Archived: The Lime Trees

People’s experience of using this service:

When we inspected in March 2018, we identified serious concerns with overall care people were receiving. We took enforcement action against the registered provider and the registered manager. The service was rated inadequate overall and placed in special measures.

When we inspected again in September 2018, the service was operating at a significantly reduced occupancy. Despite improvements that had been made across many areas of concern, we found that the registered provider remained in breach of regulations regarding premises and equipment and ensuring fit and proper staff were employed.

At this inspection, improvements made between March and September 2018 were noted to have continued, however, we found repeat concerns with aspects of the environment and ensuring staff files contained required information to ensure staff were suitable to work with vulnerable people.

The governance processes in place at the service did not identify the concerns found at this inspection. The management team carried out regular audits at the service however, we were not assured that some of these audits, particularly around medicines management and health and safety were sufficiently robust to identify concerns.

The one person living at The Lime Trees told us they felt safe. They told us that their care needs were met.

The person was involved in planning their care which resulted in an individual care plan which met their care needs.

Staffing levels were appropriate for the level of occupancy at the service. The person received their medicines as prescribed. Staff were knowledgeable around the person’s care needs.

We were unable to provide a rating for all key questions, as there was insufficient evidence available to provide a rating. This was because the service was providing care for one person. The service is registered to provide care for up to twenty people.

Rating at last inspection: Not rated. This was because there was insufficient evidence to award an overall rating. The report was published on 11 December 2018.

Enforcement: Following an inspection March 2018, CQC imposed a condition to restrict new admissions without CQC authorisation. This inspection was scheduled to check compliance with regulations previously identified as in breach.

At this inspection the provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

Full information about CQC's regulatory response to the more serious concerns found in inspections and appeals is added to reports after any concerns found in inspections and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was the first inspection since the service was registered in March 2018 under a new provider’s registration. The home had been in operation for a number of years previously.

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. On the dates of the inspection, there were 17 people living at the home.

The Lime Trees is set out over three floors with lift access. The building is both an older Victorian style and a new purpose built unit. There was a small garden at the back of the home which was mainly used as a smoking area.

There was a registered manager in place. 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.

People were not safeguarded from abuse and neglect. People were sleeping in soiled and dirty bedding. People were showered in view of communal areas and as a result were exposed naked to other people, staff and visitors. Safeguarding incidents were not always recognised or reported to the local safeguarding authority.

People were deprived of their liberty without having appropriate legal safeguards in place.

People were not treated with dignity and respect. The majority of people we spoke with during the inspection told us of their unhappiness living at the Lime Trees. Most people told us that they were not respected and exercised little choice in how they lived their lives. We observed instances of staff and the registered manager treating people in a disrespectful manner.

The home was unclean. The premises and equipment within the home was not maintained to a safe standard. Strong offensive odours were detected throughout the home. Staff were not always adhering to basic infection control procedures.

There were not always enough staff deployed in the service to consistently meet people's needs. Care staff were deployed to non-care tasks such as cooking, laundry and cleaning. Staff were not able to respond to people’s needs in a prompt manner.

The provider did not always adhere to the Mental Capacity Act 2005.

People were not always receiving care from staff who were competent, skilled and experienced. The provider did not keep appropriate records of training.

The provider did not ensure safe staff recruitment. Not all staff had undergone appropriate recruitment checks prior to working with vulnerable people as an employment history or references had not been obtained. The provider had not carried out their own criminal records checks on some staff.

Care plans were not in place for all people receiving support. People's preferences were not appropriately recorded. Care plan reviews did not evidence people’s involvement in planning their care.

People’s health, safety and wellbeing was at risk because the provider failed to adequately assess risk and did not manage medicines safely.

Overall governance of the service was ineffective. The registered manager carried out regular monthly quality checks. Where these checks had identified concerns with aspects of care delivery, improvements had not been made.

Staff received regular supervision from the registered manager.

We received mixed feedback from people regarding the food choices on offer. Where people required assistance, we observed staff patiently provide assistance. Drinks were available at all times.

We observed one instance of an organised activity, however for the majority of the inspection; people were left sitting in chairs with little staff interaction. We observed some instances of staff kindness towards people.

Overall, we found significant shortfalls in the care provided to people. We identified breaches of regulations 9, 10, 11, 12, 13, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

On 23 March 2018, we imposed a condition on the registration of the provider to restrict the admission of new service users without written authorisation from CQC.

On 18 July 2018, we issued a Notice of Decision to cancel the registration of the registered provider and registered manager. This decision was appealed to the First Tier Tribunal (Care Standards). The appeal was dismissed following a hearing in June 2019.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.