We rated The Limes as REQUIRES IMPROVEMENT because:

• Staff were not up to date with mandatory training and managers did not have clear oversight of this.
• We found several omissions in the cleaning and temperature of the clinic room and equipment and staff did not accurately adhere to national guidance for medicines management.
• Patient care and treatment files were disorganised and contained several assessments and care plans that were out of date. Care plans and mental capacity assessments varied in quality and detail.
• The hospital did not provide clinical and managerial supervision to staff as often as outlined in the provider’s supervision policy and this impacted on the hospital’s recording and auditing of supervision.
• Staff did not complete patient observations in line with the provider’s policy guidance.
• The hospital did not effectively use nationally recognised tools to monitor patients’ physical wellbeing.
• The hospital did not consistently use audits effectively to identify and learn from mistakes and make changes to processes.
• Some patients and their relatives/carers told us staff did not always engage with patients when completing their observations.
• There was no designated space for patients to meet with visitors.
• Staff were not aware of the provider’s vision and values.
• Staff did not consistently review and record emergency equipment, in line with their policy.
• Staff did not consistently record they had reviewed patient’s daily risk assessments, as outlined in their local procedures.

However:

• The hospital was well staffed and rarely used agency staff to cover short falls.
• We observed positive and friendly interactions between staff and patients.
• Staff provided a comprehensive programme of individual therapeutic activities to help patients achieve their recovery goals.
• The multidisciplinary team completed a robust assessment and regular review of risk for each patient and developed individualised plans to manage these.
• Staff worked hard to reduce restrictive practices wherever possible to support patients’ rehabilitation.
• The hospital welcomed patients of different cultures, languages, religions, sexualities and staff had embedded equality and diversity into the everyday running of the hospital.
• Staff were well supported by the hospital manager and staff told us they had been supported by the provider during the transfer process.