The Limes Care Home

Updated 2 November 2023

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

This inspection was completed by 1 inspector.

Service and service type

The Limes Care Home 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 Care Home 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 service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was no registered manager in post. However, a manager was in post who had started the processing of registering with the CQC.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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 9 people who used the service and 7 relatives about their experience of the care provided. We spoke with 12 members of staff including care workers, senior care workers, housekeeping staff, cooks, and the manager.

We reviewed a range of records. This included 4 people’s care records and numerous medication records. We looked at 4 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.

Updated 2 November 2023

About the service

The Limes Care Home is a residential care home providing personal care to up to 28 people. The service provides support to people who may be living with a physical disability, mental health needs or dementia. At the time of our inspection there were 19 people using the service.

The Limes Care home is split across two floors and two wings. People have access to their own personalised bedrooms and en-suite toilets and share communal areas such as lounges, bathrooms, dining areas and a garden.

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

The manager and providers audits were not always effective in identifying where improvements needed to be made at the service. Staff were not being recruited in line with current legislations. Safeguarding incidents and accidents were not always being reported to the correct authorities. Some risk assessments and care plans were not detailed enough to guide staff how to support people safely. Staff competency to perform their job roles was not being monitored effectively. People had not been asked for consent about CCTV. This meant people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People and relatives were happy being supported by staff at the service. One person said, ‘‘Staff are kind and always have a listening ear. We are all like a big family.’’

People felt safe using the service and staff knew how to support people safely. There were enough staff to support people in a timely manner. Staff administered people’s medicines safely. The service was clean, and staff followed good infection and prevention control measures. People were supported to eat and drink in line with their dietary needs. Staff contacted health professionals if people needed this support. The service was designed to meet people’s needs.

Staff were kind and compassionate and people were positive about their care. People were supported to make day to day and wider decisions about their care. Staff supported people with dignity and helped them to remain independent if this was their choice. Staff knew people well as individuals and supported them in line with their specific preferences. People were supported to follow their interests and leave the service to access the community regularly. People felt confident in raising concerns. Staff supported people with dignity and respect at the end of their lives.

The new manager and provider were passionate about the service and supporting people in the best way they could. They took immediate action to put improvements in place based on our feedback during the inspection. People and relatives were asked for feedback about the service and staff worked with other professionals to help people achieve good outcomes.

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 the service under the previous provider was requires improvement (published 13 July 2021). The current provider was registered on 17 March 2023. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The previous 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 this provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Enforcement and Recommendations

We have identified breaches in relation to staff recruitment and good governance at this inspection.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.