• Mental Health
  • Independent mental health service

The Limes

Overall: Good read more about inspection ratings

Main Street, Langwith, Mansfield, Nottinghamshire, NG20 9HD (01623) 746002

Provided and run by:
Elysium Healthcare (Acorn Care) Limited

Important: The provider of this service changed. See old profile

Latest inspection summary

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Background to this inspection

Updated 28 July 2022

The Limes is a specialist rehabilitation service for men with a mental illness and/or personality disorder. The hospital is in Langwith Nottinghamshire. The hospital is run by the independent provider Elysium Healthcare Limited and provides care for up to 18 male patients aged 18 years and over. Admission criteria for patients is that they may or may not be detained for treatment under the Mental Health Act (MHA) 1983, complex mental health needs including personality disorder, challenging behaviours, substance and alcohol abuse, may have a mild learning disability or forensic history, maybe treatment resistant. The aim of the service is to equip the patients with the skills needed for increased independence and community living.

The Limes Hospital has a registered manager and provides the following regulated activities:

  • Treatment of disease, disorder or injury
  • Assessment or medical treatment, for persons detained under the Mental Health Act (1983)

The Limes Hospital registered with the CQC on 17 January 2010. CQC carried out an inspection 12 – 13 September 2018. Breaches under Regulations 12, 17 and 18 were identified at this inspection. The provider submitted an action plan with all breaches now met.

Regulation 12. Safe care and treatment. The hospital did not complete patient observations at

regular intervals in line with the provider’s policy. Staff medicines management practices did not ensure that the storage and administration of medicines was safe. The hospital did not use tools to monitor deterioration in patients’ physical health accurately.

Regulation 17. Good governance. The hospital did not keep patient care and treatment records in an organised and accessible format for the sharing of information between colleagues. The hospital did not ensure records contained a complete and accurate record of actions taken by staff. The hospital did not consider the risks associated with the transition between electronic and paper systems and this was not reflected on the hospital’s risk register. The hospital management did not have oversight of staff key performance indicators.

Regulation 18. Staffing. The provider did not ensure staff had completed mandatory training necessary to complete their role. The provider did not ensure staff were supervised at the required frequency outlined in their supervision policy.

We carried out this unannounced comprehensive inspection and found improvements.

What people who use the service say

We spoke with four patients and received many positive comments. Patients told us:

“It feels like a home here, doesn’t feel like a hospital, staff don’t treat us like we are in a hospital. I have psychology in the afternoon in the mindfulness group which I sometimes go to. I don't get bored. Family comes to see me. Food is very good, home cooked food, I can get drink and food when I need it. I understand what medication I am on and can see the doctor if poorly. There are compliment and complaint forms held near the fish tank. I have personalised my bedroom. I'm encouraged to clean my room, sometimes the cleaner comes in. Men's health is spoken about here, I am able to go to the opticians and dentists. I also go to the corner shop and pub. Staff are around day and night if we need them. They check me once an hour.”

“Staff explain Section 37/41 tribunal work towards my unescorted leave. I feel listened to by staff, I can bring stuff up if need to. We have community meetings. I know the fire alarms are checked every Tuesday. I have escorted leave at present, but I can go out with my relative.”

“This is the best hospital I have been to. Staff are friendly and lovely. We go to the supermarket and staff help me to budget, I save my money. I go to the pub once a week. I am having a few driving lessons. I do a few jobs around the hospital which I am paid for. You have to be interviewed for a job first. During COVID-19 my visitors came to see me in the separate visitor’s garden. I have my key to my bedroom. I am doing good here and see the doctor face to face.”

“I have been to four hospitals and this is the best one. Staff are so different here. When the new manager came there were lots of improvements. We make suggestions and are listened to. I asked for a new television in the lounge and lighting around the television and we have that now. I go for walks with staff and go to the shops. When I was very sick staff didn’t give up on me, they kept checking on me, they sorted me out. Our doctor is the best doctor, a good doctor.”

Overall inspection

Good

Updated 28 July 2022

The Limes is a specialist rehabilitation service for men with a mental illness and/or personality disorder. The hospital is in Langwith Nottinghamshire. The hospital is run by the independent provider Elysium Healthcare Limited and provides care for up to 18 male patients aged 18 years and over. We carried out this inspection to follow up the breaches from the previous inspection.

Our rating of this location improved. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well.
  • Staff minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The psychology team provided patients a range of therapeutic groups for example Mindfulness, hearing voices group, mutual help meetings and one to one work with patients. In addition, they supported staff with support groups and one to one support.
  • We saw comprehensive patients care plans that included an extensive patient history, were holistic and person-centred. We also saw positive behaviour support plans. We saw evidence of good physical health care, with physical health leads in place.
  • We observed many positive caring interactions throughout the inspection. They actively involved patients and families and carers in care decisions. Patients were involved in a January 2022 recruitment day speaking to interviewees about the service.
  • Four patients were interviewed and overall provided very positive feedback. They told us some patients are paid to undertake household chores and gave many positive compliments about the registered manager and the service doctor.
  • Staff felt valued and empowered. Some staff told us they felt happy to come to work. Staff morale was good and had improved over time. Staff and patients told us there was strong leadership. Two student nurses complimented the support from the lead nurse.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff supported patients with protected characteristics and made sure they received the right care.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, patients discharge were not delayed.
  • The service worked to a recognised model of mental health rehabilitation. The model combined positive behavioural support with compassion focussed therapy, alongside Safewards. It was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • We found gaps in the ligature audit. Ligature points identified had not been included on the audit. For example, hinges on bedroom doors, shower doors. In addition, follow up action were not included. Following the inspection, the manager reviewed ligature audit with improvements.