The Limes

The Limes is a residential care home providing support and personal care to up to six people in one adapted building. The service provides support to people with learning disabilities, autism and mental health conditions. At the time of our inspection there were three people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The provider was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

Right Support:

Risk assessments were not in place when people were at risk of serious harm.

People’s care and support plans were either not in place or out of date and contained information that was incorrect.

Staff did not always support people with their medicines in a safe way. The service did not maintain accurate and up-to-date records about people’s medicines.

People had access to specialist health and social care support in the community.

Right Care:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Where people had a care plan, they were not person-centred. However, people were supported by a core team of staff who knew their needs well and how they liked to be supported.

People received kind and compassionate support. Staff were appropriately trained and had completed training in understanding autism.

Right Culture:

There was limited opportunity for staff to learn from incidents and improve practice.

The provider did not seek feedback or views from people or their relatives.

Staff treated people who used the service in a way which upheld their dignity, privacy and human rights.

Staff felt able to raise concerns and had training in safeguarding. Safeguarding training enables staff to recognise abuse, respond to concerns and support people to live free from abuse and neglect.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 August 2019)

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about how risks to people were being managed. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with how the provider was managing risk along with their compliance to the principles of the Mental Capacity Act, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to consent and not applying the principles of the Mental Capacity Act, safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

The Limes is a residential care home. It was registered for the support of up to six people. Four people were using the service at the time of the inspection. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The accommodation is provided over two floors. The upper floor being bedrooms, toilets and bathing facilities. The downstairs provides a communal lounge, a dining area and a large conservatory. There was a secure garden which was accessible from the rear of the property.

People’s experience of using this service and what we found

The provider had not always completed audits to reflect on areas of the home which may require changes or improvements. Other quality checks had been completed to ensure the day to day running of the home.

People received care from staff who were available to support them when needed. Relevant checks had been completed to ensure they were safe to work with people. Medicines were managed safety and risk assessments completed to reflect all areas of individual’s care. People were protected from the risk of harm and the risk of infection. Lesson's had been learnt when things went wrong.

Staff had received training for their role and used this to support their knowledge and practice. This was also supported by the latest guidance. People were able to choose the meals they received, and their health was monitored. Referrals were made to a range of health and or social care professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were encouraged to make their own decisions and had been supported to decorate their own personal space.

People had established positive relationships with people and told us they felt staff were kind and caring. Respect was show to people and their dignity maintained. Relationships had been supported and any information was stored confidentially.

The service applied the principles and values consistently of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People were supported with many opportunities for them to gain new skills and become more independent. Other people enjoyed activities of their choice.

The care plans were detailed and had been reviewed to ensure any changes had been documented and shared with the staff team. Communications methods were suited to the individual.

There was a complaints policy and any concerns raised by people or relatives had been addressed. The previous rating was displayed within the home and on the providers website links. The provider had sent us notifications about significant events and the outcomes following their investigations or actions.

The staff felt supported and people’s views had been obtained to encourage or drive improvements. There was a homely atmosphere and people were able to enjoy their environment as they wished.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Published 24 March 2017).

At this inspection we found improvements had been made in the effective domain, however we have reflected some further improvements were required in the well-led domain.

Why we inspected

This was a planned inspection based on the previous rating.

People continued to receive safe care. Safe staff recruitment processes were in place and people were protected from the risk of harm. Enough staff were in place to provide care and support to people to meet their needs. Safe medicine management processes were in place and people received their prescribed medicines safely.

Since our inspection we found improvements had been made in the way the principles of the Mental Capacity Act 2005 (MCA) were used when decisions were made for people who lacked mental capacity to make specific decisions themselves. People were supported to lead a healthy lifestyle with encouragement to maintain a balanced diet. Improvements were needed with regard to staff training, with some staff needing to complete refresher courses in some areas. Staff received regular supervision of their work and were encouraged to develop their roles through gaining relevant external qualifications.

People were treated with kindness, dignity and respect by the staff. People had developed positive relationships with staff which contributed to a positive atmosphere within the home. People’s care records were detailed and personalised which enabled staff to support people in line with their personal preferences. People were provided with an ‘easy read’ complaints process that supported people living with a learning disability. Effective systems were in place to manage any complaints that the provider may receive.

The service continued to be well-led. The registered manager carried out their role enthusiastically and professionally. People, relatives, staff and professionals commenting positively about their leadership. There was a positive ethos and an open culture at the home resulting in an enjoyable working environment for staff and a calm and friendly atmosphere for people living there. Effective auditing processes were in place.