CQC report explained · a residential care home
What the CQC found at Limes Residential Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found people were protected from abuse, risks were assessed and there were enough staff. Medicines were managed safely overall, but the application of prescribed creams had not been recorded at the time of inspection.
- Effective?
- Good
- Staff had appropriate training and support, and people's health and nutrition needs were monitored. The home worked with health professionals and had improved its approach to consent and best-interest decisions.
- Caring?
- Good
- People and relatives described staff as kind and caring. Inspectors saw staff offering reassurance, respecting people's dignity and involving people and relatives in care planning.
- Responsive?
- Good
- Care plans were detailed and personalised. Activities had improved through the appointment of a full-time activities co-ordinator, and complaints were investigated and acted on.
- Well-led?
- Good
- The management team had introduced regular audits and action plans. Inspectors found that improvements from the previous inspection had been maintained and that people, relatives and staff had opportunities to give feedback.
What inspectors found, July 2019
Limes Residential Care Home was rated Good; inspectors found kind, safe and personalised care, with improvements sustained since the previous inspection.
This was an unannounced inspection on 25 and 26 June 2019. The inspectors spoke with people living in the home, relatives, staff and a health professional. They also checked care records, medicines records, staff files and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines systems, detailed care plans and kind relationships between staff and people.
The previous inspection had rated the home Requires Improvement, with several breaches of regulations. This time, the inspectors found the required improvements had been made and that the home was no longer in breach.
There were still a few issues to watch. The application of prescribed creams had not been recorded, although a new medicines chart was being introduced after the inspection. Inspectors also asked the home to consider making pureed meals look more appetising.
Personalised care plans
Care plans recorded people's needs, preferences and the support they required. People and relatives were involved in reviews.
“Care plans were now detailed, person centred and reflected the level of support people required from staff” from the report
Kind and respectful staff
Inspectors saw positive relationships between staff and people. Staff offered comfort and reassurance when people were anxious or upset.
“We observed staff spend time speaking with people and providing reassurance where people may be anxious or upset.” from the report
Improved activities
The home had expanded activities around people's interests, including clubs, exercises, quizzes and trips into the community.
“As a result, people enjoyed a wide range of activities designed to stimulate and entertain.” from the report
Sustained improvement
The home had addressed the problems found at the previous inspection. Inspectors found the improvements were maintained and embedded.
“Improvements made following the last inspection had been sustained and embedded.” from the report
Creams were not recorded
needs fixingStaff had not recorded when prescribed creams were applied. After the inspection, the manager said a new medicines chart with guidance for creams was being introduced.
“We found that the application of prescribed creams was not documented by staff.” from the report
Pureed food presentation
minorInspectors asked the management team to improve how pureed meals were presented so they looked more appetising.
“We fed back to the management team that the pureed meals could be presented in a more appetising way.” from the report
Consent records needed clarification
needs fixingInspectors asked the management team to make clear whether a relative was giving legal consent or was simply involved in care planning.
“We spoke to the management team about ensuring where a relative signed a consent form, they had legal authorisation to do so” from the report
- 01How do you now record and check the application of prescribed creams?
- 02What changes have been made to the presentation of pureed meals?
- 03How do you confirm that a relative has legal authority to give consent?
- 04How are my relative's interests used to plan activities and review their care?
- 05How will you tell families if a person's risks, medicines or care needs change?
This was an unannounced planned inspection based on the previous rating and covered all five CQC questions. This explanation was written from the published report of 20 July 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, July 2018
Rated Requires Improvement; inspectors found kind care and good health support, but serious shortfalls in safety, care planning, consent and activities.
This was an unannounced inspection on 10 May 2018. Inspectors spoke with people, relatives, staff and managers. They observed care and looked at care files, risk assessments, medicines records, staff files, rotas, complaints and quality checks.
The home was caring in its day-to-day interactions. People were treated with dignity and respect, staff received training and supervision, and people had access to health professionals. However, some people did not feel involved in their care, and their emotional and social needs were not always met.
Inspectors found unsafe medicines practices, poor infection control in some areas, missing risk information and incomplete consent records. Care plans were not always personal or up to date. The provider's checks had not found or fixed all these problems.
The overall rating remains Requires Improvement, as it was at the previous inspection in February 2017. Earlier concerns about Deprivation of Liberty Safeguards oversight and confidential information storage had been addressed, but new breaches were found in other areas.
Kind and respectful staff
People and relatives said staff were kind and caring. Inspectors observed respectful communication, privacy and dignity during care.
“We observed staff interact with people in a kind and caring manner.” from the report
Health support
People had regular access to health and medical services. Records of visits and advice from health professionals were clear and well maintained.
“This meant that access to a variety of health care services was well documented.” from the report
Staff support and training
Staff received regular training, supervision and appraisals, and told inspectors they felt supported.
“We were satisfied that staff received appropriate support and training to deliver effective care.” from the report
Recruitment and emergency planning
The home used appropriate recruitment checks and had emergency evacuation plans for people.
“Personal Emergency Evacuation Plans were present in all files and were clear, detailing any equipment required and the level of staff support that would be needed in the event of a fire evacuation.” from the report
Previous concerns addressed
The earlier problems with oversight of Deprivation of Liberty Safeguards and confidential information storage had been resolved by this inspection.
“At this inspection, we found that these concerns had been addressed.” from the report
Medicines were not always managed safely
seriousThere were discrepancies between medicine stock and records. Guidance and recording for some as-required medicines were incomplete, and a medicines cabinet was left unlocked and unattended during two medicine rounds.
“We found two instances of a discrepancy with the stock of one medicine against what had been signed for as administered.” from the report
Infection control and cleanliness
seriousInspectors found faecal matter, overflowing bins, clinical waste on the floor, wet laundry and a soiled mattress. These conditions created a risk of infection.
“In one bathroom we found faecal matter on the floor.” from the report
Consent records were missing
seriousFive care files did not show appropriate consent. Where people may not have had capacity, there were no recorded capacity assessments or best-interest decisions.
“In five of the care files we looked at, we found that consent to care had not been appropriately obtained.” from the report
Limited activities and community access
needs fixingSeveral people described boredom and a lack of meaningful activities or trips into the community. Activities were recorded, but they were not always based on people's individual interests.
“People were not supported to engage in meaningful activities to meet their social or emotional needs.” from the report
Quality checks did not find problems
needs fixingThe home had audits and feedback systems, but these had not identified or corrected the shortfalls found by inspectors.
“Governance processes and audits were not consistently effective as they had not identified the concerns and service shortfalls that we found.” from the report
- 01What evidence can you show that medicines, including as-required medicines, are now checked and recorded safely?
- 02How are risks such as diabetes, mental health needs and catheter-related infections assessed and explained to staff?
- 03How do you record people's consent, mental capacity assessments and best-interest decisions?
- 04How are residents involved in writing and reviewing their care plans?
- 05What regular activities and community trips are now available, and how are they matched to each person's interests?
This was an unannounced inspection covering all five key questions and the overall quality of the home, including care, premises and management systems. This explanation was written from the published report of 7 July 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.
Every inspection of Limes Residential Care Home
3 rated inspections over 2 years: the service has improved, from Requires improvement to Good.
- July 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2017Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2016
Registered with the Care Quality Commission on 24 May 2016.
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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