The Limes

A condition of the provider’s registration with the Care Quality Commission (CQC) was for the service to be managed by a registered manager. At the last inspection, the service was rated 'Good' although there was no registered manager in place. At this inspection, we found there was a registered manager and the service remained 'Good.' The manager had been registered with CQC since April 2016 and had submitted notifications to the safeguarding team and CQC as required.

The service was safe, clean and tidy. Equipment was regularly tested and utility checks had been completed.

People’s nutritional and healthcare needs were met. All people in the home agreed the menu for the coming week and with staff support participated in cleaning up after each meal. People could also choose to eat independently. We found people received their medicines as prescribed and they were well-managed. Risk assessments, such as those for people to manage their medicines, guided staff in how to support people whilst maintaining their independence as much as possible. One person who used the service and a member of staff had recently become health and well-being champions. This meant they encouraged people to make healthy lifestyle choices.

Staff were knowledgeable about safeguarding vulnerable people and there were safeguards for people’s finances. Paper records were stored safely and computers were password protected. There were policies and procedures to keep people safe in the event of emergencies. These included business contingency and personal emergency evacuation plans (PEEPs.) We saw there were few accidents and incidents, but any that happened were well-managed.

Staff were recruited safely, with written references and enhanced disclosure and barring service (DBS) checks in place before they started work. There were sufficient staff to meet people’s individual needs and there was a dependency tool to enable the registered manager to accurately calculate required staffing levels. We found staff skill and knowledge was good. Staff received an induction that was linked to the Care Certificate, and training and appraisals as required. However, they did not always receive supervision in a timely manner, and these were not always documented.

The provider was willing to decorate and adapt the premises to better suit people’s needs. People who used the service and staff had participated in fundraising activities to raise funds to decorate the games room. We saw the room had been recently furnished and decorated in a style and colours suited to the people who lived there.

People told us the staff were caring and kind, and we found people’s privacy and dignity were respected. Independence was promoted, people were treated as individuals and given choices. Staff were clear about mental capacity and people being able to make their own decisions, they ensured people consented to their care. When appropriate, advocates were used to ensure people’s views and opinions were heard. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s needs were thoroughly assessed and care records were person centred. People were involved in their care plans and supported to take ownership of these where appropriate. Annual reviews of care plans took place with relatives, and staff responded to people’s changing needs. Effective outcomes for people were delivered. People were supported to access work, education and activities in the community. One person had received an award for gaining employment in the community.

Staff supported people to maintain their personal relationships and we found relationships between people who used the service were managed well. Information was provided to people in accessible formats and people were supported to use technology to maintain contact with their friends and family.

There was an open, accessible management culture and people told us communication was good. We found there were few complaints, but when any were voiced, they were managed well. The registered manager worked closely with other agencies and professionals, including the Intensive Support Team (IST) to increase positive outcomes for people.

The provider had a clear vision and values which were implemented by staff in their practice. Quality monitoring systems were sufficient for the size of the service and enabled issues to be identified. The service met all relevant fundamental standards.

Further information is in the detailed findings below.

The manager confirmed that they would complete an assessment if capacity to make decisions was in doubt and a best interest meeting would be held.

Comments included, “I like living here and having my independence”, “The staff are really nice; all of them”, and “The staff help us with things we can’t do ourselves, like when we are worried about something” and “We are able to choose our own key worker, but we can go to any of them for anything and they will sort things out.”

People were happy with the care they received and told us they saw a range of health professionals for advice and treatment. Comments included, "If I am ill, I see my doctor.”

We found that staff helped to make sure health and social care was coordinated when provided by a range of professionals.

During a check of medication we found that there was not a fridge in place for the storage of medicines, this meant that there was no separate storage facilities for items that required refrigeration.

We found that all staff employed in the service received regular supervision, training and support to enable them to fulfil the role expected of them.

Appropriate records were maintained of the care people who used the service received and for the running of the service.

We saw detailed records were kept to help staff care for people who used the service. We also saw people were protected from harm due to procedures being in place for staff to follow if they suspected anyone was subject to abuse. People told us they felt safe and would go to the manager if they had concerns or worries.

We saw people were protected from harm by recruitment procedures in place. We also saw that the service offered at the home was audited regularly and people who used the service were consulted about the running of the home.