The Limes

The Limes is a residential care home providing personal care to up to five people with a learning disability and/or autism. At the time of the inspection there were three people living in the home.

The Limes is an adapted residential building located close to local amenities. Accommodation is spread across two floors. There are five ensuite bedrooms, a shared living space, kitchen and secure garden.

People’s experience of using this service and what we found

There were policies and procedures in place which were followed to protect people from abuse and the risks of avoidable harm. There were some inconsistencies and gaps in risk assessments and in health and safety checks. These had been identified as an area for improvement by the service.

People’s medicines were managed safely and there were appropriate infection control policies and procedures in place. Staff reflected there had been an improvement in the learning culture within the service.

Staff, relatives and stakeholders reflected that the management of the service was positive and had improved the atmosphere and culture in the home. There were clear improvement plans in place and positive feedback about the changes so far.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service was small and gave people access to the local community. People’s independence was promoted in how they were supported for personal care and activities. Staff understood how to maintain people’s dignity and treated them with respect. There were clear values established for staff and role modelled by senior staff to ensure the culture was inclusive.

Right support:

• Model of care and setting maximises people’s choice, control and independence.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 good (4 January 2019).

Why we inspected

We undertook an inspection to review concerns related to how the provider was managing the service due to issues at another nearby location. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Limes on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Limes is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Limes accommodates up to five people with learning disabilities in one adapted building. There were three people at the service at the time of inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had a good oversight of the service. There were systems in place to monitor the quality and safety of the service.

People received personalised care from staff who had a good understanding of their needs. People were supported to follow their interests and staffing was arranged around people’s activities and routines. People were treated with dignity and respect and given privacy when they wanted time alone.

People were supported to maintain relationships important to them and the provider worked in partnership with families to forge effective communication between parties.

Staff understood how to keep people safe in relation to the management of their behaviour. People’s care plans reflected detailed guidance for staff to help encourage them to remain calm and safe. There were systems in place to protect people from the risk of abuse and harm.

Risks associated with people’s health and medical conditions were assessed and monitored. Where risks were identified, the provider had systems in place to promote people’s wellbeing and good health.

People had access to healthcare services as required and the provider worked in partnership with healthcare professionals to meet people’s ongoing needs.

People’s needs were regularly reviewed and they were encouraged to participate and give feedback to professionals where appropriate. People were given choices about everyday decisions about their care and had access to advocacy services to help make informed decisions where they could.

People were supported to follow a diet in line with their preferences and dietary requirements.

The atmosphere at The Limes was caring and homely. People were comfortable in staff’s company and enjoyed spending time with them throughout the day. There were sufficient numbers of suitably skilled and qualified staff in place. The provider had recruitment processes in place to identify suitable candidates for the role.

Staff received training, support and development in their role. The registered manager monitored staff’s ongoing performance and there were systems in place to ensure staff understood their responsibilities and duties.

Staff understood the need to gain appropriate consent to care. 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.

The environment at The Limes was suitable for people’s needs. There was access to outside space and people contributed in decisions about the decoration of the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People told us they were happy and content at The Limes, where they were supported by staff they could trust, who made them feel safe. Relatives told us they had no concerns for the safety of their family member because there was good continuity and consistency of care from staff who were committed to people living at The Limes.

People were protected from abuse because staff were trained and understood the actions required to keep people safe. People had been safeguarded against the risk of abuse by staff who took prompt action if they suspected people were at risk of harm.

Risks associated with people’s care and support needs were identified and managed safely to protect them from harm. We observed staff support people safely in accordance with their risk assessments and support plans. Risks affecting people’s health and welfare were understood and managed safely by staff. Environmental risks were managed effectively through prompt and regular servicing.

Daily staffing needs were analysed by the registered manager and deputy manager. The management team used this to ensure there were always sufficient numbers of staff with the necessary experience and skills to support people safely. Staff told us there were always enough staff to respond immediately when people required support, which we observed in practice.

Staff had undergone pre-employment checks as part of their recruitment. Prospective staff also underwent a practical assessment and role related interview before being appointed. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.

People received their medicines safely, administered by staff who had completed safe management of medicines training and had their competency assessed annually by the registered manager. Staff were able to tell us about people’s different medicines and why they were prescribed, together with any potential side effects.

Staff completed an induction course based on nationally recognised standards and spent time working with experienced staff before they were allowed to support people unsupervised. This ensured they had the appropriate knowledge and skills to support people effectively. Records showed that the provider’s required staff training was up to date. This training was refreshed regularly to enable and ensure staff had retained and updated the skills and knowledge required to support people effectively.

