This inspection took place on 10 May 2018 and was unannounced. The Limes Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing 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.
The Limes Residential Care Home is registered to provide care and accommodation for 26 older people some of whom may have dementia. On the day of inspection, there were 23 people living at the home.
There was a registered manager in place. 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.
When we last inspected the service in February 2017, we identified breaches of regulations relating to the oversight of Deprivation of Liberty Safeguards (DoLS) and storage of people’s confidential information. At that inspection, the service was rated as Requires Improvement overall. At this inspection, the service remains rated Requires Improvement overall.
People were not always receiving individualised care that was responsive to their needs. Some people raised concerns regarding the lack of suitable activities and access to the community. Some care plans did not contain sufficient information about people’s specific care needs.
We found instances of poor infection control practices and unclean areas on the day of the inspection.
Medicines were not always safely managed. Where people required as-required medicines, such as painkillers, guidance was not available to guide staff on when people required these medicines. We found some stock discrepancies with quantities of medicines and what was recorded.
Some risks associated with people’s care and health had not been assessed and guidance had not been provided to staff to keep people safe.
The provider was not always working within the principles of Mental Capacity Act (MCA). Documented consent to care had not always been obtained from the appropriate person. There were no records of capacity assessment or best interest decisions for people who may not have had capacity to make their own decisions about their care.
Although there were quality assurance measures in place to monitor the care provided, the provider and registered manager had not identified and addressed the shortfalls we’ve described above. Therefore, their governance processes were not consistently effective.
Although some people raised concerns regarding the staffing levels, we found that there were sufficient staff on duty on the day of the inspection. We have made a recommendation that the provider continually assesses staffing levels to ensure that there are sufficient staff available to meet people’s changing care needs.
Appropriate checks were in place to ensure staff were safe to work with people using the service. Staff received regular supervision, training and appraisals. Staff told us they felt supported.
People and relatives told us that staff were caring which was confirmed by what we saw. Feedback received from people indicated that they were not involved in planning their care.
People had access to health services and staff were pro-active in ensuring that people’s physical health needs were met.
At this inspection, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to safe care and treatment, premises and equipment, consent to care, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of this report.