CQC report explained · a residential care home
What the CQC found at Lime House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, September 2020
Lime House was rated Good overall; inspectors found safe, person-centred care and significant improvement since the previous inspection.
Inspectors visited on 12 and 17 August 2020. They spoke with people, relatives and staff, observed medicines being given, and reviewed care, medicines and management records. The visit was unannounced, with 24 hours' notice because of the Covid-19 pandemic.
The home was rated Good overall and Good for Safe, Effective, Responsive and Well-led. Inspectors found that risks and medicines were managed safely, staffing and training were suitable, people's food and drink needs were met, and care plans reflected people's choices and needs.
The home had previously been rated Requires Improvement. Inspectors found that improvements had been made and that the home was no longer in breach of the regulations identified at the earlier inspection. This was a focused inspection, so Caring was not assessed during this visit and the previous rating for that question was carried forward.
Safe medicines
The medicines records checked were complete, stock was correct and staff gave medicines safely. Staff had the required training and competency checks.
“We looked at three people's medicines administration records and found these to be completed correctly.” from the report
Personalised care
Care plans included people's preferences, strengths and independence. Staff showed that they knew how people wanted to be supported.
“Care plans were now more person-centred and contained specific individual details about people and how they wanted to be supported.” from the report
Food and drink choices
People could choose their meals and the home recorded and monitored nutrition and hydration risks.
“People's dietary needs and preferences were met, and people were involved in choosing their meals each day” from the report
Stronger oversight
The home had introduced more detailed audits, risk records and improvement plans to identify and address shortfalls.
“More robust quality assurance systems were now in place to ensure any shortfalls were identified and to drive continuous improvement within the service.” from the report
Activities and relationships
People had access to activities, interests and social opportunities. The home also had a secure garden that people could use.
“People were supported to follow their interests and take part in social activities.” from the report
Inspectors raised no specific concerns in this report.
- 01How will you make sure care plans and risk assessments stay up to date when a person's needs change?
- 02How do you monitor people's food and drink intake if they are at risk of losing weight or becoming dehydrated?
- 03How often are medicines records, stock and staff competency checked?
- 04How do you make sure people who may lack capacity are involved in decisions and that best-interest decisions are recorded?
- 05What activities and communication support would be available for my relative's particular interests and needs?
This was a focused inspection of Safe, Effective, Responsive and Well-led only; Caring was not assessed and the previous rating for that question was carried forward. This explanation was written from the published report of 18 September 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2019
Rated Requires Improvement; inspectors found kind care and enough staff, but serious gaps in safety, records, consent, nutrition and management.
The inspection took place on 28 February and 1 March 2019. Inspectors spoke with people living in the home, relatives, the manager and staff. They observed care and reviewed care plans, risk assessments, medicines records, staff files and management records.
People were generally treated with kindness and respect. Staff were recruited safely, there were enough staff, training was provided and people had activities and access to health professionals. However, important records were incomplete or out of date.
Inspectors found problems with falls monitoring, risk assessments, food and fluid records, repositioning records, consent and end of life planning. Management checks had not found or dealt with these issues. The overall rating fell from Good at the previous inspection to Requires Improvement.
Kind and respectful care
People and relatives spoke positively about the care. Inspectors saw staff protecting privacy, explaining care and encouraging people to do things for themselves.
“We saw examples of kind and supportive interactions between people and the staff supporting them.” from the report
Training and professional support
Staff had induction, training, supervision and appraisal. The home worked with doctors, therapists, social workers, dietitians and other professionals.
“Staff had received training to enable them to carry out their roles effectively and told us they had completed an induction programme.” from the report
Activities and community links
People could take part in activities, use the gardens and join some trips out. The home also worked with local schools and community groups.
“Lime House had a programme of activities for people to undertake.” from the report
Falls and changing risks
seriousThere was no formal system to record and review every fall. A person's evacuation plan and dependency level had not been updated after their health deteriorated.
“There was no formal system in place at the home to record and review falls for any person unless they led to serious harm.” from the report
Food and fluid monitoring
seriousFood and fluid records were sporadic and were not being reviewed properly. One person was not weighed as often as their care plan required.
“We saw these records were sporadic and there was no monitoring of these records being undertaken.” from the report
Weak management checks
seriousAudits did not identify important problems with care records, falls, call bells, food and fluids or night-time checks. The manager had not recorded some checks they said had taken place.
“Governance systems had failed to enable the registered person to assess, monitor and improve the quality and safety of the services being provided.” from the report
- 01How are all falls now recorded, reviewed and used to identify patterns or prevent further harm?
- 02How do you check that care plans and risk assessments are updated promptly when someone's needs change?
- 03How are food, fluid, weight and repositioning records now completed and reviewed?
- 04How do you assess mental capacity and record best-interest decisions and lawful consent?
- 05What action has been completed in response to the Warning Notice and the CQC's findings about governance?
This was a planned inspection of the overall quality of the home, covering all five CQC questions and both the premises and the care provided. This explanation was written from the published report of 14 June 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Lime House
3 rated inspections over 4 years: the service has held its Good rating throughout.
- September 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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At least 100 live-in carers within about an hour of Wigan
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 92 can care for a couple. 11 years' experience on average.
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“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
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