CQC report explained · a residential care home
What the CQC found at The Limes
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments were missing for people at risk of significant harm. Medicines records contained gaps and errors, and there were shortfalls in food temperature records, infection control and cleaning records.
- Effective?
- Requires improvement
- The home had not always followed the Mental Capacity Act, including failing to apply for a required Deprivation of Liberty Safeguards authorisation. People's needs were not always fully assessed, and people were not consistently involved in care planning or meal choices.
- Caring?
- Good
- This question was not included in the focused inspection and no rating was given.
- Responsive?
- Good
- This question was not included in the focused inspection and no rating was given.
- Well-led?
- Requires improvement
- Quality checks, medicine audits, care plan reviews and incident reviews were not reliable. The provider did not regularly seek feedback from people or relatives.
What inspectors found, October 2022
Rated Requires Improvement; inspectors found serious gaps in risk management, medicines, consent and quality checks, despite kind care from staff who knew people well.
This was an unannounced focused inspection on 13 September 2022. One inspector spoke with one person, one relative and four staff, and reviewed care, medicine, staff and management records. The inspection followed concerns about how risks and people's legal rights were being managed.
The home was not always safe or effective. Risk assessments and care plans were missing or out of date. Medicines records had gaps and errors. Required mental capacity assessments and a Deprivation of Liberty Safeguards application had not been completed. Inspectors also found that people were not always involved in care planning, meals or decisions about their support.
There were positive findings. Staff were kind, knew people well, had safeguarding training and were able to meet people's needs. However, management checks did not reliably identify problems or learn from incidents. The overall rating was Requires Improvement. Safe and Effective changed from Good at the last inspection, while Well-led remained Requires Improvement.
Kind support
People received kind and compassionate support. Staff treated people with dignity, privacy and respect.
“People received kind and compassionate support. Staff were appropriately trained and had completed training in understanding autism.” from the report
Staff knew people well
A core team of staff understood people's needs and how they liked to be supported. There were enough trained staff to meet people's needs.
“However, people were supported by a core team of staff who knew their needs well and how they liked to be supported.” from the report
Safeguarding awareness
Staff had safeguarding training and could explain how they would report concerns about abuse or preventable harm.
“Staff were able to explain how they would report any concerns to protect people from preventable harm and abuse.” from the report
Access to specialist support
People could access specialist health and social care support in the community. The provider helped one person attend important specialist appointments.
“A person was supported to access specialist services. The provider ensured that a person could attend vital appointments by driving them there.” from the report
Risks were not properly assessed
seriousRisk assessments were missing for people at risk of serious harm. Staff knew about some risks but did not have written guidance on how to manage them safely.
“Risk assessments were not carried out for people who were at risk of significant harm.” from the report
Medicines records were unreliable
seriousSome medicines were not dated when opened, and medicine administration records had gaps and incorrect dates. Inspectors could not be sure people always received their medicines as prescribed.
“We could not be assured people were always receiving their prescribed medicines.” from the report
Legal safeguards were not followed
seriousA required Deprivation of Liberty Safeguards application had not been made. Mental capacity assessments were also missing, so people may not have been supported lawfully or in the least restrictive way.
“This meant the person was being unlawfully deprived of their liberty.” from the report
Management checks missed problems
seriousMedicine audits, quality checks, care plan reviews and incident reviews were not consistent. The provider did not reliably identify problems or learn from them.
“The provider had failed to monitor and improve the quality of the service.” from the report
People had limited involvement
needs fixingThere were no regular meetings for people using the home, and feedback was not requested from people, relatives or professionals. People were not involved in planning meals.
“Feedback was not requested from people, relatives or other professionals.” from the report
- 01What risk assessments are now in place for people who may be at risk of serious harm, and how are staff guided by them?
- 02How are medicines checked now, including medicine administration records, opening dates and audits?
- 03How do you make sure mental capacity assessments and Deprivation of Liberty Safeguards applications are completed when required?
- 04How are care plans kept accurate, current and based on each person's wishes and needs?
- 05How do people and relatives now give feedback and take part in decisions about the home?
This was a focused inspection of Safe, Effective and Well-led, following a targeted inspection, so Caring and Responsive were not rated in this report. This explanation was written from the published report of 22 October 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, August 2019
Overall rated Good; inspectors found safe, kind and personalised care, but the home’s leadership and quality checks Requires Improvement.
Inspectors made an unannounced visit on 30 July 2019. They spoke with two people, three staff members, one professional and two relatives. They also reviewed care plans, medicines records, staff files, training information and management records.
The home was rated Good for Safe, Effective, Caring and Responsive. People were protected from abuse, received their medicines safely, had suitable care plans and were supported to make choices, keep relationships and access activities and health services.
The Well-led rating was Requires Improvement. The provider had not completed enough formal audits. Some checks were not recorded, including medicine stock levels and infection control checks. The overall rating remained Good, but this shows that management systems were not consistently strong.
Safe care
People were protected from abuse and risks were assessed and reviewed. Staff had the checks and training needed to support people safely.
“People were protected from the risk of abuse.” from the report
Personalised support
Care plans described people's needs and wishes in detail. Staff used this information to provide care in the way each person wanted.
“Care plans were person centred and detailed about people's needs and wishes which meant that staff provided care in the way that people wanted it.” from the report
Kind relationships
Inspectors saw positive relationships between people and staff. People were treated with respect and their dignity and privacy were maintained.
“People had established positive relationships with the staff.” from the report
Choice and independence
People were encouraged to make daily choices, develop new skills and become more independent. They could take part in activities and access the local community.
“People were supported with many opportunities for them to gain new skills and become more independent.” from the report
Quality checks were incomplete
needs fixingThe provider had not established enough formal audits to identify and track improvements. Medicine checks and provider meetings were not always formally recorded.
“The provider had not established a range of audits to reflect on the quality of care and when improvements were required.” from the report
Infection control checks
needs fixingThere was no infection control audit. Inspectors also noted that the toilet did not have a paper towel dispenser and that bins were not foot-operated.
“There was no infection control audit to consider how this impacted on the environment.” from the report
- 01What formal audits are now completed for medicines, infection control and other areas of care?
- 02How do you record medicine stock levels and check that they match people's prescriptions?
- 03What changes have been made to the toilet paper towel dispenser and the bins?
- 04How are management meetings and improvement actions recorded and followed up?
- 05How will you support my relative's choices, communication needs, activities and independence?
This was a planned inspection covering all five CQC questions, the care provided and the premises; the previous rating was Good, published on 24 March 2017. This explanation was written from the published report of 22 August 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 The Limes
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- October 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2019Goodstayed GoodSafe: GoodEffective: GoodWell-led: Requires improvement
- March 2017Goodstayed GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- September 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- October 2014
Registered with the Care Quality Commission on 6 October 2014.
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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