People were supported to make their own decisions and choices. Staff supported people to identify their individual wishes and needs by using their individual and unique methods of communication. People’s human rights were protected by staff who demonstrated clear understanding of consent, mental capacity and deprivation of liberty guidance and legislation. Records demonstrated that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare when necessary.

People can only be deprived of their liberty to receive care and treatment when this is in their best interest and legally authorised under the MCA 2005. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). The home was working within the principles of the MCA 2005. Paperwork associated with DoLS applications demonstrated the provider had taken the necessary action to ensure people’s human rights were recognised and protected.

People were supported to maintain a healthy balanced diet through the provision of nutritious food and drink by staff who understood their dietary preferences. We observed communal mealtimes where people and staff ate together. Where people had been identified to be at risk of choking staff supported them discreetly to minimise such risks, while protecting them from harm and promoting their dignity.

People were supported to attend regular health checks by staff who recognised when people were unwell or upset, and took prompt action to promote their health and wellbeing. Visiting health professionals told us that staff quickly implemented their advice and guidance in practice.

People were relaxed and calm in the company of staff who they readily approached for support or reassurance when required. Staff were attentive and responded promptly to people’s needs, following their behaviour support plans. People were supported by thoughtful staff who treated them with dignity and respect.

Relatives told us the registered manager was focused on the staff developing caring relationships with people. One relative told us, “The staff are kind and understanding. They always have time to make people feel they matter.” People experienced positive relationships with staff who worked as a team to develop people’s trust and confidence.

People were supported to keep in contact with their family and friends. One relative told us how visiting their home environment had an adverse impact on their loved one’s emotional well-being. To prevent this staff arranged fortnightly visits to meet their family at the seaside. This person told us how they really enjoyed going to the sea front and having fish and chips with their family. Another relative told us they were very pleased with the sensitive support provided to their family member in relation to a personal relationship. This ensured their emotional needs were supported, whilst promoting their independence.

People had access to information on how to make a complaint, which was provided in an accessible format to meet their needs. Since our last inspection there had been no formal complaints about the home. One relative told us they had raised minor concerns to the registered manager who had responded promptly and taken steps to address the issues raised.

People were involved in developing their care and support plans, which were personalised and detailed daily routines specific to each person. The management team were committed to ensuring people were involved as much as they were able to be in the planning of their own care.

People’s needs were assessed and regularly reviewed to ensure their care and support was responsive to changes identified. Support plans and regular reviews documented the support and care people required, and how this should be provided in accordance with their wishes. Records accurately reflected people’s needs and were up to date. Staff were provided with necessary information and guidance to meet people’s needs. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons.

The senior staff provided clear and direct leadership and effectively operated systems to assure the quality of the home and drive improvements. Feedback from people, their relatives, advocates and supporting health and social care professionals was sought to identify changes required to improve the quality of care people experienced. The provider’s audits were used to review changes implemented, and ensure all required actions were in place to address identified improvements.

People's nutritional needs were assessed and monitored appropriately. We found that people had specific care plans relating to their dietary needs and there was appropriate guidance for staff to follow. The menus in the home were planned by the staff and people living in there. We found the meals to be nutritionally balanced and in line with individual needs.

People were protected from the risk of abuse. The provider had appropriate safeguarding policies and provided staff with training. People we spoke with felt safe living at The Limes.

People who used the service benefited from suitable levels of experienced and trained staff. Staff were well trained and people told us that there were always enough staff to support them.

The provider took appropriate steps to monitor the quality of service and seek feedback from people who used the service. We found that the provider undertook a quality assurance survey and there were regular residents meetings.

The people who live in the Limes have complex needs and as such were not able to talk to us about all aspects of their care. They were spoken to with dignity and respect and were actively encouraged to make choices about their care and their activities. There was lots going on at the time of our visit and the people told us about the activities they were participating in that day.

People's needs had been assessed and support was provided in line with their individual requirements. This was clearly recorded in their support plan. Medicines were given safely and in accordance with policy and training.

Staff were supported and encouraged to undertake further training. We spoke with three staff who told us that they felt management were 'approachable and supportive' and had an 'open door policy'. They also said that they were confident that any issues would be dealt with appropriately.

People knew how to make a complaint and the manager had arranged a system to make it easier for people who live in The Limes to raise issues. These were dealt with promptly and appropriately.