Archived: The Limes

The Limes 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 accommodates eight people in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.’

The provider did not ensure that the building was consistently safe for people. Where essential safety checks were required, these had not been completed. Where potential safeguarding incidents had occurred, these had not been considered in line with safeguarding procedures. Staff were recruited appropriately and there were sufficient numbers of staff available for people. There were safe systems in place for the management of medication.

The design and decoration of the building did not meet people’s needs and left people at risk of injury. People’s capacity had not been assessed in line with the Mental Capacity Act although people were not being restricted or deprived of their liberty by staff. People had sufficient amounts to eat and drink and had access to healthcare services where required. People’s needs had been assessed and people were supported by staff who had received training and supervision.

People were supported by staff who were kind, caring and promoted their independence. People were treated with dignity and given privacy where requested. People had access to advocacy services if needed.

People were involved in the planning and review of their care. There were systems in place to ensure that people were able to partake in meaningful activities that reflected their individual interests. Where complaints had been made, these were investigated and resolved. People’s potential end of life needs had been considered when care planning.

The systems in place to monitor the quality of the service had been ineffective in ensuring the building was safe for people. Where areas for improvement had been identified, these were not acted upon in a timely way. People were given opportunity to feedback on their experience of the service.

Our inspection took place on 30 January 2017 and was unannounced.

At our last comprehensive inspection of January 2016 the provider was not meeting regulations as the quality assurance systems in place were not effective. Also our rating from our previous inspection of November 2014 was not displayed as is a requirement. This meant that the provider was in breach of the law. Following the inspection we asked the provider to make improvements. We undertook a responsive [short focussed] inspection in September 2016 and found that improvements had been made at that time. However, during this inspection we identified some new issues that should have been identified during provider audits. These included the exposure of some hot pipe work and recruitment processes that were not always effective. The provider gave assurance that these would be addressed.

At our previous comprehensive inspection of January 2016 we also found that relatives were not always informed of complaints processes and records were not always made of complaints. We identified that people had not always been involved in their care planning and where changes occurred care records had not always been updated. This inspection we found that those areas had been improved upon.

There was a registered manager. 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.

Recruitment procedures had not always been operated effectively to ensure that staff employed met all of the required conditions. People felt safe and relatives agreed with this. Staff knew what to do if they felt that someone was at risk of harm. Accidents and incidents were recorded and analysed to identify any trends and patterns. Professional input was secured where needed to minimise the risk of future incidents. There were enough staff on duty with the skills and knowledge available to meet people’s needs. People were supported to take their medication independently and as they preferred. Medicine practices were safe and ensured that people took their medicines as they were prescribed.

Staff were trained and supported on a daily basis to ensure that people were supported safely and in the way that they wanted to be. People had their rights upheld in line with the Mental Capacity Act 2005 staff sought their consent and enabled them to make their own decisions. People’s dignity, privacy and independence was promoted. People were encouraged to prepare their own food and drink with staff support. People had access to the health care services they needed to promote good health.

Complaints procedures were available to inform people and their relatives how they could complain if they had a need to. People were supported to maintain their interests and were encouraged to take part in activities daily.

People and relatives knew who the provider and registered manager were. The provider made us aware of any incidents that had occurred. Their last inspection rating was on display on their web site and in the home as they are required to by law.

We carried out an unannounced comprehensive inspection of this service on 27 and 28 January 2016. Breaches of legal requirements were found. These related to there being insufficient quality monitoring systems in place and a failure to display the outcome of the service’s most recent ratings inspection. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Limes on our website at www.cqc.org.uk.

The Limes is registered to provide accommodation and personal care for up to eight people with Learning Disabilities. At the time of our inspection, there were seven people living at the home.

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.

The provider had taken action and legal requirements had been met. We found that sufficient improvements had been made to monitor the quality of the service. We saw that quality audit systems were in place and where areas for improvement were identified, these were responded to in a timely way.

We saw that systems had been implemented to ensure that people's care records remained accurate and that when feedback was received, this had been acted on by the registered manager.

The provider had displayed the outcome of their most recent ratings inspection both within the home and on their website.

Our inspection took place on 27 and 28 January 2016 and was unannounced. At our last inspection of the home in November 2014, we found that the provider was not meeting one of the regulations associated with the Health and Social Care Act 2008 which related to there being no effective quality assurance systems in place to check the quality of the service. Following the inspection we asked the provider to make improvements. The provider sent us an action plan outlining the actions they had taken to make the improvements. During this inspection we found that these improvements had not been made.

The home had a registered manager. 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.

Quality assurance audits were not completed to ensure the quality of the service. Where areas for improvement had been identified, action was not taken in a timely way.

Notifications that the provider was required to send to us, were not always submitted. This meant that the provider was not meeting legal requirements of their registration with us.

People were given opportunity to provide feedback on the service provided but where comments were made, these were not responded to in a timely manner.

A record of complaints was not held and complaints were not analysed to identify trends.

People were involved in planning their care. However, where people’s needs changed, this was not always documented to ensure records remained up to date.

Accidents and incidents were not analysed to identify trends and reduce the risk of incidents reoccurring.

People felt safe. Staff knew how to identify abuse and the actions to take if they suspected someone was at risk of harm.

There were sufficient numbers of staff with the skills and knowledge available to meet people’s needs.

People were supported to take their medication independently. Where people required support to do take medication, this was done in a safe way.

People had their rights upheld in line with the Mental Capacity Act 2005.

People were supported to maintain their independence and were encouraged to prepare their own food and drink with staff support. People had access to the kitchen at all times.

People had the healthcare support they required to maintain their health and well-being.

People were supported to maintain their interests and were encouraged to take part in activities daily.

