Archived: The Limes Care Home

Updated 8 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 8 October 2016 and was unannounced. The inspection was completed by an inspector, two pharmacy advisors, a specialist advisor 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. A specialist advisor is a professional who has expertise in relevant areas of care for example nursing care.

Before the inspection, the registered provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. We used this information to help plan our inspection.

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 also looked at notifications which we held about the organisation. Notifications are events which have happened in the service that the registered provider is required to tell us about, and information that had been sent to us by other agencies.

During our inspection we observed care in the home and spoke with the manager, the acting deputy manager and two members of care staff. We spoke with four people who used the service and three relatives. We also spoke with three visiting professionals during our inspection and to another health professional by phone on the day of our inspection. We looked at seven people’s care plans and records of staff training, recruitment, audits and medicines.

Updated 8 December 2016

This inspection took place on 8 November 2016 and was unannounced. The Limes Care Home provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 40 people who require personal and nursing care. At the time of our inspection there were 25 people living at the home.

There was not a registered manager in post. An application for the current manager to become the registered manager had been made to CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations.

At this inspection we found that the provider had failed to ensure that previous improvements had been sustained. We found that there were five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. You can see what action we have taken at the back of the full version of this report.

On the day of our inspection people were not cared for safely. Staff knew how to safeguard people against abuse however staff did not have the appropriate competencies and skills to provide safe care. Staff did not respond appropriately and in good time to people's changing needs.

Medicines were not managed appropriately and safely. People did not always get their medicines as prescribed. The management of infection prevention and control did not mitigate the risk of cross infection.

Staff did not follow care plans when delivering care. Staff did not respond in an appropriate manner to people and did not always provide emotional support to people. Staff were not consistently kind to people when they were providing support. People did not have their privacy and dignity considered. Staff were able to tell us about people’s needs but we did not see care being provided in a way that met their needs.

We found that people’s health care needs were assessed however care was not planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. However we observed medical assistance was not always provided in a timely manner.

Staff did not always provide care according to their training. Staff were provided with training on core areas but had not received training in areas specific to the needs of people who lived at the home such as care of people with dementia. The provider had a training plan in place and staff had received supervision.

The provider did not always act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

People did not have their nutritional needs met. People had their nutritional needs assessed but were not always supported with their meals to keep them healthy. Where people had special dietary requirements we saw that these were not consistently provided for. People had choices at mealtimes.

People had access to limited activities. Signage in the home was poor and not provided in a manner which assisted people with dementia to orientate themselves.

Records were not accurate and did not include a record of the care and treatment provided to the service user and of decisions taken in relation to that care. Care plans were not updated consistently and did not reflect the care people required.

Systems were not in place to adequately assess, monitor and improve the quality and safety of the services. Audits were in place for areas such as medicines and infection control however they had not consistently improved the quality of care. Accidents and incidents were recorded and analysed.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns.

The provider had informed us of notifications as required by law. Notifications are events which have happened in the service that the provider is required to tell us about. The current rating was not displayed on the provider‘s website as required by law by CQC.