CQC report explained · a nursing 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
- Medicines were not always recorded or stored safely. Infection control was inconsistent, and the suitability of one agency worker had not been checked.
- Effective?
- Requires improvement
- This question was not inspected during this focused visit. Its previous rating was carried forward.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was carried forward.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its previous rating was carried forward.
- Well-led?
- Requires improvement
- Quality checks did not reliably identify problems or ensure guidance and policies were followed. People, relatives and staff gave positive feedback about the management.
What inspectors found, October 2021
Rated Requires Improvement; inspectors found problems with medicines, infection control, agency staff checks and quality monitoring.
This was an unannounced focused inspection in November 2020. Inspectors looked only at Safe and Well-led because the inspection followed concerns about infection control, health risks and management. They spoke with people, relatives, staff and managers, and checked care, medicine, recruitment and cleaning records.
The home was not always safe. Medicine records and storage needed improvement. Infection control measures were not always followed, including staff working across different areas and an unclean staff room. One agency worker had not had their suitability or competence checked before working in the home.
The home's checks were not strong enough to find and fix problems. Some incidents were not reported to the CQC when they should have been. The home received Requires Improvement for Safe and Well-led, and the overall rating remained Requires Improvement.
Protective equipment
Staff were observed wearing the correct protective equipment, which they changed regularly. There was spare equipment available and staff had training in its use.
“Staff consistently wore the correct Personal Protective Equipment (PPE).” from the report
Risk assessments
Assessments covered needs such as weight loss, skin condition and mobility. Staff understood people's needs.
“Risk assessments were in place in relation to people's needs, such as weight loss, skin integrity and their mobility.” from the report
Permanent staff checks
Permanent staff had checks before starting work, including employment history, references, identity and criminal record checks.
“This included asking for staff members employment history, references, verifying their identity and criminal record checks.” from the report
Open management
Relatives and staff spoke positively about the management and said managers were approachable and helpful.
“Relatives and staff felt positive about the management of the home.” from the report
Working with other services
The home worked with the local authority, health services and the local GP. It accepted support and acted on suggestions from other professionals.
“The provider and registered manager had worked in partnership with the local authority and health services.” from the report
Medicine records and storage
seriousSome medicine records had missing signatures or did not match stock levels. Guidance for medicines given when needed was missing, and fridge temperatures and storage times were not managed safely.
“Staff did not always accurately complete Medicines Administration Records (MAR).” from the report
Infection control
seriousCOVID-19 safety measures were not applied consistently. Staff moved between floors, some staff shared facilities across areas, and the staff room was unclean.
“People were not always protected from cross contamination.” from the report
Weak quality checks
needs fixingAudits did not find problems with medicines, cleaning, staff training or infection control. Policies and government guidance were not always followed.
“Overall quality assurance systems had failed to ensure guidance was followed and that systems were effective at identifying areas for improvement.” from the report
Incidents not reported
seriousSome incidents were not notified to the CQC as required. One incident was also reported late to the local safeguarding authority.
“Notifiable incidents were not always sent to the CQC as required.” from the report
Mixed staffing feedback
needs fixingInspectors observed that people did not have to wait for support, but feedback about staffing levels was mixed. One relative also reported difficulty getting through by telephone.
“Therefore, staffing levels were not always consistent.” from the report
- 01What changes have been made to medicine records, PRN guidance, fridge temperature checks and medicine labelling?
- 02How do you now check the suitability and competence of every agency worker before they start?
- 03How are staff prevented from moving between different areas of the home, and how is the staff room kept clean?
- 04How do your audits now identify missing MAR signatures, unsafe medicine storage and cleaning problems?
- 05How do you make sure all incidents that must be reported are sent to the CQC and safeguarding authority on time?
This was a focused inspection of Safe and Well-led only; ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 28 October 2021 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, April 2020
Requires Improvement; inspectors found kind and mostly safe care, but serious gaps in consent, mental capacity records and management oversight.
