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Inspection carried out on 19 November 2015

During a routine inspection

The Limes 1 is registered to provide accommodation and nursing care for up to 22 people. There were 19 people living in the home when we visited. Accommodation is provided over two floors. There are communal toilets and bathrooms for people to use. All bedrooms are for single occupancy with some having ensuite facilities. There are communal areas, including lounge areas, a dining room and a large garden area for people and their guests to use.

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 told us that they felt safe living at the home. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any concerns. People received their medication as prescribed.

There were sufficient numbers of suitably qualified staff employed at the home. There were effective recruitment procedures in place to ensure that only suitable staff were employed at the home.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager and all staff were knowledgeable about when a request for a DoLS application would be required. The registered manager told us that there was an application which has recently been submitted to the relevant local authorities and they were awaiting the outcome.

Staff respected and maintained people’s privacy at all times. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. This meant that people’s dignity was respected and that their care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Care records were detailed and up to date so that staff were provided with guidelines to care for people in the right way.

People were supported to access a range of health care professionals. Examples included appointments with their GP and a chiropodist. Risk assessments were in place to ensure that people could be safely supported at all times.

People were provided with a varied menu and had a range of meals and healthy options to choose from. There was a sufficient quantity of food and drinks and snacks made available to people at all times.

People’s care was provided by staff in a respectful, caring, kind and compassionate way. People’s hobbies and interests had been identified and staff supported people to take part in their chosen hobbies and or interests to prevent them from becoming socially isolated.

The home had a complaints procedure available for people and their relatives to use and all staff were aware of the procedure. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

There was an open culture within the home and people were freely able to talk and raise any issues with the registered manager and staff team. People, staff and stakeholders were provided with several ways that they could comment on the quality of their care. This included regular contact with the provider, registered manager, staff and completing annual quality assurance surveys.

Inspection carried out on 24 April 2014

During a routine inspection

The Limes 1 is a care home with nursing providing accommodation for up to 22 people. The service provides care and support to adults who have a learning disability, a mental health illness or physical disability. There is a registered manager at the service.

People told us that they felt safe living at The Limes and if they had any concerns about how they were treated they would discuss it with a staff member or the manager. The manager had taken reasonable steps to reduce the risk of abuse happening and had made staff aware of the policies and procedures they should follow if they suspected any abuse had taken place.

People confirmed that they had been involved in the assessment of their needs and in writing their care plans. People’s preferences and needs were recorded in their care plans and staff were following the plans in practice. Staff knew people and what their likes and dislikes were. Risks to people were assessed and where possible reduced. There was a "handover" at the beginning of each shift so that staff were aware of any issues or changes that had taken place. If needed people were referred to other health care professionals for support.

People commented that they thought the staff were caring and supported them when needed. One person told us, "Staff get to know us and build a relationship". We observed staff working with people in a kind and caring manner. People told us that they could make decisions about what they wanted to do and that they attended, "Resident’s meetings" to discuss any issues, concerns or ideas.

The home followed a robust recruitment procedure to ensure that the right people were employed. Staff received the training and support they needed so that they were aware of how they should meet people needs in an effective way.

We found that there were systems in place to ensure people received their medicines as prescribed.

Staff had a good working knowledge of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and this had been used to complete assessments and to make best interest decisions where appropriate for people living at The Limes.

The manager decided on the staffing levels according to people’s needs and preferences. People told us that there was always a member of staff to support them when they needed it.

Staff and people living at The Limes confirmed that the manager was approachable and supportive. Staff were aware of their roles and responsibilities. There were management systems in place to audit the care being delivered and the environment so that any improvements could be made where necessary. Staff meetings had been held on a regular basis so that best practice, any issues and new guidance could be discussed. There was a culture of learning from mistakes, complaints, accidents and incidents and this information was shared with the staff team.

Inspection carried out on 1 August 2013

During a routine inspection

People said that staff members were polite, kind and respectful. They confirmed that their privacy and dignity was usually respected.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members.

Medicines were stored appropriately. Administration records were kept and people normally received their medicines in a safe way.

Staff members received supervision and training to ensure that they had the required skills and support to properly carry out their roles when providing care for people.

Systems were in place to regularly check and monitor the way the service was run.

Inspection carried out on 10 January 2013

During an inspection to make sure that the improvements required had been made

We visited on 10 January 2013 to check compliance with two warning notices that had been issued in November 2012.

We found that both warning notices had been complied with as the provider had made suitable arrangements to ensure that people who used the service were safeguarded against the risk of abuse and that staff were receiving appropriate training to enable them to deliver care and treatment to people safely.

Inspection carried out on 7 November 2012

During an inspection to make sure that the improvements required had been made

As this was a follow up visit to see if improvements had been made we did not talk with people who use the service.

As a result of our inspection on 12 July 2012 we set three compliance actions. The compliance actions were in relation to safeguarding people who used the service from abuse, supporting the workers so that they had the knowledge and skills they required to meet people needs and maintaining accurate records (specifically training records).

During this inspection we found that there had been improvements made to maintaining the training records. However, people were still being placed at risk from abuse and staff had not been provided with training that was appropriate to their role and that enabled them to meet the needs of people who lived at the home.

Inspection carried out on 12 July 2012

During a routine inspection

People told us that they were happy living in the home and that they felt safe there. They also told us that they liked the staff and could,"Have a laugh" with them. One person told us that they did have certain restrictions placed on them but that they understood why. One person said, “The staff are very kind".

The relative of one person told us that if there were any changes to their relative’s health the staff responded to them. For example, their relative was not eating very big amounts so they were regularly being offered food supplement drinks.

Inspection carried out on 28 February 2012

During a routine inspection

We used some different methods to help us understand the experiences of people using the service including talking with some people who used the service and observing support being provided. Some of the people had complex needs which meant they were not able to tell us their experiences. We spoke with two individuals and a small group of people who used the service during their lunchtime. They made positive comments about the food provided at the home and valued support that was given to them by the care staff. We observed good interaction between staff and people using the service.