This unannounced inspection of The Limes took place on 20 and 21 January 2016. The home provides accommodation and support for up to five people who have learning disabilities, autism or mental health diagnoses. The primary aim at The Limes is to support people to lead a full and active life within their local community and continue with life-long learning and personal development. The home is a detached house within a residential area, which has been furnished to meet individual needs. At the time of the inspection there were five people living in the home. Each person had their own en-suite bedroom which had been specially adapted to meet their needs.The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were happy and content at The Limes, where they were supported by staff they could trust, who made them feel safe. Relatives told us they had no concerns for the safety of their family member because there was good continuity and consistency of care from staff who were committed to people living at The Limes.
People were protected from abuse because staff were trained and understood the actions required to keep people safe. People had been safeguarded against the risk of abuse by staff who took prompt action if they suspected people were at risk of harm.
Risks associated with people’s care and support needs were identified and managed safely to protect them from harm. We observed staff support people safely in accordance with their risk assessments and support plans. Risks affecting people’s health and welfare were understood and managed safely by staff. Environmental risks were managed effectively through prompt and regular servicing.
Daily staffing needs were analysed by the registered manager and deputy manager. The management team used this to ensure there were always sufficient numbers of staff with the necessary experience and skills to support people safely. Staff told us there were always enough staff to respond immediately when people required support, which we observed in practice.
Staff had undergone pre-employment checks as part of their recruitment. Prospective staff also underwent a practical assessment and role related interview before being appointed. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.
People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed annually by the registered manager. Staff were able to tell us about people’s different medicines and why they were prescribed, together with any potential side effects.
Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the provider’s required staff training was up to date. This training was refreshed regularly to enable and ensure staff had retained and updated the skills and knowledge required to support people effectively.
People were supported to make their own decisions and choices. Staff supported people to identify their individual wishes and needs by using their individual and unique methods of communication. People’s human rights were protected by staff who demonstrated clear understanding of consent, mental capacity and deprivation of liberty guidance and legislation. Records demonstrated that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare when necessary.
People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA 2005. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). The home was working within the principles of the MCA 2005. Paperwork associated with DoLS applications demonstrated the provider had taken the necessary action to ensure people’s human rights were recognised and protected.
People were supported to maintain a healthy balanced diet through the provision of nutritious food and drink by staff who understood their dietary preferences. We observed communal mealtimes where people and staff ate together. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, while protecting them from harm and promoting their dignity.
People were supported to attend regular health checks by staff who recognised when people were unwell or upset, and took prompt action to promote their health and wellbeing. Visiting health professionals told us that staff quickly implemented their advice and guidance in practice.
People were relaxed and calm in the company of staff who they readily approached for support or reassurance when required. Staff were attentive and responded promptly to people’s needs, following their behaviour support plans. People were supported by thoughtful staff who treated them with dignity and respect.
Relatives told us the registered manager was focused on the staff developing caring relationships with people. One relative told us, “The staff are kind and understanding. They always have time to make people feel they matter.” People experienced positive relationships with staff who worked as a team to develop people’s trust and confidence.
People were supported to keep in contact with their family and friends. One relative told us how visiting their home environment had an adverse impact on their loved one’s emotional well-being. To prevent this staff arranged fortnightly visits to meet their family at the seaside. This person told us how they really enjoyed going to the sea front and having fish and chips with their family. Another relative told us they were very pleased with the sensitive support provided to their family member in relation to a personal relationship. This ensured their emotional needs were supported, whilst promoting their independence.
People had access to information on how to make a complaint, which was provided in an accessible format to meet their needs. Since our last inspection there had been no formal complaints about the home. One relative told us they had raised minor concerns to the registered manager who had responded promptly and taken steps to address the issues raised.
People were involved in developing their care and support plans, which were personalised and detailed daily routines specific to each person. The management team were committed to ensuring people were involved as much as they were able to be in the planning of their own care.
People’s needs were assessed and regularly reviewed to ensure their care and support was responsive to changes identified. Support plans and regular reviews documented the support and care people required, and how this should be provided in accordance with their wishes. Records accurately reflected people’s needs and were up to date. Staff were provided with necessary information and guidance to meet people’s needs. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons.
The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements. Feedback from people, their relatives, advocates and supporting health and social care professionals was sought to identify changes required to improve the quality of care people experienced. The provider’s audits were used to review changes implemented, and ensure all required actions were in place to address identified improvements.