CQC report explained · a residential care home
What the CQC found at Lime Tree Court Residential Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People received medicines as prescribed, risks were assessed and enough staff were available. Infection-control arrangements and safeguarding systems were also found to be effective.
- Effective?
- Good
- People's needs and preferences were assessed, staff had suitable training, and people were supported with food, drinks and healthcare. The home was found to be working within the Mental Capacity Act.
- Caring?
- Good
- This question was not inspected during this focused visit. Its earlier rating was used when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its earlier rating was used when calculating the overall rating.
- Well-led?
- Good
- Managers used audits, reviewed incidents and acted on learning. However, checks did not always identify that actions about missed fluid targets had not been recorded.
What inspectors found, November 2022
Rated Good; inspectors found safe, effective and well-led care, with some fluid-monitoring records needing better completion.
This was an unannounced focused inspection on 27 September 2022. Inspectors looked at Safe, Effective and Well-led after concerns about medicines and nutrition and hydration. They spoke with people, relatives, staff and managers, and checked care records, medicine records and home audits.
The home had improved its medicines management since the previous inspection. Inspectors found medicines were given as prescribed, stored safely and recorded accurately. They also found enough staff, suitable risk assessments, infection-control measures and systems to learn from accidents and incidents.
People had assessments and care plans for their needs. Staff were trained, people received suitable food and drinks, and health professionals' advice was followed. Inspectors found the home worked within the Mental Capacity Act and sought consent.
The overall rating was Good, the same as at the previous inspection on 14 October 2021. Caring and Responsive were not examined during this focused inspection, so the overall rating used earlier ratings for the questions not inspected.
Medicines management
The home had made the improvements required after the previous inspection. Medicines were stored safely, given as prescribed and recorded accurately.
“At this inspection the provider had made the required improvements.” from the report
Staffing and safety
Inspectors found enough staff to respond promptly, with safe recruitment checks in place. Staff understood safeguarding and people's individual safety risks.
“We saw staff were able to respond promptly to people's needs.” from the report
Food and hydration support
Staff understood people's dietary needs and preferences. Care plans and monitoring were used where people were at risk of choking or needed help to eat and drink.
“People had their food and fluid intake monitored when required.” from the report
Learning and oversight
The home reviewed incidents, complaints and safeguarding concerns, and made changes when learning was identified. Several audits were helping to drive improvement.
“There was a learning culture in place at the home.” from the report
Fluid-monitoring records
needs fixingChecks did not always identify that action taken when people missed their fluid targets had not been recorded. The manager said checks would be extended so this was recorded more accurately.
“Provider systems were not consistently identifying areas for improvement.” from the report
- 01How do you now make sure action about missed fluid targets is recorded every time?
- 02How are medicines audits and electronic stock checks used to prevent missed or late medicines?
- 03How do you monitor food and fluid intake for people at risk of dehydration or choking?
- 04How often are care plans and risk assessments updated when someone's needs change?
- 05How can relatives raise concerns and receive updates about their family member's care?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their earlier ratings were used for the overall rating. This explanation was written from the published report of 2 November 2022 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, October 2021
Lime Tree Court Residential Care Home was rated Good overall, but Safe was Requires Improvement because medicines were not always managed and stored safely.
This was an unannounced focused inspection on 14 September 2021. Inspectors reviewed Safe and Well-led only because concerns had been raised about medicines and timely medical help. They spoke with five people and eight staff, reviewed care records and medicines information, and checked audits, health and safety records and recruitment checks.
People received their medicines as prescribed and there were enough staff to help people promptly. However, medicines were not always stored securely or monitored properly. Broken trolley locks meant medicines could be accessible when trolleys were unattended. Information for some medicines was not detailed enough, skin patches were not always rotated as advised, and fridge temperature checks were incomplete.
The home was rated Good overall. Safe was rated Requires Improvement, a deterioration from Good at the previous inspection, while Well-led remained Good. The other three question ratings were not inspected during this visit and previous ratings were used in calculating the overall rating.
Enough staff
Inspectors found enough staff to respond promptly while still spending unhurried time with people.
“People were supported by enough staff who were available to safely support them.” from the report
Risk awareness
Care risks were assessed, and staff understood the risks affecting people and how to reduce harm.
“Staff members knew the individual risks to people and what to do to safely support them.” from the report
Open management
People and staff felt able to share views. Suggestions about menus and activities had led to changes.
“People told us they felt the home was well managed and felt their input and opinions were valued.” from the report
Infection control
Inspectors were assured about infection prevention, protective equipment, testing and visiting arrangements.
“We were assured the provider was using PPE effectively and safely.” from the report
Medicine storage
seriousBroken locks on medicine trolleys meant people could access medicines when the trolleys were unattended. Some medicated creams were also left in people's rooms.
“This meant when the trollies were left unattended people had access to the medicines stored in them.” from the report
Medicine instructions
needs fixingSome plans for medicines given when needed did not explain clearly enough when staff should give them or what signs to look for.
“The information included was not sufficient to inform the staff of how and when to administer these medicines.” from the report
Skin patch checks
needs fixingPain-relief skin patches were not always moved around the body in line with the manufacturer's guidance. Inspectors found no evidence that people had been affected.
“We looked at four people who had been prescribed these patches and found the patches were not being rotated around the body in accordance with the manufacturer guidance.” from the report
Medicine fridge records
needs fixingThe home did not record maximum and minimum medicine-fridge temperatures daily, so it could not show that medicines needing cold storage were kept correctly.
“The service was not recording the maximum and minimum temperatures on a daily basis and therefore were not able to demonstrate medicines, that required cold storage conditions, were being stored correctly.” from the report
- 01Have the replacement medicine trolleys arrived, and how are medicines kept secure when trolleys are unattended?
- 02How do you make sure plans for medicines given when needed explain the signs to look for and when to give them?
- 03How do you now check and record medicine-fridge temperatures every day?
- 04How are staff checking that medicated creams are returned safely after use?
- 05How do you make sure skin patches are rotated according to the manufacturer's guidance?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and their previous ratings carried over. This explanation was written from the published report of 15 October 2021 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 Residential Care Home
6 rated inspections over 6 years: the service has held its Good rating throughout.
- November 2022Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Lime Tree Court Residential Care Home →
- October 2021Goodstayed GoodSafe: Requires improvementWell-led: Good
Read what inspectors found at Lime Tree Court Residential Care Home →
- August 2019Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- August 2018Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- June 2014
Report published without a new overall rating.
- April 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- August 2012
Registered with the Care Quality Commission on 2 August 2012.
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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