Archived: Lime Tree Gardens

Lime Tree Garden is a purpose-built care home for up to 24 adults with mental health needs. The aim of the service is to support people with enduring mental health illness to develop basic life skills so they can live supported in the community. On the day of our inspection there were 19 people using the service.

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

The service needed to improve how they managed and monitored people's medicines. This related to the storage of medicines, medicines administration practice when people were away from the service, and monitoring medicines administration records.

The service had made improvements since our last inspection. Apart from issues related to the management of medicines, the service provided effective care to people helping them to meet their mental and physical health needs.

The provider assessed and analysed risks to people's health and wellbeing. Care documentation provided staff with information on how to manage and minimise these risks. Safe infection prevention and control practices helped to protect people from the risk of infection, including Covid-19.

Staff understood their role in safeguarding people from abuse. The provider's recruitment practice ensured suitable staff supported people. Although recent high staff turnover, there were enough staff deployed during each shift to support people.

Staff had the training to help them to support people effectively. This included the mandatory training and specialist workshops on working with people with physical and enduring mental health illnesses. Staff could access ongoing support from a clinical team of mental health professionals to understand people's needs better and respond to them promptly.

People had access to healthcare professionals, and staff supported people to ensure people's physical health was well looked after.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible and their best interests; the policies and systems in the service supported this practice.

People and relatives told us the staff at Lime Tree Gardens were kind and caring, and their support helped people improve. Staff encouraged people's independence and ensured that people received dignified care which met their preferences.

People had care plans which guided staff on how to support people. People and relatives told us people participated in care planning and reviewing of their care. Overall, people and relatives thought the staff were meeting people's needs.

The service had a new management team who started to make improvements within the service. The feedback they received was positive. All stakeholders said the service was well managed, staff had skills to support people effectively, and people's wellbeing was improving.

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 17 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and further improvement were needed. The provider was no longer in breach of regulations 9 and 18. However the provider was still in breach of regulation 12.

Why we inspected

We undertook this inspection to check if the service had followed their action plan and to confirm they now met legal requirements.

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.

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

Enforcement

We have identified breaches in relation to management of medicines.

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.

People’s experience of using this service:

Medicines were not always managed safely. People were supported to take medicines in line with their preferences, but the service’s processes to ensure that medicines were always administered as prescribed were not always effective.

People did not always receive personalised care. Their needs had been assessed by the service prior to receiving services. However, the care plans at times provided insufficient detail for staff to provide personalised, strength-based care and support that was consistent and responsive to people's individual needs. We noted that staff we spoke with had a good understanding of the needs of people they supported.

Staff received a range of training to help them to work with people who used the service. More training was required to guide staff on how to effectively work with people when they exhibited behaviours that challenged the service.

Staff received support in the form of one to one supervision and a yearly appraisal of their personal and professional development goals. However, supervisions were not always regular. Staff also participated in a range of meetings where they could discuss matters relating to caring for people and the service provision.

The service had checks in place but these had not identified shortfalls that were found during inspection. These related to the management of people's medicines, following the principles of the MCA, staff training and effective care planning and records keeping.

DoLS applications had been submitted when required. Improvements were needed in relation to what decisions individual people with no capacity could make and how staff could support them in doing so.

Improvements were needed to ensure that people’s needs had been thoroughly assessed before they were accepted as suitable to live at the service. This was to ensure people’s needs could be met by the service.

Some improvements were needed to how the service managed risk to the health and wellbeing of people using the service and health and safety of the premises. Accidents and incidents had been reviewed to ensure lessons were learnt and the safety of the service improved.

People were encouraged to be involved in planning and reviewing of their care through one to one meetings. However, because the meetings were not always recorded, the provider could not evidence that they had taken place.

External professionals gave positive feedback about the commitment of staff working at the service. They also thought the service was well led. However, they thought further work was needed so the methodology and the recovery approach used by the service was clearly defined and visible when supporting people who used the service.

Safeguarding concerns were managed promptly. Staff had received safeguarding training and were able to recognise when people were at risk of abuse.

Safe recruitment procedures helped to protect people from unsuitable staff. There were appropriate staffing levels to response to people’s need.

The service asked people’s consent before providing care and support to them. However, when people did not have capacity to make decisions, staff did not have enough information on how to support these people with making decisions about their everyday care.

People received support to have a diet that met their needs and preferences. People had access to health professionals when needed.

The accommodation provided people with space they could use to socialise or spend time on their own if they preferred. People could move freely between different parts of the service.

Staff protected people’s privacy and dignity when providing personal care.

People could provide feedback about care received via regular residents' meetings, quarterly satisfaction surveys and via the complaints’ procedure. The service dealt with people’s concerns promptly.

