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Inspection carried out on 9 August 2018

During a routine inspection

This inspection visit took place unannounced on 9 August 2018 and we returned announced on 10 August 2018 to look at the quality assurance systems and to speak with people and staff.

The Limes is a two-storey residential home which provides care to older people including people who are living with dementia. The Limes is registered to provide care for 30 people. At the time of our inspection visit there were 27 people living at the home. Care and support was provided across both floors and each floor had its own communal lounge and dining area.

People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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.

At our last inspection we rated the service Good overall, with Well led being rated as ‘Outstanding’ because we found the provider learnt from previous inspections to drive improvements, shared good practice and the culture promoted open and continuous learning. At this inspection we found the service remained overall Good, however ‘in Well led’ we found the governance audit systems had not identified some of the issues we found which affected the standards of the care being provided.

Systems to ensure safe management of medicines were not always followed in line with current guidance and the provider’s own policies. Medicines were not always stored, recorded and given in line with current NICE guidance and staff who administered medicines were not confident or had sufficient knowledge using the electronic medicines management system.

People and relatives were very complimentary and satisfied with the quality of care provided at the home. People felt safe living with other people in the home and they were supported by a consistent, kind and caring staff team.

Staff were available at the times people needed and there were enough staff to respond to people’s needs and requests for assistance. Staff received training so that people's care and support needs were met by staff who knew how to support them. Staff understood their responsibility to safeguard people from harm and report any concerns they had to the management team.

People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. People were treated with respect by staff who addressed them by their preferred names and who supported them in line with their personal preferences and wishes.

No one at the time of our visit received end of life care. The registered manager said care was given so if people wanted, ‘this was a home for life’. Anticipatory and pain relief medicines were arranged and held so if people’s condition quickly deteriorated, their care could remain as pain free and dignified as possible.

The provider worked in partnership with other healthcare professionals to ensure people received effective care that was responsive to their needs. People’s medicines were not always stored and managed safely.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported best practice and decisions were made with family members who had legal authority to do so.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). People's right to make their own decisions about their care, were supported by staff who understood the principles of the Mental Capacity Act 2005.

There wa

Inspection carried out on 23 March 2016

During a routine inspection

We inspected The Limes on 23 March 2016. The inspection visit was unannounced.

The service was last inspected on 27 May 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The Limes provides accommodation for people in a residential setting and is registered to provide care for up to 30 people. There were 26 people living at the home when we inspected the service. People were cared for over two floors.

A requirement of the provider’s registration is that they have 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 and associated Regulations about how the service is run. There was an experienced registered manager in post at the time of our inspection who had been at the service for several years. We refer to the registered manager as the manager in the body of this report.

The home was divided into two separate ‘households’, each with their own lounges and dining rooms. This provided people with several communal areas to meet. Each household was individually supported by a care co-ordinator who was part of the duty management team. This ensured each household was supervised and staff were supported by a management team that was available seven days per week.

People’s needs and their wishes were placed at the heart of the service. This philosophy and the provider’s vision and values were understood and shared across the staff team. People were supported to maintain their purpose and pleasure in life. People planned their own care, with the support of their relatives and staff. This ensured their care plans matched their individual needs, abilities and preferences, from their personal perspective.

Excellent quality assurance procedures were in place across the provider’s group of homes to exploit learning opportunities wherever possible. Information was shared across each of the provider’s homes to ensure lessons learnt drove forward improvements. All the staff were involved in monitoring the quality of the service, which included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. There was a culture within the home to learn from feedback, audits, and incidents to continuously improve the service provided.

People who used the service and their relatives, were encouraged to share their views about how the service was run. People knew how to make a complaint if they needed to and the complaints received at the home were fully investigated and analysed so that the provider could learn from them. The provider used the information from complaints to improve their service by acting on the feedback they received.

The provider was innovative and creative and strived to improve the quality of people’s lives by working in partnership with experts in the field of dementia care. Planned improvements were focused on improving people’s quality of life.

Care staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people who were important to them.

People were supported with their health needs and had access to a range of healthcare professionals where a need had been identified. There were systems in place to ensure that medicines were stored and administered safely. People were encouraged to eat a balanced diet that took account of their preferences and, where necessary, their nutritional needs were monitored.

The manager and staff understood their responsi

Inspection carried out on 27 May 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were being cared for in an environment that was safe, clean and hygienic. The records we read showed that the home was cleaned daily. We found the environment neat and tidy with no unpleasant odours. The people we spoke with told us that they felt safe in the home. One of the people we spoke with said, �This is the cleanest home I have been in.� We saw that the service had effective infection control procedures. Equipment in the home included hoist and evacuation ski pad, which had been well maintained and serviced on an annual basis under maintenance agreements.

