We carried out an unannounced comprehensive inspection of this service on the 17, 18 and 23 July 2018. At that inspection we found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches related to the lack of person-centred care, dignity and respect, the environment and staff training and development. We also issued a warning notice with regards to a continuing breach to demonstrate good governance systems were in place to improve and develop the service. The service was given an overall rating of ‘Requires Improvement’. These areas will be reviewed at our next comprehensive inspection.

Due to recent concerns raised with us in relation to the safe care and treatment of people living at the home we undertook a focused inspection on the 12 December 2018 to look into areas linked to the concerns. Concerns included, the lack of access to care records and healthcare support, the availability of medicines particularly at night, the security of the building, management of infections, staffing arrangements and areas of health and safety. These concerns have also been shared with the Bury local authority and are subject to further investigation.

This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Limefield Court on our website at www.cqc.org.uk.

At our inspection in July 2018 a new manager had been appointed however they did not register with the Care Quality Commission (CQC). At this inspection we were told that the manager was no longer in employment and a further appointment had been made. This person was due to start employment following the inspection. We discussed with the directors the importance of having a registered manager in place and that this should be actioned without further delay. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Limefield Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Limefield Court is a two-storey property that is situated off a main road on the outskirts of Bury town centre. There is a car park at the front of the home. The home is registered to provide accommodation and personal care for up to 32 people. At the time of our inspection there were 23 people living at the home.

During this inspection we identified two further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. We have also made a recommendation about the safe use of the stairs.

Stable management and oversight of the service, along with sustained quality improvement systems will help to enhance the service and experiences of people who live at Limefield Court.

The homes ‘Statement of Purpose’ must be reviewed and updated to reflect the range of people’s needs that can be safely and effectively met by suitably trained staff at the home.

Risk assessments needed to be expanded upon to reflect the action taken to minimise risks to people, particularly in relation to falls.

Checks were to be made to ensure people had access to sufficient clothing and bedding so that their dignity and comfort was maintained. Appropriate arrangements should be made through a ‘best interest’ discussion with relevant parties so the appropriate arrangements can be made. This will be reviewed again at our next inspection.

Systems were in place

This inspection was unannounced and took place on the 17, 18 and 23 July 2018.

We last carried out a comprehensive inspection of this service on 28 September 2017. At that inspection we found three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009. This was because premises were not clean or maintained properly, records of care were not accurate or updated when people's needs changed, systems to monitor the quality of the service were not robust enough and the service had failed to make the required notifications to CQC A recommendation was also made with regards to the development of an activity programme. The service was given an overall rating of ‘Requires Improvement’.

Following the inspection, we required the provider to complete an improvement action plan to show how they would improve the key questions; safe, responsive and well led to at least good.

Prior to this inspection we had been made aware of a number of concerns about the safe care and treatment of people living at Limefield. These matters were subject to investigation by the local authority. Due to the concerns the local authority was not making placements at the home.

At this inspection we looked to see if the required improvements had been made. We found two repeated breaches in relation to the hygiene standards and good governance. A further two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were also identified. These relate to staff training and development and activities and opportunities made available to people. We have also made a recommendation in relation to a dementia friendly environment. You can see what action we told the provider to take at the back of the full version of the report.

Limefield Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Limefield Court is a two-storey property that is situated off a main road on the outskirts of Bury town centre. There is a car park at the front of the home. The home is registered to provide accommodation and personal care for up to 32 people. At the time of our inspection there were 20 people living at the home.

The service did not have a registered manager in post. A new manager had been appointed prior to the inspection however they had yet to complete their registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Whilst systems were in place to gather information about the service, we again found these were not sufficiently robust nor had findings been used to inform and develop a business improvement plan so that the quality and experiences of people were improved.

Further improvements were still needed to minimise the risk of cross infection and address the offensive odour found in several areas of the home.

Staff had not received all the necessary training and support essential to their role so that the current and changing needs of people could be met in a safe and consistent way.

Activities and social opportunities were needed to help encourage and promote the experiences of those people less able or living with dementia.

Work was required to improve and enhance the environment. We have recommended the provider refers to good practice guidance to help people maintain their independence and encourage movement around the home.

People told us they were not happy with the quality of meals p

Limefield Court Retirement Home is a large detached property in its own grounds, on the outskirts of Bury. Accommodation is provided over two floors. The service provides accommodation and personal care for up to 32 older people, some of whom are living with dementia. At the time of our inspection there were 21 people living at the home.

This was an unannounced inspection which took place on the 7 and 12 September 2017. The inspection was undertaken by two adult social care inspectors and an expert by experience.

The service was last inspected in July 2016; the service was given an overall rating of Good. However we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. That was because staff did not receive appropriate support, training, professional development, supervision and appraisal to enable them to carry out the duties effectively. Also the provider was not working within the principles of the Mental Capacity Act 2005 (MCA). This resulted in us making two requirement actions. Following the inspection in July 2016 the provider wrote to us to tell us the action they intended to take to ensure the regulations were met.

At this inspection we found that improvements had been made and the requirement actions had been met. However during this inspection, we found three further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009. This was because premises were not clean or maintained properly, records of care were not accurate or updated when people’s needs changed, systems to monitor the quality of the service were not robust enough and the service had failed to make the required notifications to CQC.

You can see what action we have told the provider to take at the back of the full version of the report.

