CQC report explained · a residential care home
What the CQC found at Lime Tree Court Limited
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found suitable staffing and recruitment checks, safe medicines management and clean premises. A diabetes risk assessment and records for as-needed medicines needed improvement, but the provider sent evidence that these were updated after the inspection.
- Effective?
- Good
- Staff had relevant training and regular supervision. People's nutritional needs were identified and met, with food, drinks and support available to help people eat and drink enough.
- Caring?
- Good
- People were treated with dignity and respect. They and their families were involved in care decisions, and people could personalise their rooms and choose aspects of their care.
- Responsive?
- Good
- Care plans reflected people's needs and were reviewed regularly. The home offered varied activities, supported family visits and had a complaints process, although one care plan had not included all current information.
- Well-led?
- Good
- Inspectors found a clearer management structure, regular handovers and positive communication with families. However, the auditing system was not robust enough to identify all actions needed for ongoing improvement.
What inspectors found, December 2018
Lime Tree Court Limited was rated Good; inspectors found safe, kind care and clear improvements, with some records and audit systems needing attention.
The inspection took place on 14 and 16 November 2018. The first day was unannounced. Inspectors spoke with people living there, relatives, staff, the owner, the manager, a GP and other workers. They also reviewed medicines, care plans, recruitment files and other records.
The home cared for 19 people in two units for people living with dementia. Inspectors found Good ratings in all five areas: Safe, Effective, Caring, Responsive and Well-led. They found enough staff, suitable recruitment checks, appropriate medicines management, kind care, activities, good food and access to health professionals.
The home had improved since the previous inspection in October 2017, when regulations were breached over unsafe manual handling, nutrition and monitoring systems. Some issues were found during this inspection, including missing details in risk assessments and care records. The provider sent evidence that several of these points had been corrected after the visit.
Enough staff
Inspectors saw enough staff to support people without rushing. People said staff responded quickly when they needed help.
“We saw that there were sufficient staff to attend to people's needs without rushing.” from the report
Food and nutrition
People had meal choices, fresh food, snacks and drinks. Those at risk of malnutrition had extra monitoring and fortified food where advised.
“People who required specific diets were monitored to ensure they consumed adequate nutrients.” from the report
Kind and respectful care
People were listened to and treated with dignity. Families were involved in care planning and decision-making.
“People were treated with dignity and respect. People were spoken to kindly, listened to and were well supported.” from the report
Activities and social contact
The home provided individual and group activities, trips, entertainment and links with local schools. Relatives could visit without restriction.
“The service offered a range of activities for people to take part in.” from the report
Diabetes risk information
needs fixingAt the inspection, one person's diabetes risk assessment did not explain what staff should do during a very low or very high blood sugar event. The provider updated it after the visit.
“However, we saw that a specific risk assessment was not in place for a person with diabetes.” from the report
As-needed medicine records
needs fixingThe home had instructions for as-needed medicines, but had not recorded the outcome after giving them at the time of inspection. The provider later sent evidence that this was being recorded.
“However, the outcome of administering the medicine was not in place at the time of our inspection.” from the report
Care plan accuracy
needs fixingOne current care plan did not include information about how covert medicines were given. The provider said this had been corrected after the inspection.
“However, we saw that some information was not transferred on to one person's current care plan.” from the report
Quality audits
needs fixingThe home had audits, but inspectors said they did not reliably identify actions needed when problems were found. The provider planned to introduce a more robust approach.
“We found the auditing procedure was not robust enough to ensure the service could identify actions to be taken in the event of issues or concerns.” from the report
- 01How do you now assess and manage risks for people with diabetes, including what staff should do during a hypoglycaemic or hyperglycaemic attack?
- 02How do you record the outcome when an as-needed medicine is given, and can we see a recent example?
- 03How do you make sure changes, including instructions for covert medicines, are transferred to each person's current care plan?
- 04What changes have been made to the quality auditing system since inspectors said it was not robust enough?
- 05How have the improvements in moving and handling and nutrition been checked since the previous inspection?
This was a comprehensive inspection covering all five key questions, with the first inspection day unannounced. This explanation was written from the published report of 28 December 2018 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, December 2017
Rated Requires Improvement; inspectors found kind and responsive care, but problems with moving people safely, nutrition, medicines and quality checks.
This was an unannounced inspection on 17 and 19 October 2017. Inspectors spoke with six people, staff, managers and visiting professionals. They looked at care plans, medicine records, recruitment files and the building, and observed care.
The home had improved some problems found in August 2016. Equipment and premises repairs had been addressed, emergency evacuation plans were up to date, and recruitment checks were in place. However, the home still did not meet some legal requirements.
Inspectors found kind staff who respected people's privacy and dignity. People had personalised care plans, activities took place and complaints were handled promptly. But medicines records were incomplete, one moving technique could have caused injury, nutritional support was not always adequate, and quality checks were not effective.
The overall rating Requires Improvement means the home was not consistently meeting the required standards at this inspection. Safe, Effective and Well-led were rated Requires Improvement. Caring and Responsive were rated Good.
Kind and respectful staff
Staff spent time with people, did not rush them, and respected their privacy and dignity.
“Staff demonstrated kindness and compassion towards the people they were supporting. We observed staff to spend quality time with people and did not rush them.” from the report
Personalised care
Care plans described people's routines and preferences, and staff could explain how people liked to be supported.
“Care plans were personalised and detailed daily routines specific for each person.” from the report
People felt safe
People told inspectors they felt safe and comfortable. Staff understood their safeguarding responsibilities and said they would raise concerns.
“People told us they felt safe, comfortable and well cared for at Lime Tree Care Home.” from the report
Improvements since the previous inspection
Problems with equipment, premises repairs, emergency evacuation plans and recruitment checks found in August 2016 had been addressed.
“During this inspection we found these issues had been addressed and improvements made.” from the report
Unsafe moving and handling
seriousStaff used an under-arm lift when helping someone from a chair. Inspectors said this could have caused serious injury.
“We saw staff assisting a person from their chair using a manoeuvre that put the person at risk of injury.” from the report
Nutrition and weight loss
seriousPeople at risk of malnutrition did not always receive enough monitoring or specialist support. One person's weight had fallen substantially and had not been checked as planned.
“Nutritional needs were not reviewed and the person had not been referred for specialist input to prevent and address weight loss.” from the report
Medicine records and checks
needs fixingRecords for medicines given when needed did not consistently show why, when or how much was given, or the person's response. Stock checks also found extra tablets.
“Medicines were not always managed according to best practice guidelines.” from the report
Weak quality monitoring
seriousThe home did not carry out effective audits of care plans, medicines and the quality of care. Records were also kept in different places and were not easy to locate.
“We found audits were not undertaken to monitor, assess and improve the quality of the service.” from the report
Limited feedback and activities information
minorResidents and families did not have meetings to give feedback. Activities took place, but they were not consistently recorded and no planned programme was displayed.
“People and those important to them did not have the opportunity to feedback their views about the quality of the service they received.” from the report
- 01What changes have you made to ensure staff use safe moving and handling techniques every time?
- 02How do you now record medicines given when needed, including the reason, dose, time and response?
- 03How are residents at risk of weight loss monitored, and when are dietitians or other professionals involved?
- 04What audits are now completed for care plans, medicines and the quality of care, and who checks the results?
- 05How can residents and families give feedback, and how are activities planned and recorded?
This was an unannounced inspection covering all five CQC questions, with ratings given for Safe, Effective, Caring, Responsive and Well-led. This explanation was written from the published report of 2 December 2017 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 Tree Court Limited
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- December 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 8 March 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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