The Limes

Updated 5 October 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors, one medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Limes 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 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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 31 August 2022 and ended on 20 September 2022. We visited the service on 31 August 2022 and 1 September 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, Healthwatch England and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

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 five people and 21 of their relatives to seek their views about living at The Limes. We also used observations of how staff and people interacted for people who could not talk with us.

We spoke to 13 staff members. This included the owner, the nominated individual, the registered manager, the deputy manager, senior care staff, care staff, catering staff and an activities co-ordinator. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with five external professionals who work regularly with the service.

We reviewed seven people’s care records and nine people’s medicine records. We reviewed two staff records to look at recruitment processes.

Updated 5 October 2022

About the service

The Limes is a residential care home providing accommodation and personal care to up to 46 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 28 people using the service.

The Limes is all on one level. There are various communal lounges and dining rooms and quiet areas as well as a shared garden. The Limes offers people the choice of single bedrooms but also shared double bedrooms if people prefer. Some bedrooms benefit from ensuite facilities. There is also an office onsite. The layout of the building is designed to support people living with dementia and/or who require support to move around safely.

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

People told us they felt safe living at The Limes. They liked the staff and told us staff treated them well, were kind and knew their likes and dislikes. Staff knew how to keep people safe and what to do if they had any concerns. Some staff were still developing the confidence to report concerns externally to safeguarding teams or CQC. A member of the management team currently still led this.

Since the last inspection, there had been a new registered manager appointed to the service as well as changes and improvements to systems, processes and the environment. This had resulted in many changes for the better but was not yet fully embedded.

People were mostly supported to safely administer and manage their medicines. However, there were some discrepancies that had not been identified during audits. The registered manager put additional measures in place to address this during the inspection.

People were supported by trained staff in all aspects of their daily life. This included going to the pub, maintaining contact with friends and relatives, having meals and drinks out, socialising and meeting their health needs. Staff had received additional training which relatives told us had been seen in improved practices and care. Staff were still being supported to fully develop their knowledge and confidence to implement learning.

People told us the management had improved since the recent start of the new registered manager and this had a positive impact on the quality of care they received. This included the care being more organised, improved communication and staff skills.

The registered manager made sure all staff and visitors followed the latest government guidance for reducing risks about COVID-19 and the spread of infection. Staff had received additional training on this topic to ensure they could keep people as safe as possible.

People had access to health professionals who worked closely with the staff and management team to ensure all health concerns were looked into straight away. The staff team worked closely with community nursing teams to look at shared care to ensure quicker responses, treatment and advice for people.

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.

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 inadequate (published 16 December 2021) and there were breaches of regulation. 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 the provider was no longer in breach of regulations.

This service has been in Special Measures since 16 December 2021. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out 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.