CQC report explained · a nursing home
What the CQC found at Limetree Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe medicines practices, suitable risk assessments, safeguarding systems and infection control procedures. They found no evidence that people were at risk of harm from the concern that led to the inspection.
- Effective?
- Requires improvement
- This area was not inspected during this focused visit. The previous rating was used when calculating the overall rating.
- Caring?
- Good
- This area was not inspected during this focused visit. The previous rating was used when calculating the overall rating.
- Responsive?
- Good
- Care plans reflected people's needs, wishes and communication preferences. People were supported with activities, relationships, complaints and end-of-life care, although some people said they were sometimes bored.
- Well-led?
- Good
- Managers used audits, risk meetings and action plans to monitor quality and learn from incidents. Inspectors found improvements in leadership and oversight since the previous inspection.
What inspectors found, December 2020
Limetree Care Home was rated Good; inspectors found safer staffing and better care planning after a previous Requires Improvement rating.
Inspectors visited on 15 December 2020 after concerns about nursing care and safety. They spoke with people living in the home, staff, relatives and a healthcare professional. They also checked care plans, medicines records, staff files, rotas, policies and audits.
The home was found to have enough staff and no longer relied on temporary agency staff. Inspectors found medicines were given as prescribed, risks were managed, infection control procedures were followed and safeguarding concerns were handled properly.
Care plans were personalised. People were supported with activities, communication, family contact and end-of-life wishes. Complaints were investigated. Managers used audits, meetings and action plans to monitor and improve the service.
This was a focused inspection of Safe, Responsive and Well-led. These three areas were rated Good. Effective and Caring were not inspected at this visit, so their previous ratings were used in the overall rating. The overall rating improved from Requires Improvement, and the home was no longer in breach of regulations.
Staffing improved
The home had enough staff and had not used agency staff during the previous six months. Inspectors found staff were present and responded quickly to people's requests.
“The service was adequately staffed by people whose suitability and fitness to work in an adult social care setting had been thoroughly assessed.” from the report
Medicines were managed safely
Inspectors found medicines care plans, trained staff, secure storage and properly maintained medicines administration records.
“People received their medicines as prescribed with dedicated trained staff to manage stock control, ordering and safe storage of medicines.” from the report
Personalised care planning
Care plans included information about people's backgrounds, interests, communication needs and preferences. Staff showed they understood this information.
“Care plans were personalised and contained detailed information about people's social needs and wishes.” from the report
Quality monitoring
Managers used regular audits, clinical risk meetings and action plans to identify problems, learn from incidents and improve care.
“Audits were routinely analysed to identify issues, learn lessons and implement action plans to improve the service they provided people.” from the report
Some people felt bored
minorAlthough activities were available and most people were happy with them, inspectors recorded that some people sometimes felt bored. This was partly linked to activities and outings that had stopped during the pandemic.
“We received a couple of negative comments from people who expressed being sometimes "bored" living in the care home, but most people said they were happy with the social activities they could participate in if they chose to.” from the report
Few questionnaire responses
minorThe provider sent questionnaires to people, relatives and other stakeholders, but only two were returned. The report says concerns identified from the responses were acted on.
“The provider had sent out quality assurance questionnaires to 84 people, their relatives and stakeholders, of which two were returned.” from the report
- 01How have you maintained the improved staffing levels and avoided relying on agency staff since the inspection?
- 02How often are each person's care plan and risk assessments reviewed, and how are changes shared with staff and families?
- 03What activities are currently available for people who are sometimes bored or unable to join group activities?
- 04How are relatives kept updated about a person's wellbeing and any changes to their medicines?
- 05What were the previous ratings for Effective and Caring, and when will those areas next be fully inspected?
This was a focused inspection of Safe, Responsive and Well-led only; Effective and Caring were not inspected and their previous ratings carried over into the overall rating. This explanation was written from the published report of 25 December 2020 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 2019
Rated Requires Improvement; inspectors found kind care and better activities, but staffing, care records and management systems remained unsafe or inconsistent.
Inspectors visited unannounced on 6 August 2019. They spoke with people, relatives and staff, observed care, and checked care files, staffing records, medicines, training, maintenance and management documents.
People were generally treated kindly and supported with choices. Activities had improved significantly. Staff supported people with medicines, health appointments and daily care. However, people sometimes waited for care because there were not enough suitably trained staff on duty.
Inspectors found inconsistent care plans, risk assessments and care records. They also found cleanliness and laundry handling problems, slow meal service, limited end of life information, and management checks that had not led to lasting improvement.
The overall rating and all questions except Caring were Requires Improvement. The home had the same overall rating at the previous inspection, although some earlier problems had been resolved, including nutrition monitoring and the response to incidents.
Kind and respectful care
People and relatives said staff were kind. Inspectors saw staff offer choices, respect refusals and support people's dignity and independence.
“Staff treated people kindly in a way that valued and respected them as individuals.” from the report
Improved activities
The home offered group and individual activities across the week. Inspectors saw people engaging with activities and staff responding sensitively to individual needs.
“There had been significant improvements in the activities provided and people were supported with a range of different activities across the week.” from the report
Support with medicines
Trained staff supported people to take medicines as prescribed. Medicines were stored safely and stock checks were completed.
“Records showed trained staff supported people to take their medicines as prescribed.” from the report
Better incident response
The provider had improved how it reviewed incidents and shared learning with staff. Inspectors found that incidents were reported and followed up.
“There were systems in place to monitor and respond to incidents.” from the report
Not enough staff
seriousStaffing levels did not always meet people's assessed needs. Some people waited for support, particularly when staff trained to use equipment were unavailable.
“During the inspection we saw people had to wait to receive support as there were not enough staff who were trained to use their equipment on duty.” from the report
Inconsistent care records
seriousCare plans and risk assessments did not always contain clear, current information. Records did not always show that planned support, such as repositioning and nutrition monitoring, had taken place.
“There were inconsistencies in the effectiveness of risk assessments and measures in place to mitigate risks were not always clear.” from the report
Cleanliness and laundry handling
seriousInspectors found a strong smell, sticky surfaces, poor separation of soiled laundry and sluice rooms that were not always locked or well organised.
“The provider had identified issues with the cleanliness within the home which we found had not been fully addressed by the time of our inspection.” from the report
Limited end of life planning
needs fixingThe home was working on improvements, but assessments and care plans did not routinely record people's end of life wishes or how they wanted to be supported.
“Information about people's end of life preferences was not yet sufficient to ensure they were supported to have a dignified and pain free experience at the end of their lives.” from the report
Weak quality monitoring
seriousManagement audits had found several problems, but action plans had not brought lasting improvement. Maintenance records also did not show when jobs were completed.
“Despite an action plan being in place, these issues remained by the time of our inspection in August 2019.” from the report
- 01What staffing levels are now in place on each floor, and how do you ensure enough staff are available in the mornings?
- 02How do you make sure care plans and risk assessments are current, consistent and easy for staff to find?
- 03What action has been taken to improve cleanliness, laundry separation and the locking and organisation of sluice rooms?
- 04How are people's end of life wishes now recorded and kept up to date?
- 05How do you check that maintenance problems are completed and that action plans lead to lasting improvements?
This was an unannounced, planned inspection of the care home covering all five CQC questions, including care, staffing, premises and management systems. This explanation was written from the published report of 5 October 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.
Every inspection of Limetree Care Home
5 rated inspections over 6 years: the service has held its Good rating throughout.
- December 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- October 2019Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- October 2010
Registered with the Care Quality Commission on 1 October 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.
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