The Limes Residential Home

The Limes Residential Home is a residential care home providing personal care to up to 34 people. The service provides support to older people. At the time of our inspection there were 32 people using the service.

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

Assessments of people’s care needs were in place, for example for falls and pressure sores. Some care plans required further details to help support consistent care. The registered manager told us they would take action to update these.

People were given choices and control over their day-to-day decisions such as meals and personal care needs. However, some people needed a reminder that alternative meals or alternative times for personal care were available.

Safety monitoring processes were in place and people felt safe living at The Limes Residential Home. People received their medicines as prescribed from staff who knew people well. There were enough staff to meet people’s needs and they had been employed following recruitment checks to help ensure they were suitable to work in care. The environment was kept clean and measures were in place to reduce the risk of transmission from infections.

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.

People had the equipment they needed as detailed in their care assessments and the environment had been adapted to help meet people’s needs. Assessments helped to reduce discrimination as people’s equality and diversity needs were assessed and considered. Staff received regular training that was relevant to people’s needs.

People received enough to eat and drink and people at risk of malnutrion were supported to help ensure they had a good level of nutritional intake. Referrals to other agencies were made when needed and this helped people access the healthcare they needed.

People were cared for by staff who were caring and who involved people in their care and decision making. Staff took actions to promote people’s independence and respected their privacy and dignity. People’s religious needs were supported.

People participated in a variety of entertainments and activities as well as pursuing their own interests, such as reading the daily paper and seeing their visitors. Staff understood people’s ways of communicating well and people had opportunities to discuss any issues and have them resolved.

Where people needed care at the end of their lives, this was provided in partnership with the local district nurse team.

The registered manager worked in an open and transparent way and staff felt supported. Staff were clear on their roles. Checks and audits were in place to check on the quality and safety of services people received. The registered manager looked to continuously improve the service. People’s views were obtained in meetings and questionnaires and people were kept updated on things that happened in their home.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 August 2019).

At our last inspection we found breaches of the regulations in relation to the assessments for people’s capacity and decision making and submitting statutory notifications to CQC. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting this regulation.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ Staff had received training in putting on and taking off personal protective equipment (PPE), and we saw this was accessible throughout the home and staff used it in accordance with the most up to date guidance. Staff had received further training in COVID-19 and infection control.

¿ The infection control policy was up to date. We reviewed audits which reflected actions had been taken to maintain the standards within the home. There was a Coronavirus Policy and procedure and also national guidance which was kept updated.

¿ There were no visitors allowed in the home due to there being a recent outbreak of COVID-19. Only essential medical professionals had entered the home during the outbreak. At the time of our inspection people living at the home were coming to the end of their isolation period and there were no new cases of the virus.

¿ The home was clean and we saw cleaners in different areas ensuring that touch points were wiped regularly.

The Limes is a residential care home providing personal care to 34 people at the time of the inspection. 32 people were living at the service at the time of the inspection.

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

People were not always supported to have maximum choice and control of their lives and received support in the least restrictive way possible and in their best interests. The policies and systems in the service did not always support this practice because records did not show how people’s mental capacity to consent to their care and treatment had been completed and how decisions made in people’s best interests had been arrived at. Not all statutory notifications had been submitted as required.

People felt safe living at The Limes and steps had been taken to ensure people were protected from abuse and avoidable harm. Risks to people’s health and care needs, as well as risks in the general environment had been assessed and actions taken to manage them. People received their medicines as prescribed and medicines were managed and stored safely. The environment was kept clean and staff followed procedures to prevent and control risks associated with infections. Enough staff were deployed to ensure people received safe care. Any accidents or incidents were reviewed so that any lessons learnt could be identified.

People’s needs were assessed before they went to live at The Limes. Assessments covered all aspects of people’s health, care and well-being and reflected the requirements of the Equalities Act. Staff were competent in meeting people’s needs and training and supervision supported their competence. People received food and drink to meet their nutrition and hydration needs. Staff worked with other healthcare professionals to ensure their care needs were met. The Limes had been adapted where necessary to meet people’s needs such as with a lift and level access ramps. People’s own bedrooms were personalised to their own preferences.

Staff were caring in their approach to people. People and their relatives were involved in expressing views about their care and treatment. These views were respected. People were cared for with privacy and dignity. People were supported to be as independent as they could be.

Staff knew people well and knew about what interested them and what they enjoyed. People were supported to remain connected to their local community through local trips out and about. Relatives visited people throughout the day at times that suited them. If people were unwell or required assistance from other healthcare professionals, this was arranged. People’s communication needs were assessed and met. Procedures were in place to ensure any complaints would be investigated and managed.

Audits and checks on the quality and safety of services were in place to help ensure people received quality care. People and relatives knew the registered manager, found her approachable and found the service to be run with an open management style. Regular meetings were held so that people and their relatives could contribute their views to the development and running of the service. The service worked well with other professionals and looked to identify learning to contribute towards improving care for people.

We found two breaches of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014.

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

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 28 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager in place at the time of our inspection. 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 who were able to, were supported to make decisions. However the registered manager and the registered provider did not always know what actions to take if people did not have the capacity to make decisions in line with the principles of the Mental Capacity Act.

People were protected by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People maintained their nutrition and staff were monitoring and responding to people’s health conditions.

People were supported by staff that had the knowledge and skills to provide safe and appropriate care and support.

People lived in a home where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

People using the service appeared relaxed and contented in their surroundings and we saw relationships with staff were friendly and respectful. One person told us 'I like living here' and another 'The staff are good'. Relatives we spoke with said they were very pleased with the care provided to their family member. One said 'I'm very happy with the care here' and another said of their family member 'She's lucky to be here'. People told us they liked the meals. One person told us "The food is marvellous" and another said "The meals are good".

We saw there were procedures in place to safeguard people and that staff training was up to date and ensured staff could meet individual needs. There were systems in place to monitor the quality of the service and people and their relatives were confident that any issues or concerns they had would be sorted out.

External professionals praised the care describing it as very, very good and another said "There's a lot of compassion there".

We found that people were fully involved in discussions about their needs and care. One person said that 'anything you want help with, the staff will help.' People told us that they were always treated with respect.

We observed and heard a good level of communication and contact between staff and people using the service. We saw that the care and daily routines were centred around people's individual needs and preferences.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.