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Inspection carried out on 25 March 2021

During an inspection looking at part of the service

The Limes is a ‘care home’ providing accommodation, personal and nursing care for up to 28 people. At the time of our inspection there were 26 people using the service.

We found the following examples of good practice.

The home had identified a designated area for visits to take place. A process was in place to support safe visits to the home. Visits were by appointment only, all visitors were required to complete a health questionnaire screening form, have their temperature taken and take a rapid COVID-19 test. Personal protective equipment (PPE) was supplied by the provider for all visitors to wear.

The provider had a process in place to support safe admissions to the home.

Staff had received training on how to wear, put on and take off their PPE. This was reiterated regularly with staff through team meetings and monitored by the infection control champions.

Inspection carried out on 10 January 2018

During a routine inspection

The Limes is a residential care home for up to 28 elderly people with a range of needs catered for.

It is an Edwardian house which has been extended and adapted to provide care and support over three floors. At the time of the inspection 26 people were using the service.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix, on duty to support people with their assessed needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professionals when required, including chiropodist and doctors to make sure that people received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. Care plans were written in a person centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

People are supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

Further information is in the detailed findings below

Inspection carried out on 5 January 2017

During a routine inspection

This inspection visit took place on 5 January 2017. The visit was unannounced. When we carried out the last comprehensive inspection in May 2015 we found that the service was good in all areas.

The service provides accommodation and care for up to 28 people. At the time of our inspection there were 25 people living at the home.

The service had a registered manager. 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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded, although the causes of these had not been analysed to allow the provider to identify preventative actions which could be taken to reduce the number of occurrences. Where people had been involved in incidents because of behaviour that could have a negative effect on others, the triggers for such behaviour had been identified and action taken to reduce the occurrence of such behaviour. People received their medicines as they had been prescribed and there were robust procedures in place for the safe management of medicines.

There were enough skilled and qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. Staff received training to ensure that they had the necessary skills to care for the people who lived at the home, and were supported by way of supervisions and appraisals.

People’s needs had been assessed when they moved into the home and they, their relatives and other healthcare professionals had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were happy and felt safe living at the home but said that they did not always have enough support with activities to keep themselves occupied during the day. They had a choice of food and drink with snacks and fruit available throughout the day.

Staff were caring and friendly. They knew the people they cared for well. They protected people’s dignity, treated them with respect and encouraged them to maintain their independence. Staff understood the need for confidentiality.

Information was available to people about how they could make a complaint. Information was also available in formats that people understood about the services provided at the home. People were assisted to access healthcare services to maintain their health and well-being. Staff worked with healthcare professionals and people’s relatives to ensure that the care provided to people best met their needs.

Staff were encouraged to attend meetings with the registered manager at which they could discuss aspects of the service and care delivery. People were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place with the registered manager and the deputy manager being officers of the provider organisation.

Inspection carried out on 12 May 2015

During a routine inspection

This inspection took place on 12 May 2015 and was unannounced. When we last inspected the service in July 2013, we found that the provider was meeting all their legal requirements in the areas that we looked at.

The Limes provides care and support for up to 28 people with a range of physical and mental health needs. At the time of our inspection there were 18 people living at the home.

The home has a registered manager as is required by the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. The registered manager of the home is also the nominated individual for the registered provider. The nominated individual is the person who is contacted by the CQC should there be anything that is needed to be discussed with the provider.

During our inspection we found that people were safe at the home. Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home. These were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences. There were effective processes in place to manage people’s medicines and referrals to other health and social care professionals were made when appropriate to maintain people’s health and well-being.

There were enough skilled, qualified staff to provide for people’s needs. Recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They were trained and supported by way of supervisions, appraisals and regular audits of the way in which they delivered care.

People had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People had plenty of choice of good nutritious food that they liked and which respected their cultural and religious preferences. Their weight was monitored and appropriate referrals were made to the dietician.

Staff were kind and considerate. They treated people with dignity and respect and assisted people to maintain their interests and hobbies whilst encouraging them to be as independent as possible.

People and their relatives had been involved in deciding what care they were to receive and how this was to be given. Relatives were involved in the regular review of people’s care needs and were kept informed of any changes to a person’s health or well-being.

