Lime Trees

Lime Trees is a residential care home providing accommodation with personal care to up to 10 people. The service provides support to people with physical disabilities, sensory needs and those living with acquired brain injury. At the time of our inspection there were 10 people using the service.

People’s experience of the service and what we found:

Medicines were given as prescribed, however some record-keeping practice required improvement. The provider acted on this feedback straight away. We have made a recommendation about medicines records. There were sufficient numbers of staff suitably deployed to meet people’s needs. Staff were recruited safely. Checks were carried out on the environment and equipment, including by external professionals. Risks were assessed and recorded in people’s care plans. Staff understood their safeguarding responsibilities and there was evidence of a proactive learning culture.

People received an initial assessment, which was used to create personalised care plans. Staff received an induction, supervision, and some specialist training. We identified an issue with healthcare related tasks but the provider took prompt action to address the concerns raised. We have made a recommendation about competency assessments relating to delegated healthcare tasks. The need for consent clearly underpinned staff practice. The service was well designed and decorated. The service worked well with other professionals to support people to lead healthy lives.

Staff were caring and kind, and spoke about people with dignity, respect, knowledge and understanding. This included using language which respected and considered people’s strengths, and not just their needs. People’s views were considered by staff. This included those who could not communicate verbally with words. Equality and diversity were considered as part of care planning and provision.

People could enjoy meaningful leisure and social activities. Care provision was regularly reviewed to ensure it met people’s preferences, choices and people could meet their ambitions and goals. People’s communication needs were known and recorded. The service had a system in place for responding to complaints openly and transparently. Good partnership working supported joined up end of life care.

There were systems in place for oversight of the service, although the provider told us of plans to further strengthen and formalise this through additional auditing. There was a positive staff culture, which promoted good outcomes for people. People and staff had opportunities to share their views and make suggestions about the running of the service. People and staff told us they found the management team approachable, open, and transparent. Effective partnership working with a range of stakeholders was seen to be taking place.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 14 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation about ensuring accurate records are kept relating to medicines practice, and a recommendation about competency assessments.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

A registered manager was in post at the service. 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 received care which was extremely person centred and responsive to their needs. They were supported and fully engaged in activities that were meaningful to them.

Staff continuously looked for ways to improve care, so people had positive experiences and led fulfilling and meaningful lives. They liaised with professionals to make sure that people’s health care needs were met.

Social interaction and community acceptance was important and opportunities to access and integrate into the local community was a priority.

Staff had an excellent understanding of people's backgrounds and they supported people to pursue their interests and hobbies, try new things and learn new skills.

Peoples’ privacy was respected. Staff supported people to make individual choices on a 'moment by moment' basis.

Staff had a common aim and purpose to achieve positive outcomes for people.

Staff were exceptional at helping people to express their views, so they could understand things from their point of view.

Procedures were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. The registered manager and staff knew of their responsibilities regarding the Mental Capacity Act 2005.

Risks were assessed and control measures were in place, which still enabled people to maintain as much independence as possible. There were sufficient numbers of staff to ensure that people's needs were met.

Recruitment practices ensured that staff were of good character and suitable for their roles, and people were involved in interviewing new recruits.

People were supported to take their medicines safely, if required. Systems were in place to record when medicines were given. When a dispensing error had occurred systems were changed to make sure this did not happen again.

Staff received an induction and on-going training to make sure they had the right skills and knowledge. Staff were well supported and had opportunities to discuss any concerns and training needs they might have.

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

There were positive relationships between people and members of staff. Staff treated people with kindness and took the time to get to know them and their interests whilst providing their care. Staff involved people in producing their care plans to ensure that care was provided to them in the way they wanted it to be.

A robust quality assurance system was in place and the registered manager looked at ways they could continuously improve the service people received.

We saw that staff knew people well and we saw caring interactions between members of staff and people living in the home; staff listened to people, treated them with respect and involved them in making decisions about their care.

People told us they were happy with the environment and their rooms were lovely.

They also said they enjoyed the food at Lime Trees and we saw that their individual nutritional needs and preferences were met.

Staff understood their responsibilities around keeping people safe and we found that care was provided safely and to a good standard. We saw that staff listened to people and responded promptly to their needs. People who completed surveys as part of the home's quality monitoring process were complimentary about staff. One relative said: 'Staff are patient and cheerful. Many thanks' and another stated: 'Staff are always kind and helpful.' A health professional stated: 'Excellent staff.'

Lime Trees was well managed and there were effective processes to monitor the quality of the service. They consulted with people and took their views into account to make improvements.

People living at Lime Trees had complex needs and some were not able to speak with us. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home. One person was able to talk to us about living in the home and they were happy.

Relatives who returned questionnaires as part of the home's own quality assurance process were complimentary about the care provided at the home. One relative stated '[Our relative] couldn't wish for anywhere better.' Another relative said 'Staff are always kind and helpful.'

A health care professional who completed the home's survey made positive comments about the service and stated 'We have always had a good working relationship with Lime Trees.'

A relative told us they had chosen Lime Trees after considering a number of other homes. They said they and their relative were happy with the decision and things were working well.

During our inspection we saw that people received good care and that staff treated them with respect.