The inspection took place on 12 June 2018 and was unannounced.

Limegrove is a home that provides accommodation and personal care to up to 55 adults. People living at the home had physical disabilities and long-term health conditions. Most people at the home were living with dementia. At the time of our inspection there were 52 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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. The registered manager was not present during our inspection and the service was being managed by an interim manager. The manager and the provider’s district manager assisted us with our inspection.

At our last inspection to this service in May 2017 we identified shortfalls in the governance of the service. This was due to a lack of registered manager and a lack of contemporaneous records held about people. We also made recommendations to the registered provider around staffing levels and medicines management. We used this inspection to check if these shortfalls had been addressed.

Providers should be meeting the standards set out in the regulations and display the characteristics of good care however, we identified some shortfalls within the service. People received the medicines they required, however we found some shortfalls with medicines management within the service. We have made a recommendation in this respect. Staff were aware of their responsibility to keep people safe and free from harm. However, there were inconsistencies in the records relating to people’s risks and staff was not always following guidance that was in place.

There had been a high number of falls at the service and the manager had started to address this by increasing the staffing levels. We did not see anyone having to wait for care on the day of our inspection.

People were supported by kind and caring staff. Staff communicated with people in a way that demonstrated understanding of their needs. People told us that staff were respectful and staff understood how to promote people’s privacy and dignity when providing care. People were supported to remain as independent as possible.

Appropriate checks were carried out when recruiting staff to ensure that they were suitable for their roles and the provider took steps to ensure that people were kept safe in the event of an emergency. People lived in an environment that was clean and hygienic and adapted to suit their needs.

Important information about people’s healthcare needs and medicines were recorded in their care plans. Staff worked alongside healthcare professionals to meet people’s health needs. Where any accidents, incidents or infections occurred, staff took appropriate action in response to them.

People’s needs were assessed before they moved into the service and these assessments formed the basis of a person’s care plan. People were provided with food that matched their preferences and ensured any dietary needs were met. Staff routinely offered people choices and involved them in their care. We found some missing evidence in relation to mental capacity assessments and best interests decisions in relation to the Mental Capacity Act (2005).

Staff received training appropriate to their roles and the provider’s values. Staff benefitted from supervision and appraisals. Although management responded to complaints received, the paperwork held in relation to complaints was not complete. We have made a recommendation to the registered provider in this respect.

Care plans included the relevant information about people and staff were knowledgeable about individuals and their likes and dislikes. No one was receiving end of life care at the time of our visit. However, there w

Limegrove provides accommodation, personal care and support for a maximum of 55 people, some of whom may be living with dementia. Accommodation is set over three floors. On the day of our inspection 50 people were living at Limegrove.

This was an unannounced inspection that took place on 4 May 2017.

The home did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run. The deputy manager assisted us with our inspection on the day.

We carried out this inspection to check the registered provider had taken action in relation to the concerns we identified at out inspection in March 2016. At that inspection we found breaches of regulation in relation to medicines, person-centred care, records and people not being shown respect by staff. Shortly after our inspection the registered manager left the service and since then the service has been without a consistent manager. The provider had implemented management support for the service which was overseen on a daily basis by the regional support manager, deputy manager and weekly visits by the district manager. We found at this inspection many of these areas we had identified had improved. This was mainly down to the hard work of staff and the newly appointed deputy manager. However, there was still further work to be done.

Although there had been a lot of work undertaken on reviewing people’s care records, this had not yet been completed and we found some people’s care records were not accurate or reflected people’s most current needs. We found records relating to medicines were not always completed as they should be. There was a lack of evidence that people were receiving their topical medicines (medicines in cream format) as they should because charts were not being completed.

Overall there was a sufficient number of staff on duty. However we have made a recommendation to the registered provider to review deployment of staff during break times.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. People and relatives were happy with the care provided and they were made to feel welcome when they visited. Staff supported people to take part in various activities although we have recommended the provider consider introducing more purposeful activities.

Where people had risks identified guidance was in place for staff to help reduce these risks, although some of these risks required updating as people’s health deteriorated. Staff were aware of their responsibilities to keep people safe and the registered provider carried out robust recruitment processes in order to help ensure only suitable staff worked at the home. Care was provided to people by staff who were trained and received relevant support from their manager.