Meaningful activities were available at the service and people enjoyed them. More spontaneous, social interactions between staff and people using the service were required.

People using the service, staff and external professionals thought the service was well managed and the managers were supportive. The manager was caring and strived to provide high quality care.

Managers and staff knew their roles and were able to explain what their responsibilities and accountabilities were.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made one recommendation about staff training, the Mental Capacity Act.

Rating at last inspection: Requires Improvement (last report published on 30 December 2015). At the time of the previous inspection the service was providing care and support to adults with a history of alcohol dependence.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We asked the provider to submit to the Commission an action plan to show how they will make changes to ensure the rating of the service improves to at least Good. We will continue to monitor the service and we will revisit it in the future to check if improvement have been made.

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

Burghley Road is a residential care home for up to 24 adults with a history of alcohol dependence. The home is in Kentish Town in Camden. There were 19 people staying at the home at the time of our visit.

There was a manager for the service, but as they had only recently taken up the post, they were not yet registered with the Care Quality Commission. We were informed that they were currently applying to be registered.

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.

People told us they felt safe at the home and safe with the staff who supported them. They told us that staff were kind and respectful and they were satisfied with the numbers of staff on duty at the home.

The management and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks should be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. The service was following the appropriate procedures regarding Deprivation of Liberty Safeguards (DoLS) but this was not relevant to the people being supported at the home.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the management of the home.

People confirmed that they were asked about the quality of the service and had made comments about this. Quality assurance systems were in place in order that suggested improvements could be actioned and monitored.

The service had a number of quality and safety audits which were designed to ensure a safe environment was maintained.

You can see our judgements on the front page of this report.

At this inspection we sought to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them, a visitor and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff we spoke with demonstrated awareness of the different types of possible abuse and all were confident about reporting concerns should they need to.

Is the service effective?

We viewed the records of five people using the service and saw each person's records contained an assessment of needs completed with the person as well as an assessment by the referring local authority.

Is the service responsive?

Most of the comments people made were complimentary although the provider may wish to note that someone told us '90% of the time I am treated with respect', another person said 'some staff knock on my door all of the time, others only some of the time'.

Is the service well-led?

We were informed by the manager that a recent survey of people using the service had been completed.

We made a further visit on 28 November 2013 when we judged that the provider had now taken sufficient action to ensure that people experience care and support that met their needs. The provider had also improved medication management and we noted that people were protected against the risks associated with medicines.

This report is a follow up to our report published in April 2013. We had inspected this provider on 5 and 10 April 2013, when we noted some issues which had a moderate and minor impact on people using the service. These related to standards regarding respecting and involving people, their care and welfare, management of medicines, and monitoring the quality of the service. We set compliance actions requiring the provider to take steps to comply with Regulations 9, 10, 13, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We made a further visit on 24 July 2013 when we found that the provider had taken sufficient action to ensure dignity and independence of the people.

We also found that the provider had a working system in place to regularly assess and monitor the quality of service that people received.

Whilst there had been some significant improvements in care provided to people who use the service and medication management there were still some outstanding concerns. We judged that the provider had not taken sufficient steps to ensure that people experience care and support that met their needs. People were not always protected against the risks associated with medicines.

People using the service told us that staff had not always acted on what they promised. This related to the purchase of some equipment and the redecoration of one of the rooms.

During our visit we observed some poor interaction between staff and people who use the service. Staff did not always talk about people in a respectful way and there were minimal opportunities for positive interactions between people who use the service and care workers.

People told us that their care needs were met and we saw that care plans were up to date. We noted that risk assessments were not sufficiently detailed. The provider had developed improvement plans to allow people greater involvement in suggesting and participating in activities, but the plans had not been fully implemented.

We raised concerns regarding administration of medication as we noted discrepancies in records and the medication stock kept at the home.

Since our previous visit the provider had made some improvements relating to staffing levels and additional staff were employed to ensure people's care needs were met.

The provider did not have effective systems in place to assess and monitor quality of the service.

Most people we spoke with were happy with the care being provided. One person said of the home 'it's good,' but that there was 'not much going on.' We did not see any structured activities taking place. The need for more activities to be provided at the home had recently been noted by one of the local authorities commissioning the care. Because of this, the provider was actively working with people at the home to identify and introduce more activities which the people would enjoy and benefit from.

People said that at times there was not enough staff to meet their needs. Staff members we interviewed also expressed concerns over staffing levels and the impact this had on the care being provided.

The atmosphere at the home was quite calm and relaxed. We saw that staff members were friendly and confident in their interaction with people and the support they provided.