The inspection took place on 14 and 15 June 2018 and was unannounced. At the last inspection of the service in October 2017 we rated the provider as Requires Improvement in all five of the key questions. At this inspection, we found that although improvements had been made, further work was required.

Lime Tree Court Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lime Tree Court accommodates 60 older people, who may have a diagnosis of Dementia in one adapted building. At the time of the inspection, there were 49 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

People were supported by staff who knew how to manage risks and report concerns to keep people safe. There were sufficient numbers of staff available to support people, infection control procedures were effective and medication was given in a safe way.

Although people’s rights were upheld in relation to Mental Capacity Act , further work was required to ensure that all best interest decisions were specific to the decision that required making and that all people who should be involved in decisions were consulted. People had sufficient amounts to eat and drink and had access to healthcare services where required. The design and decoration of the building met people’s needs.

People were supported by staff who were kind and caring. People were treated with dignity and respect and supported to maintain relationships with those closest to them. Advocacy services were available for people where required.

People were involved in the planning and review of their care and were supported by staff who knew them well. Activities required improvement to ensure that these were available when the activity co-ordinator was not present. Complaints made had been investigated and resolved.

Further work was required on records to ensure these were detailed and accurate. Audits in place to monitor the quality of the service had been effective in identifying areas for improvement. People were given opportunity to feedback on their experience of the service.

This inspection took place on 19 October 2017 and was an unannounced inspection. At the last inspection of the service in April 2016, the provider was rated as Good.

Lime Tree Court Residential Care Home provides accommodation and personal care for up to 60 older people. At the time of our inspection, there were 56 people living at the home.

There was a manager registered with us. 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. However we were informed prior to the inspection that the registered manager was no longer working at the location and that a new manager had been recruited. The new manager was present during this inspection.

People felt safe living at the home and were supported by staff who knew how to recognise and report any signs of abuse.Risks to people were assessed and managed to ensure risks were reduced where possible. Medication was administered safely and accurate records of medication given was kept. There were sufficient numbers of staff for people throughout the day although people reported longer waits for support during the night.

People were supported by staff who had received training and had the skills and knowledge required to support people effectively. There were effective communication systems in place to ensure that staff had the information they required to support people. The oversight and application of the Mental Capacity Act [MCA] and Deprivation of Liberties Safeguards [DoLS] was in need of review at the home. Staff understanding of DoLS was variable. Staff established consent from people before providing care. People had their dietary needs met and were supported during mealtimes as required. People had access to healthcare services when this was needed.

People felt that although staff were caring, they did not spend enough time with them in order to build a caring relationship. Staff ensured that people were treated with dignity and respect and that people’s independence was encouraged where possible. People had been encouraged to maintain relationships with people close to them and had access to advocacy services should they require this.

People’s care needs had been assessed prior to them moving into the home and these needs were reviewed regularly. People did not feel there were sufficient activities available to them to keep them occupied during the day. People knew how to make complaints and there was a system in place to ensure complaints made were investigated.

A new manager had been recruited and people reported that this has had a positive effect on the service. Audits had not been completed consistently and had not identified some of the issues we found during the inspection. Notifications about people who were subject to a Deprivation of liberty safeguard had not been sent to us as required by law. Feedback was gathered from people through resident, relative and staff meetings.

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.

Our inspection was unannounced and took place on 7 April 2016. Our last inspection of the service took place on 4 September 2014 and was complaint in all areas inspected.

Lime Tree Court Residential Care Home is registered to provide accommodation and personal care to a maximum of 60 older people who may have Dementia or sensory impairments. At the time of the inspection there were 60 people living at the home.

The home had 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.

People told us they felt safe at the home. Staff had an understanding of how to identify and report abuse and had a good understanding of how to manage risks to keep people safe.

We saw there were sufficient numbers of staff on duty to support people. We saw that staff had undergone checks prior to starting work to ensure they were suitable to care for people. Staff had appropriate training and support to enable them to meet people’s needs.

We saw that people were supported with their medication in a safe way. Staff had training before being able to handle medication and checks were completed in order to ensure people had received their medication as required.

People were supported to make their own decisions and had their rights upheld in line with the Mental Capacity Act 2005.

