What life is like for people using this service:

Since our last inspection the provider had failed to act to show a sufficient and sustained improvement in the service provided for people. There continued to be a lack of clear quality monitoring processes in place to provide the oversight required to improve the quality of care provided for people.

The lack of up to date clear robust information on people’s care needs impacted on the care they received. The risk assessment tools used to assess risks to people were not utilised effectively to provide guidance for staff on the care people should receive. People’s medicines were not always managed effectively.

There was a lack of analysis of incidents and accidents to look at trends and reduce risks.

People told us they were happy at the service, they felt safe and well cared for. They were treated with dignity and respect.

More information is in the detailed findings below. we identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and safe care and treatment. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the provider had not notified us of some events at the service.

Rating at last inspection:

The service was rated as Requires Improvement at the last two inspections (reports published September 2016 and November 2017).

About the service: The Limes care home is a residential care home that was providing personal care and accommodation for up to 40 people aged 65 and over. There were 16 people using the service at the time of the inspection.

Why we inspected: This was a planned inspection based on the rating at the last inspection. sufficient improvements had not been made since out last inspection which means the rating remains at requires improvement. This is the third consecutive time this service has been rated requires improvement.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

We carried out an unannounced inspection of the service on 14 September 2017

The Limes Care Home provides accommodation and care for up to 40 older people. There were 16 people receiving care at the time of our visit. The service was last inspected July 2016 and the rating for that inspection was Requires Improvement.

There was a manager registered with the Care Quality Commission (CQC). 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.

People were supported by staff that knew how to recognise when people were at risk of harm.

Assessments of the risks to people’s safety were in place and regularly reviewed, but themes and trends were not monitored or analysed.

There were enough experienced staff to keep people safe and to meet their needs. Safe recruitment processes were in place. However, no record was made during interviewing of staff to demonstrate interviews had taken place. People were protected from the risk associated with the management of medicines, but this was not always monitored robustly.

Staff did not receive sufficient training or regular supervision. The principles of the Mental Capacity Act 2005 (MCA) were considered when supporting people. People were supported and encouraged to follow a healthy and balanced diet. People’s day to day health needs were met effectively by the staff.

People and their families had a good relationship with the staff who cared for and supported them. People were treated with respect and dignity. People were involved with decisions made about their care and support. Information was available for people if they wished to speak with an independent advocate. People were supported to live as independently as possible.

People knew how to raise concerns or complaints and were encouraged to do so if needed. We could not tell if the service was following the provider’s procedures to ensure any complaints or concerns were dealt with in a timely manner, as there were none recorded.

People and staff spoke highly of the registered manager and the service provided. A number of systems were in place that enabled people, staff and relatives to give their views about the service. Robust quality assurance processes were not in place or consistently being applied. Some policies and procedures were out of date.

The provider had not displayed their rating prominently in the home.

We found breaches to the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced inspection of the service on 20 July 2016.

The Limes Care Home provides accommodation to older people. It is registered for a maximum of 40 people. There were 21 people receiving care and support at the home at the time of our visit.

On the day of our inspection there was a registered manager in place. 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.

People felt safe and the home offered a safe environment for people to live. People were supported by staff who understood how to protect and keep people safe. Appropriate processes were in place to support staff to report allegations of abuse if required. Risk assessments were in place to identify and reduce the risk to people’s safety. Sufficient numbers of staff were in place to keep people safe and the provider followed safe recruitment processes. Medicines were stored and handled safely.

People were supported by staff who had completed an induction and relevant training to help them carry out their role. Staff were knowledgeable about the people they cared for and how to best meet their needs.

People’s rights were protected under the Mental Capacity Act 2005. People were supported to have sufficient to eat and drink, but did not always have a good experience at lunch time. People received effective care relevant to their needs. They had access to relevant health care professionals to maintain their health and wellbeing.

People were cared for by kind and compassionate staff. Staff interacted with people in a caring and friendly manner. People were able to contribute to their care and support. People’s privacy and dignity was protected. Arrangements were in place to share information to support people with independent advocates if and when required.

Care plans were personalised to meet people’s relevant needs and what was important to them, but contained limited information. The staff did not always encouraged people to participate in activities that were available in the home. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were complimentary about the management team. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. The service was led by a registered manager who had a clear understanding of their role and how to improve the lives of people at the service.

People and their relatives told us that staff members obtained their consent before supporting them with care or treatment. Care records recorded which decisions people were able to make for themselves and which decisions they did not have the capacity to make.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if the person needed to be supported in this way. One person told us that their meal was, "Always nice".

Appropriate actions had been taken to make sure that people were safe from infection or to resolve infection prevention and control issues when they were identified.

Staff rotas and training information showed there were enough staff members and that training had not been kept up to date. People using the service said there were always enough staff available to meet their needs.

The service had a policy and procedure to guide people in how to make a complaint. No complaints had been made in the 12 months prior to this inspection.

During our visit we spoke with three care staff, the registered manager of the service and the activities worker. We spoke with five people who used the service.

People expressed their views and were involved in making decisions about their care and treatment. One person said, "They know my routines now and they always help me to do what I want to. Coming here was the best move I ever made."

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The people we spoke with who used the service said they were very comfortable at the home. One told us, "I've got all I need here." Another said, "Everything is as it should be here." We observed a senior care worker administering medication and saw that each person received what they needed and as it was prescribed by a doctor.

People who used the service described the staff as, "Marvellous" and "very good". We saw the staff worked together when helping people to move around the premises. We found there were enough qualified, skilled and experienced staff to meet people’s needs and no one had long to wait for assistance from staff.

The provider visited daily and questionnaires were used to help the manager and provider to regularly assess and monitor the quality of service that people received.

On the day of the visit to The Limes there were 38 people living at the care home.

During our visit to the Limes we spoke with three people who live at the care home. We were told that: “It’s very comfortable and the staff are very good.” “I have no complaints about my care what so ever.” “I think I am treated very well.” Throughout the visit we saw the staff speaking to people who live at The Limes in a helpful, friendly and respectful way. All three people told us that they had no complaints about the care that they received. All of the people spoke positively about the staff.

We asked people if they felt safe, and they told us that they did.

People told us they thought there were enough staff. Observations during our site visit did not raise any concerns about staffing levels.