Archived: The Lime Trees

Updated 16 July 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: The inspection was carried out by two inspectors.

Service and service type: The Lime Trees 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 Lime Trees accommodates up to 20 people in one adapted building. Upper floors are accessible by a lift and the ground floor is wheelchair accessible.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection: The inspection was unannounced.

What we did: Before the inspection, we reviewed information we held about the service including an action plan submitted by the provider following the last inspection.

During the inspection, we spoke with the registered manager, nominated individual and two members of staff. We spoke with one service user.

We checked the environment of the service which included communal areas, bedrooms, kitchen and bathrooms. We reviewed one person’s care file which included their care plan, risk assessments, daily observation notes and medicines records.

We reviewed five staff files which included identity and recruitment checks, training and supervisions.

We looked at quality monitoring and other records associated with the running of the service which included staff rotas and health and safety checks.

Updated 16 July 2019

This inspection took place on 14 September 2018 and was unannounced.

At our last inspection on 13, 15 and 19 March 2018, we found breaches of regulations relating to person centred care (Regulation 9), treating people with dignity and respect (Regulation 10), consent to care (Regulation 11), safe care and treatment (Regulation 12), safeguarding people from abuse (Regulation 13), premises and equipment (Regulation 15), good governance (Regulation 17), staffing (Regulation 18) and fit and proper persons (Regulation 19).

The service was rated inadequate and placed into special measures following the March 2018 inspection. Special measures are designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Its purpose is to ensure that inadequate care significantly improves and provides a clear timeframe within which the provider must improve the quality of care they provide. When a provider is placed into special measures, the CQC will re-inspect within six months.

A Notice of Decision was served on the registered provider on 23 March 2018 to impose a condition to restrict the admission of new people without authorisation from CQC. Full information about additional CQC regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The Lime Trees is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Lime Trees is registered to accommodate up to 20 people and does not provide nursing care. At the time of this inspection, there was one person living at the home. This meant that although we could carry out an inspection we could not fully rate the quality of the service as we had insufficient evidence on which to do so.

The registered manager had left the service three weeks before the inspection, a new manager was in place who had started the process of applying to be registered. 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.

At this inspection, we found that the provider had achieved compliance with seven of the nine regulations previously identified as breached during the comprehensive inspection in March 2018. However, we found improvement was still needed with regards to safe staff recruitment and equipment being fit for purpose. This meant the provider was still in breach of two regulations.

We identified concerns with how staff were recruited. While checks such as criminal records checks (DBS) and identification checks were completed, the provider’s referencing process was not sufficiently robust at ensuring staff were suitable to work with vulnerable people.

In two bedrooms, we found old odorous urine stains on mattresses from when the bedrooms were last occupied. We identified additional environmental concerns such as a water leak in one room and some kitchen equipment in a poor state of repair. Some of these concerns were addressed either during the inspection or shortly afterwards.

Increased quality assurance processes were in place which helped the service identify areas for improvement. New quality monitoring checks included weekly medicines audits, dining experience and cleanliness checks. However, we could not be assured that the quality monitoring systems in place were robust as we identified repeated areas of concern at this inspection.

Staff had received training around medicines management and had their competencies assessed. The person living at the service was receiving their medicines safely and processes had been implemented to ensure medicines were monitored effectively.

Staffing levels were appropriate for the level of occupancy at the service.

No safeguarding concerns were identified during this inspection. Staff had received training on safeguarding and knew where they could report concerns.

The provider had implemented procedures to ensure compliance with the Mental Capacity Act 2005.

The person living at the service was happy with the care they received and complimentary of care staff and the management team.

The person had a care plan and risk assessment in place which identified their care needs, risks associated with their care and provided guidance to care staff on how to work with the person.

Staff received training in areas such as fire safety, first aid, infection control and basic life support. They received regular supervisions and an annual appraisal. This helped ensure they had the knowledge and skills to provide effective care.

At this inspection, we identified repeated breaches of regulations 15 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.