The Limes

Updated 28 October 2021

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 Care Act 2014.

Inspection team

This inspection was carried out by one inspector and one assistant inspector.

Service and service type

The Limes 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.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We looked at the information we held about the service, such as information we had received from members of the public and information submitted by the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. The local authority shared the information they held about the service; they had some concerns. We used all of this information to plan our inspection.

During the inspection

We spoke with three people who used the service. We were unable to speak with some people about their experiences of care. Therefore, we made observations in communal areas to see how people were supported. We also spoke with the deputy manager and nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with two senior care staff, three care staff, one domestic staff member and the activities coordinator. We also spoke with an agency member of staff. We looked at three people’s care records plus other documents such as medicine administration records. We looked at other documents such as cleaning records. We looked at the recruitment records for one staff member and two agency staff.

After the inspection

We made phone calls to relatives of people who used the service as they were unable to visit the home on the day of our inspection; we spoke with three relatives over the phone. We also made further calls to staff who we did not manage to speak with on the day of our visit; we spoke with a member of kitchen staff, another domestic assistant and another care assistant. We also carried out a phone interview with the registered manager as they were not able to be present on the day of our visit. We requested documentation to be sent to us after the site visit so we could review it off-site. We continued to seek clarification from the provider to validate evidence found.

Updated 28 October 2021

About the service

The Limes provides personal care and accommodation, for up to 55 younger and older people some of whom are living with dementia. The building consisted of two floors. At the time of the inspection there were 40 people living at the service. 35 people were present in the home during our visit, with another five in hospital.

People’s experience of using this service and what we found

Quality assurance systems were not always effective at identifying areas for improvement and did not always ensure people received safe care. Incidents were not always notified to the CQC as required. Government guidance and the provider’s own policies had not always been followed to ensure people were consistently kept safe. Lessons had not always been learnt when things had gone wrong.

Whilst people had not come to any harm, we found the management of people’s medicines required strengthening. Some guidance was missing for staff and storage was not always safe. Other risks, such as risk associated with people’s mobility and health conditions to people were assessed.

The provider had failed to ensure there were robust systems to check the suitability of agency staff. However, permanent staff were recruited safely. There was also mixed feedback about staffing levels, however we observed people did not have to wait for support.

People, relatives and staff felt positively about the management and felt supported. They were asked for feedback about the service. The provider and registered manager worked in partnership.

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 requires improvement (report published 18 April 2020). You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Limes on our website at www.cqc.org.uk.

Why we inspected

The inspection was prompted in part due to concerns received about infection control, supporting people with risks to their health and management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Limes on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified two breaches. We identified breaches in relation to the management and oversight of the quality and safety of the service and in relation to notifying us of certain incidents.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

The provider has already provided us an action plan about what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.