The Limes Retirement Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked at all the quality statements for Responsive at this assessment. We found the service was not responsive. There has been a decline in the service since the last inspection. People’s care, treatment and support did not always promote equality, remove barriers or delays and protect their rights, including those people living with dementia or other protected characteristics. The service did not meet people’s individualised needs in relation to communication, supporting hobbies and interests, contact with the community or meaningful occupation.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care and support was not planned and delivered in an individualised or personalised way and therefore people’s health, social, emotional and psychological needs were not consistently and properly met.

There was a lack of effective processes and oversight to carry out a comprehensive review of a person’s needs to inform delivery of care tailored to the individual. Although people’s care plans lacked relevant and important personalised information staff told us they did not regularly look at or use care plans anyway. Whilst they could outline the basic needs of people, they were not aware of their individual needs and social histories which would help them to understand the person and deliver the right care. Skills were lacking in person centred care, engaging with people in purposeful activity and responding effectively to the wider aspects of people's dementia related needs including communication, unsettled behaviours, nutrition and dysphagia (difficulty swallowing).

We saw a person distressed and disorientated. Several staff responded in a way which distressed this person further. Staff did not understand the reasons people became anxious or upset. There were no details in peoples care plans to tell staff why people may become agitated or anxious, triggers that might make this worse, or ideas about how to distract or engage positively with them. Without this understanding staff were unable to provide person centred care with a holistic approach to ensure people’s well-being.

People could not be assured the service understood their diverse health and care needs. Care was not joined up, flexible and did not support choice and continuity.

The providers website says the service provides specialist care for people with Alzheimer’s and dementia. Our assessment found this was not the case and the service was not responsive to the needs of people living with dementia. Staff’s poor understanding of people’s diverse needs and ability to communicate affected their care provision, integration and continuity of care.

There were no processes in place to promote a personalised and diverse culture that supported choice and continuity. None of the care records looked at contained a care plan that adequately demonstrated how staff responded to individuals differing needs in terms of interests, social activities and meaningful interventions, types of dementia and the varying stage of dementia they were at.

People were not provided with information in formats that were tailored to their individual needs.

The service lacked pictorial signs, visual clues and sensory stimuli to help people recognise their rooms, navigate their way around the home and points of interest. In the dining room, we saw a folder which contained photographs of ‘our favourite meal’s’, however this contained photographs of people’s favourite meals who no longer lived in the service. There were no alternative methods used for the current people living in the service to make choices about food and drink.

People and their relatives told us they knew how to raise a complaint if they needed to. However, our assessment found complaints were not used as an opportunity to improve outcomes for people.

Whilst a response was given to a complainant, the complaint had not been explored or managed properly to address all their concerns. The concern from a relative related to the attitude, language and approach of a member of staff to another resident. The outcome of the complaint was giving assurance the staff member would not attend to their family member. Supervision records for the staff member showed the complaint was not addressed through structured support, training and development to improve their practice.

The Limes is in an older style building; areas of the premises, facilities and equipment did not provide equal access to people. The premises lacked adequate bathrooms or wet rooms for the number of people using the service. The service had only 1 wet room and 1 bathroom in operation, restricting people’s access to a bath or shower when they wanted. One person told us they had not received a bath or shower since they had lived at The Limes because the facilities were not accessible to them. People did not have access to a safe garden. The premises had a large garden, with a green house, and summer house, however neither were accessible and safe for people to use.

There were no systems in place to ensure equity of access was considered prior to people’s admission to the service.

People with more complex needs could not be assured equity in their experiences living at The Limes. There was an inequality in supporting people with their communication. Where people were able to verbally communicate well with staff, their voice was being heard. However, improvements were needed where people had sensory loss, and/or dementia. Insufficient attention was given to involving and engaging appropriately with people who had dementia.

The registered manager was unable to show us how the experiences of people with more complex needs were explored and how care and support was tailored to the individual to ensure equity and reduce barriers to care.

The provider had no systems in place to check if people’s life and experiences of living in the service could be improved upon in any way. Managers and staff failed to identify inequalities in people’s care, such as restricted access to shower and bathing facilities, and restrictions due to a lack of aids to help mobility. No action had been taken, until prompted by external agencies, to proactively address barriers to improve people’s experience, and opportunities to achieve equity for all people using the service.

People were not supported to make informed decisions and plan for important life changes, including at the end of their life. Their end-of-life care plans did not contain information about their preferences or choices about care delivery at the end of their life. There was no recognition that a diagnosis of dementia or Alzheimer’s is a terminal condition.

Care and support provided was task led rather than planned. Staff had not received adequate training to support people approaching the end of their life to ensure they were able to respond to people’s changing needs sensitively and support them to have a comfortable and dignified death.

Some information relating to end-of-life care was contained in care plans, but this required further personalisation to ensure people’s spiritual and emotional needs were met in a holistic way. End of life care planning showed staff did not have the skills and confidence to have a meaningful conversation with people to help prepare and inform a plan about how the individual wished to be cared for at the end stage of their life.