CQC report explained · a nursing home
What the CQC found at Lime Tree House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Risk assessments were in place and followed, staffing was considered sufficient, and medicines were overall managed safely, although one evening dose had been missed.
- Effective?
- Good
- People's needs and choices were assessed and reviewed. Staff received relevant training and supervision, and people were supported with food, healthcare and decisions about their care.
- Caring?
- Good
- Inspectors found kind and supportive relationships. People were involved in decisions, and their privacy, dignity, independence and family relationships were respected.
- Responsive?
- Good
- Support was individualised around people's routines, preferences and activities. People knew how to complain, and information was provided in accessible formats.
- Well-led?
- Good
- The home had audits, an improvement plan and regular meetings with people and staff. Staff said they felt supported, and inspectors found clear responsibilities and positive teamwork.
What inspectors found, March 2019
Lime Tree House was rated Good; inspectors found kind, person-centred care and improvements since the previous inspection, with one missed medicine dose identified.
This was an unannounced inspection on 20 February 2019. One inspector spoke with people living at the home, relatives and staff, and checked care, medicine and other records.
Inspectors rated the home Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. They found people were protected from harm, supported to make choices, treated with dignity and helped to take part in activities they enjoyed.
The home had improved from Requires Improvement at the previous inspection, published in September 2017. Inspectors found better risk assessments, clearer guidance for supporting behaviour and stronger checks on the quality of care.
One person had missed an evening medicine dose on one night shortly before the inspection. The provider investigated this and took action to reduce the chance of it happening again.
Improved risk management
The home had addressed earlier concerns about risk assessments and guidance for supporting behaviour. Inspectors found that risks were assessed, managed and reviewed.
“At this inspection we saw improvements had been made to ensure risks to people were minimised.” from the report
Personalised daily life
Staff supported people to choose when they got up, ate, went out and went to bed. Activities were adapted to people's interests and choices.
“The care is focused on them and their preferences.” from the report
Kind and respectful care
People had caring relationships with staff and were involved in decisions about their care and how they spent their time.
“People had caring, kind supportive relationships with the staff who supported them.” from the report
Good leadership checks
The home used audits, meetings and an improvement plan to identify and act on issues. Staff described the management team as supportive.
“There were quality audits in place to measure the success of the service and to continue to develop it.” from the report
One missed medicine dose
seriousOne person did not receive their evening medicine on one night in the week before the inspection. The provider investigated and acted to reduce the risk of a repeat, but families should ask how this is now checked.
“However, we identified that one person had not received their evening medicine on one night the week before our inspection.” from the report
- 01What checks are now in place to make sure every medicine dose is given and recorded correctly?
- 02What would staff do if a person became anxious or upset, and when would physical intervention be considered?
- 03How would you support my relative to keep their preferred daily routine and take part in activities outside the home?
- 04How are relatives involved in care planning and decisions about changing health needs?
- 05How do people living here raise concerns, and what action is taken when they do?
This was an unannounced inspection covering the premises and care provided, with ratings given for all five CQC questions; the previous overall rating was Requires Improvement. This explanation was written from the published report of 19 March 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.
What inspectors found, September 2017
Rated Requires Improvement; inspectors found kind, responsive care but gaps in risk assessments, behaviour plans and people's legal rights.
This was an unannounced inspection of the home. The inspector spoke with people living there, relatives, staff and health professionals. They observed care and reviewed care records, medicines, staff files, training and quality checks.
The home was caring, responsive and well-led, all rated Good. People were treated kindly, involved in decisions and supported with activities, health appointments and their independence. Relatives and professionals were positive about the staff and management.
Safe and Effective were rated Requires Improvement. Some risks, including risks of self-harm, were not fully assessed or reflected in care plans. Behaviour support plans lacked clear guidance, and staff did not always understand how to apply the Mental Capacity Act and Deprivation of Liberty Safeguards.
The manager took immediate action on several issues, including fitting window restrictors and reviewing records. The overall rating means the home was not consistently meeting the expected standard at the time of this inspection.
Kind and respectful staff
Inspectors saw staff showing patience, empathy and good communication. People were treated with dignity and their independence was encouraged.
“Staff were kind, caring and sensitive in their approach towards the people they supported.” from the report
Enough staff
Staffing levels were described as sufficient and flexible. Rotas and feedback indicated that people had the support they needed to stay safe.
“There were sufficient staff available to meet people's needs and ensure their safety.” from the report
Personalised support
Care records included people's routines, interests and communication needs. People were supported with activities, community access and their own goals.
“People received opportunities to participate in a variety of activities.” from the report
Good leadership response
The management team accepted the feedback and began work on the issues during and after the inspection. Quality checks and an improvement plan were in place.
“Where some issues were identified during our inspection visit the management team were quick to respond.” from the report
Risk information was incomplete
seriousSome risks, including self-harm risks, were not identified or updated in care plans. This meant staff did not always have clear guidance to protect people.
“Risks associated with people's needs had not been fully assessed and planned for.” from the report
Behaviour support guidance
seriousSome behaviour plans were too general and did not clearly explain what staff should do. Three of the four staff asked could not confidently explain the physical intervention method for one person.
“Some people's behavioural strategy plans lacked specific detail.” from the report
Legal rights were not always protected
seriousStaff did not always understand how to apply the Mental Capacity Act and Deprivation of Liberty Safeguards. One person's independent access to the community had been restricted without the required assessment or application.
“People's rights under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were not fully protected.” from the report
Medicines records needed improvement
minorMedicines were generally managed safely, but preferences for taking medicines were not always recorded. One eye drop had not been dated when opened, and the medicine trolley temperature records could not be found.
“We identified the way people preferred to take their medicines had not been consistently recorded.” from the report
Some care records lacked detail
needs fixingA catheter care plan did not explain the signs of infection. Goals and aspirations also needed updating and clearer actions and timescales.
“One person's catheter care plan lacked information about the signs and indicators of an infection” from the report
- 01Have all people's risk assessments now been reviewed and updated, especially where there are risks of self-harm or changing mental health?
- 02How do you make sure staff understand each person's behaviour support plan and know exactly what to do before physical intervention is considered?
- 03How do you check that decisions affecting a person's freedom follow the Mental Capacity Act and Deprivation of Liberty Safeguards?
- 04How do you record people's preferences for taking medicines, opening dates and medicine trolley temperatures?
- 05Have the care records and personal goals that lacked detail been updated with clear guidance, actions and timescales?
This was an unannounced comprehensive inspection covering all five key questions, with the report text giving the visit as 3 August 2017 and the front page as 04 August 2017. This explanation was written from the published report of 7 September 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 House
2 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- March 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- March 2017
Registered with the Care Quality Commission on 23 March 2017.
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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