complaints were raised, these were addressed.

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 14 August 2019).

Why we inspected

This inspection was prompted in part due to concerns received around poor infection control practices, lack of staff, poor medication records, a high number of falls within the service and people not receiving adequate drinks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements, although we did not find anyone was at immediate risk of harm. Please see the key questions of Safe and Well-led of this full report.

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

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

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 found breaches of regulation in relation to recognising potential safeguarding concerns, staffing and good governance within the service. You can read what action we have asked the provider to take at the end of this report.

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