Archived: The Limes

The Limes is a residential care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service can support up to 28 people.

The care home is in one building spread across two floors. There are 26 single rooms and 2 double bedrooms. All bedrooms have ensuite facilities with a shared lounge, kitchen and garden.

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

People did not always have risks in relation to choking, falls and medicines fully assessed and so there was not enough guidance for staff on how to support their needs in these areas.

People’s medicines were not all administered or recorded safely. Amounts of some medicines did not match the recorded stock and some people’s pain relief medicines were not administered as prescribed.

People’s home was not always kept clean as there was food on the floor in one area and some cleaning required in a bathroom. Not all staff were wearing the correct face masks to help prevent the spread of COVID-19 and other infections.

There were no effective quality monitoring systems in place at the time of the inspection which meant that the standards of people’s care could not be assessed with a view to make improvements.

People’s care records had been transferred to an electronic system that was still being developed and so there were some gaps and inconsistency in records.

However, people told us they felt safe and they were happy living at the home. They said that staff were caring and patient and treated them well. People said the food was good and they had choices in what they ate and how they spent their time.

Staff had received training in safeguarding and other relevant topics and were in the process of receiving refresher and specialised training. This included Dementia awareness, Deprivation of Liberty Safeguards for people living with Dementia, nutrition and infection prevent and control.

Staff had a good understanding of how to act in emergencies and how to safeguard people. They were confident about reporting any concerns both inside and outside of the organisation.

There was a new manager and deputy manager in post who people, relative’s and staff all felt were approachable and open and they could raise any issues with them. They felt there had been a lot of improvements made. They had confidence the actions being taken by the new manager were positive and they would ensure all concerns were addressed.

We have made a recommendation about the management of staff rotas, recruitment procedures and infection prevention and control measures.

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 04 May 2018).

Why we inspected

We received concerns in relation to risk management of person to person abuse, falls, eating and drinking and pressure care. Also, appropriate reporting and recording of incidents, staffing levels, staff skills, adherence to follow guidelines from health professionals and the general management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

The manager was aware of the areas that required improvement. The manager had created an action plan for all areas of concern and was in the process of making the necessary changes to ensure people were safe and the service was well managed. However, this had not yet been implemented or embedded into practice.

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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to unsafe infection prevention and control practices, managing falls risks, safe management of medicines, reporting and recording and effective management of the service 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The home had identified a designated area for visits to take place. A process was in place to support safe visits to the home. Visits were by appointment only, all visitors were required to complete a health questionnaire screening form, have their temperature taken and take a rapid COVID-19 test. Personal protective equipment (PPE) was supplied by the provider for all visitors to wear.

The provider had a process in place to support safe admissions to the home.

Staff had received training on how to wear, put on and take off their PPE. This was reiterated regularly with staff through team meetings and monitored by the infection control champions.

It is an Edwardian house which has been extended and adapted to provide care and support over three floors. At the time of the inspection 26 people were using the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix, on duty to support people with their assessed needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professionals when required, including chiropodist and doctors to make sure that people received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. Care plans were written in a person centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

People are supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

Further information is in the detailed findings below

The service provides accommodation and care for up to 28 people. At the time of our inspection there were 25 people living at the home.

The service 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded, although the causes of these had not been analysed to allow the provider to identify preventative actions which could be taken to reduce the number of occurrences. Where people had been involved in incidents because of behaviour that could have a negative effect on others, the triggers for such behaviour had been identified and action taken to reduce the occurrence of such behaviour. People received their medicines as they had been prescribed and there were robust procedures in place for the safe management of medicines.

There were enough skilled and qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. Staff received training to ensure that they had the necessary skills to care for the people who lived at the home, and were supported by way of supervisions and appraisals.

People’s needs had been assessed when they moved into the home and they, their relatives and other healthcare professionals had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were happy and felt safe living at the home but said that they did not always have enough support with activities to keep themselves occupied during the day. They had a choice of food and drink with snacks and fruit available throughout the day.

Staff were caring and friendly. They knew the people they cared for well. They protected people’s dignity, treated them with respect and encouraged them to maintain their independence. Staff understood the need for confidentiality.

Information was available to people about how they could make a complaint. Information was also available in formats that people understood about the services provided at the home. People were assisted to access healthcare services to maintain their health and well-being. Staff worked with healthcare professionals and people’s relatives to ensure that the care provided to people best met their needs.

Staff were encouraged to attend meetings with the registered manager at which they could discuss aspects of the service and care delivery. People were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place with the registered manager and the deputy manager being officers of the provider organisation.

There was a relaxed atmosphere in the home, and we observed that people were offered support at a level which encouraged independence and assured their individual needs were met. The staff were friendly and courteous in their approach to people and interacted confidently with them. One person said. "They're lovely, it's good fun living here."

We observed the midday meal service and found people were provided with a choice of nutritionally balanced meals. People were assisted at a level that suited them, and the meal time was an unhurried and enjoyable activity for those involved.

We found there were sufficient staff on duty, and those that we spoke with told us they felt well supported. Records we looked at showed us that staff attended a variety of training, which equipped them to understand the needs of the people they cared for and deliver appropriate care.

The provider had clear quality monitoring systems in place which were used effectively to identify any areas of concern, and drive improvements in this home.

During the course of our visit we saw staff providing care and support to people living at the home. They spoke in a calm and respectful way, varying their approach depending on the person they were assisting. The staff gave people time to communicate and did not rush them.

People and their relatives told us that they were involved in decisions about the care provided. They said they were involved in writing and reviewing their care plans and we saw that systems were in place to obtain consent to care being provided.

We found that medicines were stored and administered safely to people who received a service at the home.

We saw evidence that the provider carried out regular surveys of people's views, and had acted on concerns raised. These actions included the provision of additional training for staff in moving and handling.

Everyone we spoke with told us the Registered Manager was approachable and addressed any issues of concerns quickly.