Archived: The Limes

Updated 15 July 2021

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 Care Act 2014.

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 three inspectors.

Service and service type

The Limes is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission; however, this person was no longer working at the service and was in the process of de-registering as registered manager. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. The service did have a manager in post who was not yet registered with the Care Quality Commission.

Notice of inspection

This inspection was unannounced.

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.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service and eight relatives about their experience of the care provided. We spoke with seven members of staff including the manager, deputy manager, senior care workers, care workers and housekeeping staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included seven people’s care records and eleven medication records. We looked at one staff file in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 15 July 2021

About the service

The Limes is a residential care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service can support up to 28 people.

The care home is in one building spread across two floors. There are 26 single rooms and 2 double bedrooms. All bedrooms have ensuite facilities with a shared lounge, kitchen and garden.

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

People did not always have risks in relation to choking, falls and medicines fully assessed and so there was not enough guidance for staff on how to support their needs in these areas.

People’s medicines were not all administered or recorded safely. Amounts of some medicines did not match the recorded stock and some people’s pain relief medicines were not administered as prescribed.

People’s home was not always kept clean as there was food on the floor in one area and some cleaning required in a bathroom. Not all staff were wearing the correct face masks to help prevent the spread of COVID-19 and other infections.

There were no effective quality monitoring systems in place at the time of the inspection which meant that the standards of people’s care could not be assessed with a view to make improvements.

People’s care records had been transferred to an electronic system that was still being developed and so there were some gaps and inconsistency in records.

However, people told us they felt safe and they were happy living at the home. They said that staff were caring and patient and treated them well. People said the food was good and they had choices in what they ate and how they spent their time.

Staff had received training in safeguarding and other relevant topics and were in the process of receiving refresher and specialised training. This included Dementia awareness, Deprivation of Liberty Safeguards for people living with Dementia, nutrition and infection prevent and control.

Staff had a good understanding of how to act in emergencies and how to safeguard people. They were confident about reporting any concerns both inside and outside of the organisation.

There was a new manager and deputy manager in post who people, relative’s and staff all felt were approachable and open and they could raise any issues with them. They felt there had been a lot of improvements made. They had confidence the actions being taken by the new manager were positive and they would ensure all concerns were addressed.

We have made a recommendation about the management of staff rotas, recruitment procedures and infection prevention and control measures.

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 04 May 2018).

Why we inspected

We received concerns in relation to risk management of person to person abuse, falls, eating and drinking and pressure care. Also, appropriate reporting and recording of incidents, staffing levels, staff skills, adherence to follow guidelines from health professionals and the general management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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.

The manager was aware of the areas that required improvement. The manager had created an action plan for all areas of concern and was in the process of making the necessary changes to ensure people were safe and the service was well managed. However, this had not yet been implemented or embedded into practice.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Limes on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to unsafe infection prevention and control practices, managing falls risks, safe management of medicines, reporting and recording and effective management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.