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Inspection carried out on 4 October 2016

During a routine inspection

The Limes 2 is located in a residential area of Brierfield, near to the town centres of Burnley and Nelson. The purpose of the service is to provide accommodation and personal care for up to seven people who have a mental disorder. There are some amenities close by, such as shops and pubs. . Public transport links are nearby and on road parking is permitted.

The last inspection of this location was conducted on 08 January 2014, when all five outcome areas assessed at that time were being met. This inspection was conducted on 04 October 2016 and it was unannounced, which meant that people did not know we were going to visit the home.

A registered manager was in post at the time of our inspection. 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 of the Health and Social Care Act and associated regulations about how the service is run. The deputy manager was in charge of the home on the day of our inspection. However, the registered manager attended the inspection later in the day.

The care planning system was person centred providing clear guidance for staff about people's needs and how these needs were to be best met. The plans of care had been reviewed periodically.

Risks to the health, safety and wellbeing of people who used the service had been appropriately assessed and managed effectively. Where risks were identified these were addressed through robust care planning.

Fire procedures were easily available, so that people were aware of action they needed to take in the event of a fire and records we saw provided good information about how people needed to be assisted from the building, should the need arise.

A range of internal checks were regularly conducted and environmental risk assessments were in place, showing that actions taken to protect people from harm had been recorded.

Records showed that equipment and systems within the home had been serviced in accordance with the manufacturer’s recommendations. This helped to protect people from harm. Evidence was available to demonstrate that good infection control protocols were being followed in day-to-day practice.

Records showed that Mental Capacity Assessments had been conducted, in order to determine capacity levels.

The rights of people were protected as the service worked in accordance with the Mental Capacity Act and associated legislation. People's privacy and dignity was consistently respected.

The service had reported any safeguarding concerns to the relevant authorities and suitable arrangements were in place to ensure that sufficient staff were deployed, who had the necessary skills and knowledge to meet people's needs safely. A range of training for staff was provided. However, some areas of learning could have been completed by a higher percentage of the staff team. We have made a recommendation about this.

Recruitment practices adopted by the agency were robust. Appropriate background checks had been conducted, which meant that the safety and well-being of those who used the service was adequately protected.

There were effective systems in place for monitoring the safety and quality of the service. Audits viewed had identified any areas which were in need of improvement and action was taken to address these shortfalls.

Complaints were managed well and people we spoke with were aware of how to raise concerns, should they need to do so. Systems were in place to ensure that any complaints received were responded to in a timely manner and a thorough investigation was conducted.

During the course of our inspection we assessed the management of medications. We found that, in general these were satisfactory. However, we made recommendations in relation to recording of staff competencies, PRN [as and when required] protocols and the processes for the dispensing of medications. The service worked well with a range of community professionals. This helped to ensure that people's health care needs were being appropriately met.

People we spoke with were highly complementary about the staff team. They felt that they were treated in a kind, caring and respectful manner. People expressed their satisfaction about the home and the activities, which they were supported to enjoy.

Regular meetings were held for those who used the service. This enabled people to discuss topics of interest in an open forum and people's views were also gained through processes, such as satisfaction surveys.

We did not find any breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection carried out on 8 January 2014

During a routine inspection

People spoken with told us they liked living at the home and were involved in making decisions about their lifestyle and daily routine. People also explained that they were happy with the care and support they received. One person said, “The food’s nice.”

We saw that suitable arrangements were in place for the safe keeping and handling of medicines.

We found that a sufficient number of staff was employed at the home in order to ensure that people received the help and support they needed. One person said, “The staff are all right.”

We noted that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were consulted about the care and facilities provided at the home.

Inspection carried out on 6 March 2013

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

We carried out this inspection to follow up areas of non-compliance found during our inspection of 19 November 2012. During this inspection, we found the required improvements had been made.

Staffing levels have been increased during the day in order to ensure that people received the help and support they needed.

Members of staff told us they were supported by the manager through regular supervision meetings. Arrangements were in place to ensure members of staff received the training they needed in order to ensure they were kept up to date with current practice.

Inspection carried out on 19 November 2012

During a routine inspection

People using the service told us they were satisfied with the care and support they received at The Limes. One person said, “It’s warm and comfortable and the staff are friendly and polite.”

Members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.

We found that low staffing levels from mid-afternoon until the following morning meant that people were at risk of not having their needs met.

We noted that training for members of staff was provided. However, a member of staff qualified to administer first aid was not always on duty.

We saw that appropriate and accurate records were kept for people using the service and the overall effective management of the home.

Inspection carried out on 16 December 2011

During a routine inspection

People said staff were friendly and caring and would generally respond quickly to

requests. Some people said they would approach a carer for advice on who to approach

should they have a concern; others said they would talk to staff directly about concerns.

People said that care was good at the home and they had generally been involved in

agreeing their care. One person said on his arrival to the home staff explained how the

home worked and gave him information about the home.

Comments supporting this view included: "They talk to me about my day to day things and

ask if anything has changed or do I want things doing differently. I feel really well looked

after here."

Some people said they fed back views at the home's monthly residents meetings; whilst

others said they chose not to attend these meetings. People said that issues raised at

residents' meetings would be 'taken on board' by the Manager.

Reports under our old system of regulation (including those from before CQC was created)