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Inspection carried out on 2 October 2017

During a routine inspection

This inspection was unannounced and took place on 2 October 2017.

The Limes provides accommodation and personal care for up to six people who have an acquired brain injury. On the day of the inspection three people were living in the home.

The home had a registered manager who was present on the day of the 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not recognise that information shared with them were complaints and records were not maintained of what action had been taken to resolve them.

People were supported by sufficient numbers of staff and the provider had contingency plans in place to ensure there were always enough staff on duty to meet people's needs.

People felt safe living in the home and staff knew how to safeguard them from potential abuse. Staff were aware of how to reduce the risk of harm to people and had access to risk assessments that supported their understanding about how to do this. People had consented to their treatment and were supported by skilled staff to take their prescribed medicines.

People could be assured they would receive a service specific to their needs because of their involvement in their care assessment. They were also supported by staff to pursue their social interests.

People were cared for and supported by skilled staff. People’s human rights were protected because staff were aware of the importance of enabling them to make their own decision. People had access to a choice of meals and staff were aware of suitable meals for the individual to reduce the risk of choking. Staff assisted people to access relevant healthcare services when needed to promote their physical and mental health.

Staff were kind, caring and sympathetic to the individual’s needs. People’s involvement in their care planning ensured they received a service the way they liked. People’s right to privacy and dignity was respected by staff.

People, a relative, and staff were aware of who was running the home. Staff felt supported by the management team to carry out their role. The provider had systems in place to monitor the quality of service provided to people.

Inspection carried out on 7 July 2015

During a routine inspection

The inspection was unannounced and took place on 7 July 2015. At the last inspection in September 2013, the provider was meeting all of the requirements of the regulations we reviewed.

The Limes is registered to provide accommodation and personal care for a maximum of six adults who have an acquired brain injury. There were six people living at home on the day of the inspection. There was a registered manager in place. 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 they felt safe living at the home and considered there were enough staff to support them. Staff followed risk assessments to keep people safe. Staff were experienced and had received training in protecting people from harm. They knew what action to take if they had any concerns about potential abuse. People were supported with the management of their medicines to support their well-being.

Staff were provided with training which they felt reflected the needs of the people they supported. Staff knew how to support people’s rights and shared examples of how they respected people's choices.

People told us they had enough to eat and drink to keep them healthy. People told us they enjoyed the meals provided and were involved in shopping for, and choosing what they ate. We found that people’s health care needs were assessed, and care and support was planned and delivered to meet their needs. People had access to healthcare professionals that provided treatment, advice and guidance to support their health needs.

People described staff as kind and caring. They told us they were happy with the care and support they received and felt listened to. Staff respected people’s right to privacy and promoted their dignity.

People were involved in the planning and reviewing of their care. People’s needs were assessed and detailed plans were in place to meet their needs and preferences. People told us they went out into the community most days to participate in activities they chose. We saw people were encouraged to be as independent as possible. People knew who to speak with if they had any concerns or complaints about the service they received.

The registered manager promoted an open culture within the home and was available to staff for guidance and support. There were systems in place to gain people’s views and to monitor and review the quality of the service people received.

Inspection carried out on 6 September 2013

During a routine inspection

The name of the recently resigned manager appears in this report as they were still the registered manager for the service at the time of our inspection. Any comments made about the manager in this report refer to the person who is newly employed in this position at The Limes.

When we visited The Limes we met the six people who lived there. We were invited to go to some people�s bedrooms. We saw the rooms were well furnished and people had their own things. We were told how everyone was encouraged to keep their rooms clean and tidy. We were shown around the rest of the building which was well kept.

One person we met showed us the pictures of his family which he had put into a frame. He told us where he lived before he came to The Limes. He said he like the home and he liked his breakfast early. He told us that he enjoyed going ten pin bowling and out for dinner. He said he had plenty of choice in what he did and what he had to eat. He said �at this home I am a person and not a number�. Another person told us he liked to go to the football with his dad. He also liked police shows on the TV and listened to any kind of music. He said �hoovering is my favourite job�.

We observed the staff give the people their breakfast. We saw that people had choice. We saw that people could change their mind if they wanted something else. We observed that the staff provided personal care and support in a person centred way. The people and the staff team were relaxed and the staff understood the people�s needs. We saw the staff working with the people to achieve their goals and undertake their activities.

At lunchtime the staff asked everyone what they wanted for their lunch. We observed lunch being prepared. Everyone sat together talking and enjoying their meal.

We were told by the staff and the registered manager how the staff team work with the people to promote independence. We saw in the peoples activity plans the daily tasks included house work, bedroom cleaning and meal preparation.

We spoke to three members of staff about their work and training. They said the work they did was very challenging but very rewarding. They told us about their previous experience and how they used this knowledge in their work at The Limes. One member of staff said they were teaching some basic sign language. The staff we spoke to demonstrated how well they knew the people they supported. They told us how they recognised changes in people�s health and behaviour. They told us how they managed people�s challenging behaviours safely. All the staff spoke highly of the training they received. They were all appreciative of the support of management and colleagues.

Inspection carried out on 13 June 2012

During a routine inspection

We met all five of the people currently living at The Limes on the day of our inspection and spoke with four people in private to establish their views and experiences about the service that they received. We also spoke with all three staff working at the home on the day of our visit, the registered manager and the communities manager. As part of the process we were shown parts of people�s care and support plans and additional information as detailed within this report.

People told us that they were very happy with the support that they received. One person reflected the views of everyone we spoke with when they said, �It�s a lovely home, we get on well with each other and we are well supported�.

We were told that staff met people�s care and support needs in ways that they preferred. Care and support reflected people�s individual needs.

People said that they were involved and consulted in the development of their care plans. People�s likes, dislikes, preferences and goals were considered in relation to support that they received. Everyone told us that they were treated with dignity and respect and our observations reflected this.

People were supported to live the lives they chose. They took part in a range of activities within the local community. The level of support that individuals required varied and the home was able to accommodate changes to staffing levels to reflect this.

People were supported to regain their independence and took part in cooking, cleaning and other household tasks as well as managing their own money. One person told us that they managed their own medication and were happy to do this.

Plans were in place to support people to enjoy their lives and staff were aware of risks, people's rights and their responsibilities in order to enable them to do this.

People were supported by a knowledgeable and well trained staff team who knew their care and support needs well. Staff were offered a range of training opportunities that were specifically designed to meet the needs of the people they supported.

People were protected because staff were confident to recognise and report abuse. The home had implemented changes in response to incidents to keep people safe and following our visit the manager updated their knowledge in relation to referral processes to ensure that any incidents were investigated openly and as part of a multi agency team.

The home effectively ensured that people's views were considered and listened to in relation to the running of the service. The organisation had a range of quality monitoring tools in place to ensure that they maintained good quality care.

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