Lime Trees

Updated 19 December 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 1 inspector and 1 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.

Service and service type

Lime Trees is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Lime Trees is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is not required to have a registered manager to oversee the delivery of regulated activities at this location.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 1 person and 6 relatives either in person or over the telephone. We also received written feedback from 1 person’s relative and 1 professional who works with the service. We reviewed 3 people’s care plans, 2 staff recruitment files and multiple documents relating to the oversight and governance of the service such as policies, procedures, and audits. We observed care and support provided in shared areas of the service. We spoke with 8 members of staff, including care workers, senior care workers, the maintenance person, the deputy manager, the care manager, and the nominated individual (who is also the company director). The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 19 December 2023

About the service

Lime Trees is a residential care home providing accommodation with personal care to up to 10 people. The service provides support to people with physical disabilities, sensory needs and those living with acquired brain injury. At the time of our inspection there were 10 people using the service.

People’s experience of the service and what we found:

Medicines were given as prescribed, however some record-keeping practice required improvement. The provider acted on this feedback straight away. We have made a recommendation about medicines records. There were sufficient numbers of staff suitably deployed to meet people’s needs. Staff were recruited safely. Checks were carried out on the environment and equipment, including by external professionals. Risks were assessed and recorded in people’s care plans. Staff understood their safeguarding responsibilities and there was evidence of a proactive learning culture.

People received an initial assessment, which was used to create personalised care plans. Staff received an induction, supervision, and some specialist training. We identified an issue with healthcare related tasks but the provider took prompt action to address the concerns raised. We have made a recommendation about competency assessments relating to delegated healthcare tasks. The need for consent clearly underpinned staff practice. The service was well designed and decorated. The service worked well with other professionals to support people to lead healthy lives.

Staff were caring and kind, and spoke about people with dignity, respect, knowledge and understanding. This included using language which respected and considered people’s strengths, and not just their needs. People’s views were considered by staff. This included those who could not communicate verbally with words. Equality and diversity were considered as part of care planning and provision.

People could enjoy meaningful leisure and social activities. Care provision was regularly reviewed to ensure it met people’s preferences, choices and people could meet their ambitions and goals. People’s communication needs were known and recorded. The service had a system in place for responding to complaints openly and transparently. Good partnership working supported joined up end of life care.

There were systems in place for oversight of the service, although the provider told us of plans to further strengthen and formalise this through additional auditing. There was a positive staff culture, which promoted good outcomes for people. People and staff had opportunities to share their views and make suggestions about the running of the service. People and staff told us they found the management team approachable, open, and transparent. Effective partnership working with a range of stakeholders was seen to be taking place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 Outstanding (published 14 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation about ensuring accurate records are kept relating to medicines practice, and a recommendation about competency assessments.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.