The Limes

Updated 12 November 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.

Inspection team

Two inspectors, a specialist advisor and an Expert by Experience carried out this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. A second Expert by Experience made phone calls to people's relatives. The specialist advisor looked at medicines.

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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

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 reviewed information we had received about the service. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager, deputy manager, team leaders, head of housekeeping, and care workers. We spoke with nine people who used the service about their experience of the care provided and ten relatives. We reviewed a range of records. This included seven people's care records and multiple medication 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. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Following the inspection

We continued to seek clarification from the provider and registered manager to validate evidence found. The registered manager sent us further information which included a variety of records relating to the management of the service, including staff training records, policies and procedures.

Updated 12 November 2022

About the service

The Limes is a care home which provides accommodation and personal care for those who may have dementia or a physical disability. The service can support 97 people in one adapted building, with a separate unit for people living with dementia. At the time of the inspection 75 people were using the service.

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

People were not always receiving a service that provided them with safe, effective, well led care. We received mixed feedback from people about their experiences at the service. Some people’s experiences were positive, however other people did not experience this same level of care or support.

Risks to the health and safety of people were not consistently monitored and mitigated. This included risk associated with catheter care and individual health conditions. Staff had not always had sight of people's care plans or risk assessments. Medicines were not managed safely.

There was insufficient staff to meet people's needs. People and staff reported delays in providing care due to staff shortages. The tool used by the provider to calculate staffing levels did not always contain accurate information about people’s support needs.

Staff moral was low and staff did not always feel supported or listened to. Staff did not always benefit from training and constructive supervision to support them in their role.

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.

The mealtime experience for people was poor and did not always follow best practice. People and staff gave negative feedback about the meals provided.

The provider lacked the appropriate systems and processes to drive forward improvements in a timely manner. The provider's own systems of oversight had not identified the concerns we found during the inspection.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 October 2017).

Why we inspected

The inspection was prompted in part due to concerns received about medicines, staffing and management oversight. A decision was made for us to inspect and examine those risks.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

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 have identified breaches in relation to safe care and treatment, staffing and management oversight at this inspection. We have made a recommendation about the mealtime experience at the service.

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.