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Inspection carried out on 4 December 2018

During a routine inspection

This inspection took place on 4 and 14 December 2018 and was unannounced.

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

Inspection carried out on 20 January 2016

During a routine inspection

This unannounced inspection of The Limes took place on 20 and 21 January 2016. The home provides accommodation and support for up to five people who have learning disabilities, autism or mental health diagnoses. The primary aim at The Limes is to support people to lead a full and active life within their local community and continue with life-long learning and personal development. The home is a detached house within a residential area, which has been furnished to meet individual needs. At the time of the inspection there were five people living in the home. Each person had their own en-suite bedroom which had been specially adapted to meet their needs.

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 wh

Inspection carried out on 19 November 2013

During a routine inspection

We found that people who lived in the home were well cared for. One person told us "I like everything about living here". Another said "I love the staff. They really look after me".

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.

Inspection carried out on 16 October 2012

During a routine inspection

We were welcomed into the house by one of the residents. Three people showed us their rooms which they told us they liked. We saw that they were full of personal items. At the time of our visit the house was undergoing redecoration to the communal areas. The people who lived in the house had been involved in choosing the d�cor and had each chosen the colour of a room.

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.

Inspection carried out on 20 October 2011

During a routine inspection

One person told us �I like living here, I look after the staff. They are nice to me so I look after them.�

Another person said of her fellow residents �They�re all nice people here�.

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