About the service Limetree Care Centre is a nursing home providing personal and nursing care to 90 people at the time of the inspection. The service can support up to 92 people in one adapted building. The home is divided into three floors. The ground floor provided residential care to people living with dementia. The first and second floors provided nursing care to people living with dementia and other nursing needs.
People’s experience of using this service and what we found
People and their relatives told us staff were kind and they received good care from them. There had been significant improvements in the activities provided and people were supported with a range of different activities across the week.
People told us they did not always think there were enough staff. This was confirmed by our analysis of staffing levels which showed there were not always enough staff on duty to meet people’s assessed needs.
People and relatives told us they felt there had been improvements in how the home was managed. While there had been progress in some areas, particularly regarding the response to incidents and accidents, other issues had persisted. Although the provider’s systems had identified inconsistencies in records, and issues with the cleanliness of the service, the actions in place had not been effective at driving improvement.
People received the care they needed to stay safe and well. However, there were inconsistencies in care plans, risk assessments and records of care. While some people had detailed life stories and information about their preferences, this was not easily available to staff, and some people did not have this information in place. Care plans were not in a format that was accessible to people. We have made a recommendation about this.
People’s needs were assessed and reviewed using a range of standardised assessment tools. We identified inconsistencies in how these tools were used. We also found these assessments did not explore people’s religious beliefs, cultural background, sexual and gender identity. We have made a recommendation about ensuring all aspects of people’s lives are explored in assessments.
People were supported to take their medicines by trained staff. The medicines care plans were not in line with best practice and we have made a recommendation about this.
The provider recognised they still had work to do to improve the quality of support they provided to people approaching the last stages of their life. They were working on making improvements in this area.
People and relatives were able to make complaints and told us they felt the manager responded positively and constructively to complaints that had been made.
Staff had received the training they needed to do their jobs. Staff were involved through staff meetings and received regular coaching sessions where appropriate. Staff shared information about people living in the home via handover meetings which helped to minimise the impact of the inconsistent care plans.
People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The provider recognised the systems in the service needed amending to ensure information about restrictions placed on people were easily available to the staff who needed to know.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was Requires Improvement (published 18 September 2018).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection some improvements had been made and some of the breaches had been resolved. However, in other areas not enough improvements had been made and breaches of regulations remained.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to person centred care, staffing and good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.