CQC report explained · a nursing home
What the CQC found at Lime Tree Manor Nursing and Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that people were protected from avoidable harm. Staff understood safeguarding and risks, medicines were administered safely, staffing was considered sufficient, and infection control arrangements were in place.
- Effective?
- Good
- This area was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This area was not inspected during this focused visit. Inspectors did record positive comments about kind, respectful and personalised care.
- Responsive?
- Good
- This area was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Good
- Inspectors found consistent management, regular audits, staff involvement and partnership working. This rating improved from Requires Improvement at the last inspection.
What inspectors found, March 2022
Lime Tree Manor Nursing and Residential Home was rated Good; inspectors found safe care, enough staff and strong management.
This was an unannounced focused inspection on 22 February and 3 March 2022. Inspectors looked mainly at Safe and Well-led because concerns had been raised about staffing, medicines and management responses.
Inspectors found people were safe. Staff understood safeguarding and risk management. Medicines were given by trained staff, infection control arrangements were in place, and people and relatives said there were enough staff.
People and relatives spoke positively about the kindness and personalised support from staff and the registered manager. Audits, meetings and reviews were used to identify improvements and share lessons.
The overall rating stayed Good. Safe was rated Good and Well-led improved from Requires Improvement to Good. The other areas were not inspected during this visit, so their previous ratings were used in the overall rating.
Safe medicines practice
Medicines were administered by trained staff whose competence was checked. Regular audits were used to identify and correct errors.
“Staff administered people's medicines following best practice guidelines. Staff were trained and had their competency observed before they could administer people's medicines on their own.” from the report
Staffing and recruitment
People, relatives and staff said there were enough staff. Recruitment checks included references and criminal record checks.
“People told us they felt there were enough staff. This was because their call bells were answered promptly, and their needs were met in a timely way by staff.” from the report
Infection control
Inspectors were assured about infection prevention, protective equipment, testing and the provider’s arrangements for managing outbreaks.
“We were assured that the provider was using PPE effectively and safely.” from the report
Kind and personalised support
People and relatives praised staff and the registered manager for kindness, respect and support tailored to people’s wishes and preferences.
“People and relatives praised the registered manager and staff for the personalised support they provided.” from the report
Quality monitoring
Regular audits and reviews helped the management team find areas for improvement. Lessons from incidents and complaints were shared with staff.
“The regular audits carried out by the registered manager and the deputy manager to assess different parts of the service helped them identify areas where improvements were needed.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you decide when staffing numbers need to increase as people’s needs change?
- 02What medicine errors or near misses have happened recently, and what was changed as a result?
- 03How do you check that lessons from accidents, incidents and complaints are put into practice?
- 04What are the current ratings and findings for Effective, Caring and Responsive, which were not inspected during this visit?
- 05How do people and relatives contribute to meetings and decisions about the running of the home?
This was a focused inspection of Safe and Well-led only; the other ratings carried over from the last inspection. This explanation was written from the published report of 16 March 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 2017
Lime Tree Manor Nursing and Residential Home was rated Good overall, but inspectors found the home was not always well-led because its quality checks missed some problems.
The unannounced inspection took place on 20 July 2017. Inspectors spoke with people living at the home, relatives and staff. They observed care and checked care records, medicines records, recruitment files, training records and quality checks.
The home remained Good overall, with Good ratings for Safe, Effective, Caring and Responsive. Inspectors found people felt safe, staff were trained, care was kind and respectful, care plans reflected people's needs, and activities and complaints processes were available.
Well-led was rated Requires Improvement. Quality checks did not always identify problems with daily records, medicines storage, medicines records and inconsistencies in some care plans. Inspectors said these issues had not affected the care people received, but could lead to inaccurate information.
Safe staffing and risk planning
Inspectors found enough staff were on duty and that personalised risk assessments gave staff guidance on reducing risks.
“There were sufficient staff on duty to meet people's needs at all times.” from the report
Kind and respectful care
People and relatives praised the staff. Inspectors observed calm, patient and respectful interactions, with privacy and dignity protected.
“We observed positive interactions between staff and people who lived the service and found this to be caring, friendly and respectful.” from the report
Individual care and activities
Care plans included people's backgrounds, preferences and interests. People could join group and one-to-one activities and ask for activities they wanted.
“Each was individualised to reflect people's needs and included clear instructions for staff on how best to support people.” from the report
Approachable management
The registered manager was visible and people, relatives and staff felt able to raise concerns or suggestions.
“There was an open culture amongst the staff team and staff felt management were supportive and approachable.” from the report
Quality checks missed record problems
needs fixingManagement checks did not identify that some food, fluid and repositioning records had been completed retrospectively. Inspectors also found inconsistencies in some care plan information.
“However, none of these reviews by the management team had identified that people's daily records such as food, fluid or repositioning charts had been completed retrospectively.” from the report
Fluid records were incomplete
needs fixingThere was no recorded optimum fluid intake for each person. Fluid charts were not totalled and were not completed after 7pm, making it difficult to check people's full daily intake.
“However, there was no optimum fluid intake recorded for each person which meant it was difficult to ensure people received adequate amounts of fluids per day.” from the report
Medicines storage temperature
needs fixingThe medicines room was consistently recorded at 25 degrees, described as the upper limit for safe medicines storage. Inspectors also found two discrepancies between medicines and records on one unit.
“However, the temperatures of the medicines room was consistently noted as being at 25 degrees, which is the upper limit for the safe storage of medicines.” from the report
- 01What changes have been made to make sure food, fluid and repositioning records are completed at the correct time?
- 02How do you now record each person's recommended fluid intake and check their full 24-hour drinking records?
- 03How are medicines room temperatures checked and acted on when they reach the upper limit?
- 04How do managers reconcile medicines with the medication administration records after the discrepancies found on one unit?
- 05How do you check that different sections of each person's care plan and risk assessment contain consistent information?
This was an unannounced inspection of all five CQC questions, with the home rated Good overall and Well-led rated Requires Improvement. This explanation was written from the published report of 5 October 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 Manor Nursing and Residential Home
3 rated inspections over 7 years: the service has held its Good rating throughout.
- March 2022Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Lime Tree Manor Nursing and Residential Home →
- October 2017Goodstayed GoodSafe: GoodWell-led: Requires improvement
Read what inspectors found at Lime Tree Manor Nursing and Residential Home →
- May 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 17 December 2010.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Hertfordshire
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 £1,300 a week. 82 can care for a couple. 12 years' experience on average.
“She handled the new situation in front of her with such professionalism and I felt I could trust her 100%.”
“She was v competent and confident and we felt our mum was safe in her care. She supported us through a difficult time.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.