Background to this inspection
Updated
22 October 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 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
One inspector carried out the inspection.
Service and service type
The Limes is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Limes is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We used information gathered as part of a monitoring activity that took place on 30 June 2022 to help plan the inspection and inform our judgements.
We sought feedback from the local authority and professionals who work with the service such as Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
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 used all this information to plan our inspection.
During the inspection
We spoke with one person who used the service and one relative about their experience of the care provided.
We spoke with four members of staff including the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included two people’s care records and three medicine records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
22 October 2022
About the service
The Limes is a residential care home providing support and personal care to up to six people in one adapted building. The service provides support to people with learning disabilities, autism and mental health conditions. At the time of our inspection there were three people using the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
The provider was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.
Right Support:
Risk assessments were not in place when people were at risk of serious harm.
People’s care and support plans were either not in place or out of date and contained information that was incorrect.
Staff did not always support people with their medicines in a safe way. The service did not maintain accurate and up-to-date records about people’s medicines.
People had access to specialist health and social care support in the community.
Right Care:
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Where people had a care plan, they were not person-centred. However, people were supported by a core team of staff who knew their needs well and how they liked to be supported.
People received kind and compassionate support. Staff were appropriately trained and had completed training in understanding autism.
Right Culture:
There was limited opportunity for staff to learn from incidents and improve practice.
The provider did not seek feedback or views from people or their relatives.
Staff treated people who used the service in a way which upheld their dignity, privacy and human rights.
Staff felt able to raise concerns and had training in safeguarding. Safeguarding training enables staff to recognise abuse, respond to concerns and support people to live free from abuse and neglect.
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 23 August 2019)
We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about how risks to people were being managed. A decision was made for us to inspect and examine those risks.
We inspected and found there was a concern with how the provider was managing risk along with their compliance to the principles of the Mental Capacity Act, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.
Enforcement
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 have identified breaches in relation to consent and not applying the principles of the Mental Capacity Act, safe care and treatment and good governance at this inspection.
Please see the action we have told 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.