People knew who the registered manager was and felt able to raise concerns with them.

Staff knew how to support people to meet their needs and ensure their healthcare requirements were met. One person living there told us, 'I'm well and I'm happy here.'

Improvements had been made to the environment so it was safe for people to live in. One person told us and we saw that the repairs needed to their furniture had been reported by staff so they would be made.

People were asked for their views about the home and audits of the quality of care that people received were completed.

We saw that people were encouraged to do things for themselves which promoted their independent living skills and self esteem.

We saw that people were supported to have regular health checks to ensure their well being. Other professionals were involved in people's care and staff followed their advice to help to meet people's needs.

Improvements had been made to the management of people's medicines. This helped to ensure that people got their medicines as prescribed to meet their health needs.

Several improvements had been made to the decoration of the home. Repairs had been completed and a system had been put in place to report repairs so they could be completed in a timely way to ensure that people were safe.

We saw that more staff had been recruited to work there which meant that people were supported to meet their needs.

Staff had received most of the training they needed to know how to meet people's needs.

An audit had been completed and a system was now in place which should ensure that action would be taken where needed to make improvements.

We saw that bank staff working there were not aware and did not have the information needed to know how to support the people living there to meet all their needs.

We observed that staff promoted people's independence.

Since we last visited some work had been done to improve the premises and the provider told us that further work was planned. However, we saw that repairs were needed but these had not been identified. Repairs identified at previous inspections had not been completed to reduce the risks to people's safety and welfare.

At the last three inspections we saw that some staff were working long hours without a break. Staff told us that they now could have a break if they wanted one. The rota showed that breaks had not been identified and arrangements were not made to ensure people were supported when staff had their breaks. This meant that the risks to the health and safety of staff and the people living there had not been considered and arrangements made to reduce these risks.

We saw, the staff spoken with told us and records showed that the risks to people's safety and welfare were not identified and action was not taken to ensure the safety and welfare of the people living there and staff.

We observed that staff promoted people's independence.

Medicine records were not clear to show that people received their medicines as prescribed to ensure their health and well being.

Since we last visited some work had been done to improve the premises and the provider told us that further work was planned. However, we saw that there were repairs needed but these had not been identified and some repairs identified at previous inspections had not been completed to reduce the risks to people's safety and welfare.

At the last two inspections we saw that some staff were working long hours without a break. Staff told us that they now could have a break if they wanted one. The rota showed that breaks had not been identified and arrangements were not made to ensure people were supported when staff had their breaks. This meant that the risks to the health and safety of staff and the people living there had not been considered and arrangements made to reduce these risks.

We saw, the staff spoken with told us and records showed that the risks to people's safety and welfare were not identified and action was not taken to ensure the safety and welfare of the people living there and staff.

People spoken with told us that they had enjoyed Christmas either with their relatives or at the home.

We saw that staff promoted the independence of the people living there. People were preparing the evening meal and helping to do their laundry.

Since we last visited some work had been done to improve the premises. We saw and people told us that there were still problems with the ground floor shower room as the shower cubicle had not been fitted properly. This meant there was a risk of people slipping after using the shower. The provider told us that there were plans to refurbish this shower room again. The upstairs shower room was now being used. We saw that there were other repairs needed but these had not been identified as a risk to people's safety and welfare.

We saw that some staff were working long hours without a break. This meant that the risks to their health and safety and that of the people living there had not been considered and arrangements made to reduce these risks.

We saw, staff spoken with told us and records showed that the risks to people's safety and welfare were not identified and action was not taken to ensure the safety and welfare of the people living there and staff.

All people spoken with told us that staff had supported them to go out to do their Christmas shopping and they were looking forward to going to Christmas parties.

We saw that people were comfortable in the company of staff and they spent time talking with and listening to people.

Since we last visited some work had been done to improve the premises. We saw and people told us that there were still problems with the ground floor shower room as the water did not drain away so creating a slipping hazard. The upstairs shower room was not working so people had to use the ground floor room. We saw that there were other repairs needed but these had not been identified as a risk to people's safety and welfare.

Since we last visited we saw and staff told us that they had received the training they needed so they knew how to support the people living there to ensure their safety and well being. Training was needed for some staff in how to meet people's specific needs and ensure their health needs were met.

We saw, staff spoken with told us and records showed that the risks to people's safety and welfare were not identified and action was not taken to ensure the safety and welfare of the people living there and staff.

When we inspected the home in August 2012 we found that monitoring systems did not protect the people living there against the risks of unsafe care and treatment. At this inspection we looked at what improvements had been made in relation to this.

We found that action was not taken by the provider as a result of audits that staff completed to ensure the safety and welfare of the people living there.

The provider had submitted an action plan that stated when the outstanding repairs to the home would be completed. However, we found that there were concerns as to how this work would be funded.

We saw that the views of the people living there, their representatives and staff were not considered by the provider so that action could be taken to make improvements.

We saw that staff interacted well and had a good rapport with the people living there. People were dressed in individual styles and attention had been given to their personal care. People told us they chose what clothes they wanted to buy and staff helped them if needed.

Records showed that staff referred people to other professionals and followed their advice to ensure that people's health needs were met.

Staff showed that they knew how to protect the people living there from being abused and they would report any abuse to ensure that people were safeguarded from harm.

We saw that the home was in need of redecoration and refurbishment to make sure that people lived in a safe and comfortable home. People told us their bedrooms had not been redecorated and they needed new furniture.

Before staff started working at the home, appropriate checks were done to ensure they were suitable to work with the people living there.

Staff needed training to give them the skills and knowledge to know how to meet people's needs and ensure their well being.

Staff completed audits to ensure that people were safe. They reported action needed to the provider but this was not done to ensure people's safety and well being.