We visited The Limes to follow up on a warning notice we served on the provider in relation to safeguarding people who use services from abuse. This was due to us finding at our inspection on the 20 and 21 August 2013 that the service did not have suitable arrangements to ensure that people who use the service were safeguarded against the risk of abuse.

During this inspection we also checked if the provider was meeting essential standards where we had asked them to make improvements following the August 2013 inspection. These areas were in regard to having adequate systems to assess and monitor the quality of the service, and to ensure appropriate records were maintained relating to staff supervision and to demonstrate how risks to people who use the service were being managed.

As part of the inspection we spoke with six staff and the representative of one person who uses the service. We were unable to speak with most of the people who use the service as they had complex needs and were unable to share their experiences with us.

We found that improvements had been made to ensure that people were safeguarded against the risk of abuse. Improvements had also been made to assess and monitor the quality of the service and to ensure that records were fit for purpose.

People told us what it was like to live at The Limes. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people in hospitals were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of patients who could not talk to us.

The relatives we spoke with told us that the staff were “very caring towards people”, and that they “go out of their way” to ensure people’s dignity was maintained. They said they had not had any concerns about the service or the way people were cared for, but if they did they would raise this with the manager.

At the time of inspection there were nineteen people using the service. We spoke with six staff, two people using the service and two visitors. The registered manager was present at the time of inspection and was knowledgeable about the people and the services provided. The sector manager who had overall responsibility for the unit was not present at the time of inspection. We spoke with her following the inspection to gain some additional information about the service.

Patients and their visitors said that they were involved in decisions about their own or their relative’s treatment and care and they were satisfied with the care provided. They said they had opportunities to discuss and feedback how the services were provided. Patients told us that staff working in The Limes were kind, supportive and treated them as individuals. They told us the units were kept very clean and one commented ‘This place is so clean, I knew that this is where I wanted to be ‘.

We carried out this inspection because our last inspection on the 30 August 2012 showed that the provider was not complying with a Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because people who use the service were not protected from risk of abuse as the provider had not taken steps to ensure allegations of abuse were responded to appropriately.

We imposed a compliance action so that the provider would make improvements to safeguard people from abuse. The provider sent us an action plan stating they would achieve compliance by June 2013.

At this inspection of the service we found that the provider had not met the compliance action and had failed to ensure that risks to people were minimised. This is being followed up and we will report on any action when it is complete.

During our inspection we spoke with four members of staff as well as two student nurses. We also met with the sector manager, who is referred to as the manager in this report. On the second day the senior nurse manager was present during the inspection. We were unable to speak with most of the people using the service as they had complex needs and were unable to share their experiences with us.

We found that the systems for monitoring incidents that had occured at the service did not identify risks. Records relating audits were inaccurate and did not reflect what had occured in the service. Some staff records were also inaccurate.