The provider had good quality assurance process and checks were carried out by staff to help ensure the environment was a safe place for people to live and they received a good quality of care. Staff were involved in the running of the home as regular staff meetings were held. People were asked for their views about all aspects of their care and could make their own decisions.

Staff followed the principals in relation to the Mental Capacity Act 2005 and staff were heard to obtain people’s consent before they supported them. Where people had restrictions in place to keep them safe appropriate DoLS applications had been submitted.

People were provided with a choice of meals each day and those who had specialist dietary requirements received the appropriate food. Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, dietician or district nurse.

Complai

Limegrove provides care and accommodation for a maximum of 55 older people, some who may be living with dementia and or have physical health needs. The accommodation for people is provided in five units and spread across three floors. At the time of this inspection there were 51 people living at the home.

This was an unannounced inspection which took place on 22 March 2016.

During our inspection the registered manager was present. A registered manager is a person who has registered with the Care Quality Commission 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.

Safe medicines management procedures were not always followed by staff. Although risk assessments were in place for people, those suffering from particular medical conditions did not have risk assessments in relation to this. Care records held for people were not always completed fully and did not reflect their current level of needs.

Although staff knew people well and were able to describe to us people’s individual characteristics and routines, they did not always treat people in a thoughtful way. People may not always receive responsive care because staff did not always follow guidance included in care plans.

Although staff understood the Mental Capacity Act they had not always completed mental capacity assessments with people before making decisions on their behalf. However, where people did not have the capacity and were being restricted, staff had followed the legal requirements in relation to this.

People were cared for by a sufficient number of staff which meant they did not have to wait to be assisted. Staff understood their responsibility in relation to safeguarding people from abuse. When people had an accident this was recorded and accidents and incidents monitored to help prevent reoccurrence.

Staff had guidelines in place to help ensure people’s care and treatment continued with the least interruption possible, should the home have to be evacuated or an emergency stopped the service running.

Recruitment checks were completed to ensure permanent staff were safe and skilled to support people. Staff received an induction and on-going training to help ensure they were competent in their role. Staff supervision and appraisal took place in order to provide support to staff and they worked to best practice guidelines.

People had access to a range of meals as well as snacks throughout the day. People’s health was monitored and staff referred people to external health care professionals when needed.

People’s privacy was respected by staff and staff welcomed relatives into the home. There was a range of activities available to people which we observed people taking part in.

People were made aware of how to make a complaint should they feel the need to. People and their representatives were encouraged to give their feedback and feel involved in the running of the home.

Quality assurance checks were carried out in order to improve the service and actions identified were addressed by staff. Staff felt supported by the registered manager and were included in the running of the home through regular staff meetings.

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

All the people we spoke with were happy with the quality of care they received. One person told us, “We’re very well looked after.” Relatives spoke positively about the care their family members received. One relative said, “It was difficult for Mum to adapt at first but the staff supported her brilliantly and now she loves it here.”

We found that people’s nutritional needs were assessed when they moved into the home. Information about people’s nutritional needs was communicated to the chef and referrals were made to specialists where necessary. People said that the food at the home was good and that they had opportunities to give their views about the food.

We checked a sample of staff files and found that the provider carried out appropriate checks before staff began work. At our last inspection there were not enough staff on duty to meet people's needs. At this inspection we found that the provider had increased the staffing hours. Whilst this had improved people’s experience in terms of their care, people said that staff rarely had time to stop and talk with them.

People had opportunities to have their say about the service they received and the provider had systems in place to monitor the quality of service provision. The standard of record-keeping was generally good but we noted two issues that the provider may wish to note. Risk assessments relating to falls were not dated and two sections had not been completed in the majority of care plans we checked.

People who use the service said that they liked living there. They felt that the home was relaxed and friendly, and that the staff were caring and kind.

They said how they are consulted about how they want their care to be carried out. Someone said “I am slow, but the staff give me plenty of time”.

Another said “I would rather be at home but this is the next best thing”

There were good comments about the food and meals observed appeared appetising and nutritious.