This was an unannounced inspection over two days. Inspectors spoke with people, a relative, managers and staff. They reviewed 16 care records, medicines, complaints, incidents, recruitment, training and audits. They also observed care where people could not explain their experiences.
The home was rated Good for Safe, Caring and Responsive. Inspectors found risks were assessed, staff were usually kind and respectful, and people's care, communication and activities were personalised. Medicines records were accurate, but two medicine trolleys were left unlocked and unattended during a medicines round.
The home was rated Requires Improvement for Effective and Well-led. Mental capacity assessments and best-interest decisions were incomplete, and staff did not always understand the rules about consent and restrictions on liberty. The quality checks had not found these problems.
The overall rating was Requires Improvement. This was the same as at the previous inspection, although Safe improved from Requires Improvement to Good. Effective fell from Good to Requires Improvement, while Caring and Responsive stayed Good and Well-led stayed Requires Improvement.
Risk management
Inspectors found that identified risks were assessed, managed safely and reviewed regularly. Staff used safe moving and handling techniques.
“Risk assessment documentation provided guidance to staff and showed the actions taken to manage and reduce risks to people.” from the report
Kind and respectful care
People and relatives said staff were caring and approachable. Staff knocked before entering rooms, offered choices and carried out personal care privately.
“All personal care was carried out behind closed doors to maintain people's privacy and dignity.” from the report
Personalised support
Care plans recorded people's preferences, needs, interests and communication methods. Staff adapted information so people with additional needs could understand it.
“The provider had ensured people received information related to the service and their support in a format they could understand.” from the report
Activities and social contact
People could choose whether to join activities, including quizzes, bingo, group events and individual activities. Inspectors saw people enjoying an organised event.
“People had access to individualised and group activities and received the necessary support to follow their interests.” from the report
Links with health professionals
The home worked with GPs and specialist teams. Records showed that professionals shared information about people's changing health needs.
“The provider worked in partnership with GPs and specialist teams to make sure care and treatment met people's needs.” from the report
Consent and mental capacity
seriousSome people's capacity assessments and best-interest decisions were missing or unclear. This meant staff might support people inconsistently or without the required legal decision-making records.
“The principles of the MCA were not consistently followed to ensure people were supported to make decisions about their care.” from the report
Staff understanding of restrictions
seriousSome staff could not explain which people were subject to Deprivation of Liberty Safeguards or how this restricted their liberty. The registered manager also said they did not have a clear understanding of the Mental Capacity Act.
“Staff did not always know which people were subject to DoLS and how this would restrict their liberty.” from the report
Management checks
needs fixingThe home's quality assurance system had not identified the missing capacity assessments and best-interest decisions. Staff training did not ensure everyone understood mental capacity.
“The provider's quality assurance system had failed to identify that people's mental capacity assessments were incomplete or there were best interest decisions to support staff when providing care for people.” from the report
Medicine trolley security
needs fixingTwo medicine trolleys were left unattended and unlocked while containing people's prescribed medicines. Inspectors found a risk that medicines could be taken by the wrong person.
“There were risks people's prescribed medicines could have been taken by people who they were not prescribed to.” from the report
- 01Have all outstanding mental capacity assessments and best-interest decisions now been completed, and how are they kept up to date?
- 02How do you check that staff understand the Mental Capacity Act and know which people are subject to Deprivation of Liberty Safeguards?
- 03What has changed to make sure medicine trolleys cannot be left unattended and unlocked?
- 04What actions are included in your improvement plan, and how will you show that they have been completed?
- 05How are people's care files checked to make sure they clearly explain their current needs and level of capacity?
This was an unannounced inspection of the care home, covering the premises and care provided and all five CQC questions. This explanation was written from the published report of 18 April 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.
Every inspection of The Limes
5 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- October 2021Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2020Requires improvementstayed Requires improvementSafe: GoodWell-led: Requires improvement
- March 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- October 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 14 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.
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