There were enough staff on duty to meet the needs of the people living at the home and keep them safe. The staff records we read showed that the staff had received appropriate training to keep people safe. Training included health and safety and manual handing training. Staff were able to explain how this training kept the people who used the service safe. We observed staff interaction with people who used the service. We saw they followed the infection control procedures and wore gloves and aprons when appropriate.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing with first aid training, regular. Regular fire drills, personal evacuation plans for each person that used the service and a call alarm that people could use to call for assistance.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt their identified needs were being met. One of the people we spoke with said, �The staff are always very helpful.� We observed staff�s interaction with people and saw that they were attentive to their needs. We heard staff comments, such as, �Is that OK?� and �Is that how you want it� as they delivered care to people.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, �I�ve no complaints at all about the staff, they�re good� and �It�s like a family atmosphere here. We saw staff treated people in a pleasant manner and took time to re-assure people and understand what they wanted. For example, we observed one member of staff say, in a calm and pleasant manner, �X, do you want to get ready and have some breakfast?�

Is the service responsive?

People�s needs had been assessed before they moved into the home. People told us the service had asked them about their likes and dislikes prior to them moving into the home. We saw activities records that showed people had access to activities that were important to them. People had been supported to pursue activities that they enjoyed. We saw the care plans were regularly updated and people were given the opportunity to change their mind about what they wanted to do.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and had a good understanding of the quality assurance processes that were in place. We saw that people were regularly asked what they thought about the service and the manager took action to resolve any issues. We read the most recent annual customer feedback questionnaire and found that the majority of residents were positive about the service. People told us that the management had consulted with them before implementing changes to service the home provided and that their views had been taken into consideration. For example, changes that were made to meal times following consultation with residents.

Inspection carried out on 29 July 2013

During a routine inspection

When we visited The Limes we spoke with five people who used the service and one relative to obtain their views about the home. We also spoke to the manager, the deputy manager, the area manager, three care staff and the cook.

People who lived at the home told us, �I am well looked after� and �I am happy, the staff are nice.�

We saw staff were kind and attentive when they delivered care to people. We saw people were supported and encouraged to maintain their independence.

We looked at three people�s care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

We looked at recruitment practices and saw checks were carried out on staff prior to starting work to ensure they were suitable to work with people.

We found the service was well led and had systems in place to monitor the quality of service provided at The Limes.

Inspection carried out on 3 May 2012

During a routine inspection

We visited The Limes on 2 and 3 May 2012 and we spoke with two people using the service, one relative, two members of care staff the manager and the service manager for WCS.

We spent time observing staff interaction and talking with staff about how they meet the needs of the people they support. Staff demonstrated a clear understanding of people�s needs and engaged with people in a positive manner.

People using the service told us they liked living at the care home and felt well cared for. One person told us, "they spoil me, they could not do better." Another person told us, "very friendly, efficient and all staff are nice.�

Each person we spoke with told us they felt safe and would be able to talk with staff if they felt concerned about their care. Some people were not able to tell us about their care, so we observed staff interaction and the people appeared relaxed and happy in the company of the staff.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. One person told us, "they change the menus often and will get you something else if you wish."

We saw people�s bedrooms were clean, warm and well furnished. People had brought in some personal items with them into the care home and this made their rooms "homely". The communal rooms in the home were also clean and tidy and during our visit activities were available throughout the day. In the morning there was a singing duet and a musical trio in the afternoon. Both of these activities were well attended and we saw people being asked individually if they wanted to be included.

We spoke with one relative about the care provided to their family and they told us �brilliant care here, very supportive� and �if there are any concerns, they contact me straight away and keep me up to date.�

Inspection carried out on 14, 15, 16, 21, 22 June 2011

During a routine inspection

During this review we visited five of the provider's care homes. We visited The Limes on 14 June 2011, we visited Westlands on 15 June 2011, we visted Fourways on 16 June 2011, we visited Woodside on 21 June 2011 and we visited The Sycamores on 22 June 2011.

We spoke with 17 people using these services and eight relatives who were visiting at the time. People told us they liked living at the care home and felt well cared for. One person told us 'we like it because staff 'speak nicely' and said staff were �friendly� towards them. People told us they were happy with the care they received and encouraged by staff to maintain as much independence as possible. We saw people making their own drinks when they wanted to and helping with the washing up after lunch. People told us they liked doing this. Each person we spoke with told us they felt safe and would be able to talk to staff if they felt concerned about their care. Some people were not able to talk to us about their care because of their dementia, however when we asked them if they were comfortable they smiled and nodded.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice.

Relatives told us they had no concerns about how their family member was being cared for. They told us that care given was 'respectful' and 'nothing was to much trouble'.

Relatives we spoke with at each care home told us that staff had �time for everybody� and the managers were very approachable. Relatives liked the way that they could be involved with the care of their family member and join in with activities if they wanted to. Relatives made particular comments about how well the staff kept them informed about their family member's care needs.

Relatives told us the food looked good and people always had sufficient to eat and drink. They told us that snacks and drinks were always �available' and they could make a cup of tea for their family member whenever they visited.