We also made two recommendations about activities on offer at the home and ensuring people were awrae how to provide feedback on the servcie and any improvementss that they think should be made.

On the first day of our inspection we found that there was a strong smell of urine in the corridors, several areas of the home were not clean and some communal areas of the home, including a shower area had not been maintained properly. On the second day of our inspection we saw that all these issues had been addressed.

People’s needs were assessed before they started to live at the home. Care records were detailed and contained risk assessments and care plans to guide staff on how to provide the support people needed. We found one of the records was not accurate and another had not been updated when the person’s needs had changed.

Systems were in place to monitor the quality of the service, but they were not robust enough and had not highlighted incomplete records and issues with cleanliness and maintenance in some areas of the building.

The service had not notified CQC of all events they are required to. They had notified CQC of safeguarding concerns, serious incidents and events but had not notified CQC when DoLS applications were authorised.

There was a limited programme of activities and social events on offer to reduce people’s social isolation. We have made a recommendation that the provider explores current good practice guidance on suitable activities for people living with dementia.

There was a system in place to record complaints and the service’s responses to them. We saw there was a system for gathering people’s views about the service. We have made a recommendation that the provider ensures people who use the service and their families are aware of how they can provide feedback on the service and suggest improvements.

People told us they felt safe living at Limefield Court Retirement Home. Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them. Staff were confident any issues th

This inspection took place on 4 July 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

Limefield Court Retirement Home was last inspected by CQC on 12 February 2014 and was compliant with the regulations in force at that time.

Limefield Court Retirement Home provides care and accommodation for up to 32 elderly people. Nursing care is not provided at this location. On the day of our inspection there were 15 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Accidents and incidents were appropriately recorded and risk assessments were in place for people who used the service and staff, and described potential risks and the safeguards in place.

Appropriate health and safety checks had been carried out and the home was clean, spacious and suitable for the people who used the service. Medicines were stored safely and securely and procedures were in place to ensure people received medicines as prescribed.

Staff did not receive appropriate support, training, professional development, supervision and appraisal as was necessary to enable them to carry out the duties they were employed to perform.

The provider was not working within the principles of the Mental Capacity Act 2005 (MCA).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service were complimentary about the standard of care at Limefield Court Retirement Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into Limefield Court Retirement Home and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

People did not have any complaints about the service but were aware of how to make a complaint.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service and staff were regularly consulted about the quality of the service. People told us the management were approachable and understanding.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

On the last inspection of 27 November 2013 we found issues of concerns in relation to the lack of support and training for staff, inadequate monitoring of the service and facilities provided, and poor record keeping.

During this inspection we found that improvements in all areas had been made. We found that arrangements were in place to ensure that people using the service were cared for by staff that were properly trained, supported and supervised.

We spoke with two people using the service and with a relative. The people using the service told us they were happy with the care provided. One comment was, “Yes, I am fine and they are lovely”. The relative told us, “I wouldn’t want (my relative) to be anywhere else. Things are fine here”.

We saw that the services and facilities provided were regularly monitored. This helps to protect people against the risk of inappropriate or unsafe care.

An inspection of two people's care records showed they contained enough information to enable staff to safely care and support them. The records were kept secure but remained accessible to care staff.

During our inspection we spoke with two people who lived at Limefield Court, the relative of one person and visiting healthcare professionals. We asked about their experience of living and when visiting the home.

People told us; “The staff are very nice, friendly”, “It’s a nice place to be” and “I’ve been here a while”. The relative of one person said; “The staff care for my relative” and “We’re always made welcome”. We were told that staff considered people’s privacy and dignity when offering support.

Staff worked closely with other agencies so that people’s health and physical needs were effectively met.

Adequate numbers of staff were available to meet the needs of people.

Arrangements for staff training and development needed to be improved so that staff were adequately supported and had the knowledge and skills to support people safely.

The home has been without a registered manager for some time. A new manager has now been appointed and was to commence the week following our inspection. This will help to ensure that staff are provided with clear leadership and support in carrying out their duties.

Systems to monitor and review all areas of the service would benefit from being expanded upon so that improvements are identified across the service.

We looked at the individual care records for people. Whilst information had been regularly reviewed, care plans and risk assessment did not fully reflect the individual needs of people nor clearly direct staff in the safe delivery of care.

People were very complimentary about the staff and about the care provided.

Some of the comments were:

“The staff are very pleasant and work well together”.

“My relative is always clean, well dressed and well cared for”.

“No complaints, very happy”.

During our inspection we spoke with some people living at Limefield Court Retirement Home and some visitors. People told us they were happy with the care provided and staff asked for their consent before carrying out personal care. People also said they had a choice of food that they liked at mealtimes. People commented “I don’t think I could get anywhere better than this” and “The food isn’t bad at all. There’s plenty of choice”.

We saw that risk assessments had been completed for people and where an increased risk was identified a care plan had been put in place. These were usually reviewed monthly. Staff told us they found the care plans easy to follow so they always knew what care and support was required. The provider also completed a mental capacity assessment to assess if people had the capacity to make their own decisions.

An effective complaints procedure was in place and people knew what they should do and who they should tell if they had any complaint or comment to make.

A robust recruitment process had been followed for all staff whose records we saw, and the provider ensured they had references, evidence of identity and a satisfactory Criminal Record Bureau (CRB) check in place before a staff member started work.

The home was spacious and regular checks were carried out to ensure it was safe for people living there.