Archived: The Limes Nursing Home

Updated 30 April 2015

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 was 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 over 2 days, 2 and 9 December 2014. The inspection was unannounced.

The inspection team consisted of two inspectors, a specialist nurse advisor and an expert by experience, who had experience of older people’s care services. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we sent the provider 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 improvements they plan to make. We had not received the PIR back from the provider at the time of our inspection.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Before our inspection, we reviewed the information we held about the home, and spoke with commissioning officers from Manchester City Council. During our visit we spoke with 21 people who used the service, three relatives and 10 members of staff including the registered manager, the cook, an administrator, the housekeeper, care assistants and registered nurses. We observed care and support in the lounge and dining room and also looked at the kitchen, the laundry and several people’s bedrooms.

We reviewed a range of records about people’s care and how the home was managed. These included eight care plans, four of which we looked at in detail, to ensure the correct support was being delivered in line with the care plan. We looked at food diaries, continence logs, daily incident logs and medication records for all people residing in the main part of the home. We looked at two records reviewing dressings management and information relating to capacity assessments and best interest decisions for three people. We looked at staff training and supervision records as well as staff files, and maintenance audits the housekeeper had completed.

Following our visit we spoke with the community nursing home team and the safeguarding team and received feedback on the quality of the service from the local authority contracts officer and a healthcare professional who visits the home on a regular basis.

Updated 30 April 2015

We carried out an unannounced inspection of this service on 2 and 9 December 2014. When we last inspected the service in June 2014 we found that the registered manager had not taken proper steps to give written guidance to inform care staff on how to support people in line with their care plan, provide adequate staffing levels to support people with their meals or maintain their mobility, provide training for staff in dementia care, ensure there was a clean and safe environment for people using the service or conduct quality audits across all service areas to ensure people using the service were happy with their care.

Following that inspection the registered manager sent us an action plan to tell us the improvements they were going to make. They said their improvements would be completed within two months of 16 July 2014.

During this inspection we found that improvements had not been made to protect people who used the service and there were still significant breaches which the registered manager had failed to address. Some people living at the home were being unlawfully deprived of their liberty and had unnecessary restrictions on their choices and personal freedom. The quality of life for people who lived at the home was poor.

The Limes Nursing Home is a care home providing residential and nursing care for up to 42 people. At the time of our inspection 38 people resided at the home. The Limes Nursing Home is separated into two units. The main part of the home, The Limes unit, and a smaller part, The Pines unit.  Some people who reside in the Limes unit spend their day in the Pines lounge. 

There was a registered manager in post at the time of this inspection. 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 about how the service is run.

The staff we spoke with were not confident in describing the different kinds of abuse and the signs and symptoms that would suggest a person they supported might be at risk of abuse. They did not know what action to take to safeguard people from harm.

People told us contradictory things about the service they received. While some people were happy, others were not. In addition, our own observations, the opinions of visiting professionals and the records we looked at did not always match the positive descriptions some people had given us.

People’s safety was being compromised in a number of areas. This included how well equipment was cleaned and maintained and the lack of support for people who could mobilise if they wanted to.

Staff were not always following the Mental Capacity Act 2005 for people who lacked capacity to make a decision. For example, the registered manager had not made an application under the Mental Capacity Act Deprivation of Liberty Safeguards for two people, even though their liberty may have been restricted.

We found that people’s care was not planned or delivered consistently. In some cases, this either put people at risk or meant they were not having their individual care needs met. People were not always supported to eat and drink enough to meet their nutrition and hydration needs and this was not monitored effectively.

We were concerned that some people living at the home were isolated because they did not leave their rooms. There were not enough opportunities for people to engage in hobbies, social interests or activities either as a group or on an individual basis.

People were not involved in the decisions about their care. We also found that staff did not always respond appropriately to people if they became agitated or distressed.

Staff working in the home did not understand the needs of the people they supported. There were no person centred plans in use and staff did not access the nursing care plans which were being used by the nurses. Person centred plans are designed to capture the needs of a person on an individual basis. Person centred plans are crucial to guide staff in how to support individuals in the way they want to be supported. They also help staff understand the different ways people communicate if they are unable to communicate verbally. Without them staff cannot provide effective care and support. We had addressed this with the registered manager at the last inspection in June 2014 who assured us this would be looked as a priority. There was little or no interaction between staff and people living at the home and people were not encouraged to make their own choices or be involved in decisions about them.

People who used this service did not receive safe care and support from a trained and skilled team of staff. There had been six new staff recruited to replace those who had left. Some had not received an induction, were new to care and did not know what they were expected to do. They did not understand their caring responsibilities and they received little or no support from the registered manager of the home.

There were not enough staff to respect the rights and promote the dignity for all people living at the home. We found people were got up early by the night staff as there were not enough day staff available to support a flexible morning routine. We did not see evidence that the care and support afforded to people living at the home was based on best practice guidance, and nurses did not receive adequate training or clinical supervision to keep their skills and knowledge up to date.

At the last inspection in June 2014 we had raised the issue with the registered manager about the need for staff to be clear about their roles and responsibilities. We asked that job descriptions be made available for staff so they fully understood what they were expected to do. We found this had not happened and there was still ambiguity between the team about who did what. There were no clear lines of accountability and there was friction between different members of the team and the registered manager.

The provider had no effective systems of quality assurance which measured the outcomes of service provision. Leadership within the service was weak and there was a lack of communication and involvement between the registered manager, the staff and people living at the home, regarding the day to day things which affected their lives or work.

Inspectors found that improvements required as a result of a previous inspection had not been made, and we also identified further concerns. As a result CQC is considering all options available to them in relation to protecting people who use the service.