CQC report explained · a residential care home
What the CQC found at Limegrove
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Staff rotas showed repeated occasions when staffing fell below the expected level. Some risks, including epilepsy, choking, behaviour and fluid intake, were not fully recorded, although staff often knew people's needs.
- Effective?
- Good
- People received sufficient food and drink, appropriate training and support, and access to healthcare professionals. Mental capacity and best-interest processes were in place.
- Caring?
- Good
- People said staff were kind, respectful and listened to their choices. Inspectors saw staff supporting independence and treating people with patience and dignity.
- Responsive?
- Requires improvement
- The ratings table gives Responsive as Requires Improvement. Inspectors saw few organised activities and recommended reinstating them to reduce the risk of social isolation, although the detailed section says the rating remained Good.
- Well-led?
- Requires improvement
- Audits and management systems did not reliably identify or fix problems with staffing, care plans, fluid charts and medicines processes. Four potential safeguarding concerns had not been notified to CQC.
What inspectors found, April 2022
Limegrove rated Requires Improvement; inspectors found kind care and good support with food and healthcare, but staffing, records and management needed improvement.
Inspectors visited without notice on 3 March 2022 and contacted relatives on 8 March 2022. They spoke with people, relatives, staff and a health professional. They reviewed care plans, medicines, staff files, rotas, audits, complaints and other records.
People generally said they felt safe and were treated kindly and respectfully. Inspectors found good training, food and drink, healthcare support, medicines practice and infection control. However, staffing levels fell below the expected level on several occasions. Some risks and care information were not recorded properly, and potential safeguarding concerns were not always reported to CQC.
The overall rating changed from Good to Requires Improvement. Safe and Well-led were rated Requires Improvement. Effective and Caring were rated Good. The ratings table also shows Responsive as Requires Improvement, although the detailed Responsive section says its rating remained Good. The home was not found to have left anyone at immediate risk of harm, but CQC required an action plan and will monitor progress.
Kind and respectful care
People were generally happy with the care. Inspectors saw staff being kind, attentive and patient, while supporting people's choices and independence.
“People told us they were happy living at Limegrove. They said staff were kind and caring towards them and showed them respect.” from the report
Food and drink
People were offered regular drinks and meals, with choices and support where needed. Special diets were provided and people were weighed regularly.
“People were provided with sufficient food and drink to maintain their health.” from the report
Healthcare support
People could see healthcare professionals when needed. Records showed involvement from GPs, district nurses, physiotherapists and other professionals.
“There was evidence of people receiving input from the GP, district nurse, physiotherapist, speech and language therapy team and an optician.” from the report
Medicines practice
Inspectors found that people received their prescribed medicines. Medicines records had no gaps during the inspection, and medicines were stored safely.
“There were no gaps on people's MARs and each MAR contained a dated photograph of the person for identification purposes, any allergies they had and the GP information.” from the report
Staff training
Training records showed good compliance with the provider's requirements. Staff said they received supervision and opportunities for further training.
“We reviewed the training matrix provided to us by the registered manager following our inspection. This showed good compliance with the training requirements of the registered provider.” from the report
Staffing levels
seriousRotas showed repeated periods below the expected staffing levels. Inspectors said this left people at risk of not receiving care when they needed it.
“We found at least nine nights when there were less than five care staff on duty, 15 days when there were less than three team leaders on duty and 12 days when there were less than 10 care staff.” from the report
Incomplete risk information
seriousSome risks were not identified or recorded clearly. Examples included epilepsy, behaviour that could harm others and fluid intake targets.
“Some risks had not been identified or recorded however.” from the report
Safeguarding notifications
seriousFour potential safeguarding concerns had not been reported to CQC as required. The local authority had been told about some concerns.
“However, we identified four potential safeguarding concerns that had not been notified to CQC” from the report
Weak management checks
needs fixingAudits were carried out, but actions were not always completed. Care plan audits also failed to identify missing information about some people's conditions and risks.
“However, although these audits took place, actions arising from them were not always carried out.” from the report
Limited activities
needs fixingThere were no organised activities observed during the visit, and the activity shown on the weekly planner did not happen. Inspectors recommended reinstating activities to reduce social isolation.
“Throughout the day, there were no organised activities observed.” from the report
- 01What are the current staffing levels on each floor during the day and at night, and how do you cover staff shortages?
- 02How have you updated risk assessments and care plans for epilepsy, behaviour risks and fluid intake?
- 03What action have you taken to make sure all potential safeguarding concerns are reported to CQC correctly?
- 04What activities are now available, and how do you include people who prefer to stay in their rooms or live with advanced dementia?
- 05How do you check that audit actions, care plan updates and medicines reviews are completed on time?
This was an unannounced inspection covering all five key questions, including infection prevention and control; inspectors visited on 3 March and contacted relatives on 8 March. This explanation was written from the published report of 14 April 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, February 2022
Inspected but not rated; inspectors found good infection control arrangements during the COVID-19 review.
Inspectors visited on 18 January 2022. This was an announced, targeted inspection of infection prevention and control, with one day's notice. They also asked about staffing pressures linked to COVID-19.
The inspectors were assured that the home was managing infection risks. This included visitors, social distancing, admissions, protective equipment, testing, cleaning, outbreaks and visits. The home also met the COVID-19 vaccination requirement for non-exempt staff and visiting professionals.
The home supported family contact during outbreaks. Relatives could visit as essential caregivers, and tablet devices with headphones helped people stay in touch when visits were not possible.
The service was inspected but not rated. This report does not give a full quality rating for the home or ratings for all five areas.
Family visits
Relatives were supported to continue visiting during COVID-19 outbreaks when they were essential caregivers.
“Relatives were encouraged to visit their loved ones, as an essential caregiver throughout any covid outbreaks to support people's wellbeing by continuing to see their families.” from the report
Support with isolation
The home changed its layout to help people who did not understand why they needed to isolate, while helping protect others.
“The service had adapted the environment by re-arranging furniture for people who found it difficult to understand the need to isolate.” from the report
Keeping in touch
Tablets and headphones were available to help people stay connected with family when face-to-face visits were not possible.
“Staff supported people with these devices.” from the report
Clean uniforms
Extra uniforms were available for agency staff so they could change into clean clothing when they arrived.
“This ensured that all staff changed into clean uniforms on arrival at the service, thus reducing risk of infection.” from the report
Inspectors raised no specific concerns in this report.
- 01What measures are currently in place to manage staffing pressures linked to COVID-19 or other infections?
- 02How are visits managed now during an infection outbreak, and can relatives act as essential caregivers?
- 03How does the home support residents who find it difficult to understand the need to isolate?
- 04Are tablets and headphones still available for residents who cannot receive visitors?
- 05What is the home's latest full inspection rating for areas not covered by this visit?
This was a targeted inspection of infection prevention and control, with questions about COVID-19-related staffing pressures; the service was inspected but not rated and the other areas were not assessed. This explanation was written from the published report of 8 February 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.
Every inspection of Limegrove
5 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- April 2022Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2022Inspected but not ratedSafe: Inspected but not rated
- August 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2014
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 25 November 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
77 live-in carers within about an hour of Surrey
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 £1,250 a week. 66 can care for a couple. 11 years' experience on average.
“Without his support we wouldn't have been able to navigate bringing and keeping Dad at home.”
“Not only has she looked after him beautifully, she has also been great company for him with lively conversation, kindness and humour.”
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.