The Care Quality Commission
  • 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

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about The Limes on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Limes, you can give feedback on this service.

04 May 2022

During a routine inspection

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.

12-13 September 2018

During a routine inspection

We rated The Limes as REQUIRES IMPROVEMENT because:

  • Staff were not up to date with mandatory training and managers did not have clear oversight of this.
  • We found several omissions in the cleaning and temperature of the clinic room and equipment and staff did not accurately adhere to national guidance for medicines management.
  • Patient care and treatment files were disorganised and contained several assessments and care plans that were out of date. Care plans and mental capacity assessments varied in quality and detail.
  • The hospital did not provide clinical and managerial supervision to staff as often as outlined in the provider’s supervision policy and this impacted on the hospital’s recording and auditing of supervision.
  • Staff did not complete patient observations in line with the provider’s policy guidance.
  • The hospital did not effectively use nationally recognised tools to monitor patients’ physical wellbeing.
  • The hospital did not consistently use audits effectively to identify and learn from mistakes and make changes to processes.
  • Some patients and their relatives/carers told us staff did not always engage with patients when completing their observations.
  • There was no designated space for patients to meet with visitors.
  • Staff were not aware of the provider’s vision and values.
  • Staff did not consistently review and record emergency equipment, in line with their policy.
  • Staff did not consistently record they had reviewed patient’s daily risk assessments, as outlined in their local procedures.

However:

  • The hospital was well staffed and rarely used agency staff to cover short falls.
  • We observed positive and friendly interactions between staff and patients.
  • Staff provided a comprehensive programme of individual therapeutic activities to help patients achieve their recovery goals.
  • The multidisciplinary team completed a robust assessment and regular review of risk for each patient and developed individualised plans to manage these.
  • Staff worked hard to reduce restrictive practices wherever possible to support patients’ rehabilitation.
  • The hospital welcomed patients of different cultures, languages, religions, sexualities and staff had embedded equality and diversity into the everyday running of the hospital.
  • Staff were well supported by the hospital manager and staff told us they had been supported by the provider during the transfer process.