There was an up to date complaints policy in place and a notice about the complaints system was on display in the entrance of the home. There were a number of other information leaflets on the notice boards around the home which included information about the service.

There was a very friendly, family atmosphere about the home. There was an open culture and staff were supported by the managers. Staff were aware of the visions and values of the provider. People, relatives and staff were able to make suggestions as to how the service was provided and developed. There was an effective quality assurance system in place.

Inspection carried out on 30 July 2013

During a routine inspection

When we inspected The Limes on 30 July 2013, we found people who used the service looked well cared for, and were satisfied with the care and support they received. They told us the staff were friendly and helped them when they needed assistance. One person said. "I'm looked after and feel very well."

There was a relaxed atmosphere in the home, and we observed that people were offered support at a level which encouraged independence and assured their individual needs were met. The staff were friendly and courteous in their approach to people and interacted confidently with them. One person said. "They're lovely, it's good fun living here."

We observed the midday meal service and found people were provided with a choice of nutritionally balanced meals. People were assisted at a level that suited them, and the meal time was an unhurried and enjoyable activity for those involved.

We found there were sufficient staff on duty, and those that we spoke with told us they felt well supported. Records we looked at showed us that staff attended a variety of training, which equipped them to understand the needs of the people they cared for and deliver appropriate care.

The provider had clear quality monitoring systems in place which were used effectively to identify any areas of concern, and drive improvements in this home.

Inspection carried out on 20 November 2012

During a routine inspection

We visited the service on 20 November 2012 and spoke with two people who live at the home and two other people�s relatives. All told us the care they, or their relatives, received met their needs. One person told us, �I�m able to laugh and joke with the staff, but they are direct when they need to be about my [health needs].� A family member told us they were �absolutely thrilled� with the care their relative had received.

During the course of our visit we saw staff providing care and support to people living at the home. They spoke in a calm and respectful way, varying their approach depending on the person they were assisting. The staff gave people time to communicate and did not rush them.

People and their relatives told us that they were involved in decisions about the care provided. They said they were involved in writing and reviewing their care plans and we saw that systems were in place to obtain consent to care being provided.

We found that medicines were stored and administered safely to people who received a service at the home.

We saw evidence that the provider carried out regular surveys of people�s views, and had acted on concerns raised. These actions included the provision of additional training for staff in moving and handling.

Everyone we spoke with told us the Registered Manager was approachable and addressed any issues of concerns quickly.

Inspection carried out on 13 January 2012

During an inspection looking at part of the service

People that we spoke with during our visit on the 13 January 2012 said that they were very happy living at The Limes, and that the staff were respectful and treated them well.

We observed staff interacting positively with people, explaining care procedures as they were carried out.

People looked clean and well cared for, and told us that were always plenty of staff available to assist them. We observed that staff communicated confidently with people as they assisted with their care.

We saw people being assisted to transfer and mobilise in an appropriate way, and noted that the staff were competent when using hoists and other assistive aids.

People had access to a wealth of information about the home, which was displayed in the reception area. They were involved in making personal decisions about their care, and encouraged to contribute their views and suggestions with regards to any other matters arising in the home.

Inspection carried out on 25 July 2011

During a routine inspection

Generally people that we spoke with said that they were very satisfied with the care and support they received in The Limes.

One person told us, �I�m thoroughly enjoying my life here, I�ve been here six years and it�s the best year so far�.

We observed staff interacting well with people, explaining care procedures as they were carried out, and people generally looked clean and well cared for.

Although we did not see any formal activity sessions taking place during this visit. People advised us that there was a wide variety of leisure activities available to them. One person said, �There is something for everyone here�.

People spoke positively about the staff. Stating that there was always plenty of staff available and that they were pleasant and attentive.

We observed good interactions between staff and people using the service and we saw assistance being offered to help people transfer and mobilise in an appropriate way. The staff were generally competent and attentive when assisting people to meet their needs.

However we did observed one person being assisted with a meal that was not appropriate for them. The staff assisting was unaware of the short term dietary needs for this person

People told us that they attend resident meetings in the home and were given the opportunity to share their views and make suggestions about how the home is run.

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