People were given choices at mealtimes and were supported to have enough food and drink. There was a system in place to ensure any changes to what people wanted to eat was reflected in the menu.

People’s health needs were met as they were supported to access a range of healthcare support when required.

Staff had a kind and caring approach and treated people with dignity and privacy. Staff supported people to maintain their independence where possible.

People and their relatives were involved in the assessment and review of their care. People were supported by staff who had a good knowledge of people’s needs.

People were supported to take part in activities that reflected their personal interests. Activities were adapted to suit people’s preferences.

People and their relatives were aware of how to make complaints. Complaints made had been investigated fully by the registered manager. People were supported to give feedback on the service via resident meetings and questionnaires.

The registered manager completed monthly audits to monitor the quality of the care provided.

We completed this inspection because we received information of concern about how people were supported and that there was insufficient staff working with people who used the service.

At the time of our inspection, 59 people were using the service. We spoke with eight people who used the service and two relatives during our visit. People told us they were happy with the care they received and shared no concerns with us.

We spoke with the registered manager and seven members of staff. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Prior to our inspection, we spoke with two social care professionals and reviewed information we held about the service.

The premises comprised of three floors where people lived and spent their time. We observed how people were supported on all three floors of the home and how staff spoke with people.

We looked at five people’s care records to see if they were accurate and up to date.

Below is a summary of what we found. The summary describes what we observed, the records we looked and what the staff told us.

Based on the information we received we asked if this service was safe?

Is the service safe?

We saw that systems were in place to manage and monitor how the staffing was provided to ensure people received the agreed level of support. The staff we spoke with told us there was generally enough staff on duty to meet people’s needs. People we spoke with told us that staff were always available and they never had to wait long if they needed any support.

There was positive interaction between staff and people who used the service. Staff spoke to people in a friendly and respectful manner and responded promptly to any requests for assistance. The staff knew how people wanted to be supported and information was available to ensure people’s needs were met safely.

We carried out this inspection because we had found previous non-compliance during an inspection we carried out on 26 February 2014.

At the time of our inspection there were 60 people living at the home. We spoke with five people, three members of staff, the deputy manager and the manager. We looked at eight people’s care records.

Records reflected the support people received and important information relating to their health. However, we found one example of a record which did not fully reflect a person’s health condition. This meant staff did not have the information they required about their condition in order to support them safely.

We used a number of different methods to help us understand the experiences of people who used the service, because the people who used the service had complex needs which meant they were not able to tell us their experiences.

We found appropriate systems were in place which ensured the management of medicines for the people who used the service were safe.

We carried out this inspection because we had found previous non-compliance during an inspection we carried out on 17 July 2014. Since this inspection we received information of concern from different sources about how the home was being run. We considered this information during this inspection.

At the time of our inspection there were 57 people living at the home. We spoke with seven people, three relatives, four members of staff and the manager. We looked at seven people’s care records and 10 people’s Medical Administration Records (MAR), which showed what medicines had been administered to people.

People and their representatives were positive about the care they received. One person told us, “It’s always been very good for me”. We found improvements in care had been made since our last inspection.

We found that medicines were not always being stored safely. We found examples of people not receiving the medicines they needed in order to support their health which put their wellbeing at risk.

We found that the premises were appropriately maintained and the provider responded to resolve issues in a timely way. One person told us, “I had a problem with the overflow from upstairs. Staff fixed it promptly”.

We found that records did not always provide staff with the latest guidance on how people should be supported. We saw that some records, such as repositioning charts, were not always appropriately completed which meant that it was not possible to determine whether people had received the support they required.

During our inspection we spoke with seven people, five relatives, six members of staff and the manager. We looked at six people’s care records.

We found that people were supported in making day to day decisions about the care they received. People’s preferences were respected and promoted. One relative told us, “They do listen”.

People did not always receive the care detailed in their care plan. People, staff and visitors told us there were not always enough staff to support people.

Records of medication were not always correctly completed by staff. We found gaps in some people’s medication administration records, which meant that people could not always be sure they had received their medications.

We found that staff were recruited in a safe way and correct checks were carried out to ensure their suitability to care for people. One person told us, “They know what they are doing”.

The service maintained a number of audits to ensure the quality and safety of care. People’s views about their care were obtained by the provider.