We carried out a review of the data available to us about The Limes on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Limes, you can give feedback on this service.
A condition of the provider’s registration with the Care Quality Commission (CQC) was for the service to be managed by a registered manager. At the last inspection, the service was rated 'Good' although there was no registered manager in place. At this inspection, we found there was a registered manager and the service remained 'Good.' The manager had been registered with CQC since April 2016 and had submitted notifications to the safeguarding team and CQC as required.
The service was safe, clean and tidy. Equipment was regularly tested and utility checks had been completed.
People’s nutritional and healthcare needs were met. All people in the home agreed the menu for the coming week and with staff support participated in cleaning up after each meal. People could also choose to eat independently. We found people received their medicines as prescribed and they were well-managed. Risk assessments, such as those for people to manage their medicines, guided staff in how to support people whilst maintaining their independence as much as possible. One person who used the service and a member of staff had recently become health and well-being champions. This meant they encouraged people to make healthy lifestyle choices.
Staff were knowledgeable about safeguarding vulnerable people and there were safeguards for people’s finances. Paper records were stored safely and computers were password protected. There were policies and procedures to keep people safe in the event of emergencies. These included business contingency and personal emergency evacuation plans (PEEPs.) We saw there were few accidents and incidents, but any that happened were well-managed.
Staff were recruited safely, with written references and enhanced disclosure and barring service (DBS) checks in place before they started work. There were sufficient staff to meet people’s individual needs and there was a dependency tool to enable the registered manager to accurately calculate required staffing levels. We found staff skill and knowledge was good. Staff received an induction that was linked to the Care Certificate, and training and appraisals as required. However, they did not always receive supervision in a timely manner, and these were not always documented.
The provider was willing to decorate and adapt the premises to better suit people’s needs. People who used the service and staff had participated in fundraising activities to raise funds to decorate the games room. We saw the room had been recently furnished and decorated in a style and colours suited to the people who lived there.
People told us the staff were caring and kind, and we found people’s privacy and dignity were respected. Independence was promoted, people were treated as individuals and given choices. Staff were clear about mental capacity and people being able to make their own decisions, they ensured people consented to their care. When appropriate, advocates were used to ensure people’s views and opinions were heard. 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.
People’s needs were thoroughly assessed and care records were person centred. People were involved in their care plans and supported to take ownership of these where appropriate. Annual reviews of care plans took place with relatives, and staff responded to people’s changing needs. Effective outcomes for people were delivered. People were supported to access work, education and activities in the community. One person had received an award for gaining employment in the community.
Staff supported people to maintain their personal relationships and we found relationships between people who used the service were managed well. Information was provided to people in accessible formats and people were supported to use technology to maintain contact with their friends and family.
There was an open, accessible management culture and people told us communication was good. We found there were few complaints, but when any were voiced, they were managed well. The registered manager worked closely with other agencies and professionals, including the Intensive Support Team (IST) to increase positive outcomes for people.
The provider had a clear vision and values which were implemented by staff in their practice. Quality monitoring systems were sufficient for the size of the service and enabled issues to be identified. The service met all relevant fundamental standards.
Further information is in the detailed findings below.
The Limes is a large semi-detached property in a pleasant residential area of Grimsby close to the centre of town and overlooking an established park. The home is registered to provide care and accommodation for up to nine younger adults with a learning disability and/or autism.
It has seven ensuite bedrooms and a further two-bedroomed flat, accessible by stairs. The house has two large communal lounges and a dining room. It benefits from its own established garden and has car parking facilities.
The aim of the service is to promote personal autonomy; independence and achievement, ensuring people have the same rights and opportunities for inclusion, fulfilment and feeling valued in society as everyone else.
This inspection took place on 16 and 22 October 2015. The service was last inspected on18 June 2013 and was compliant with all of the regulations we assessed.
The service is required to 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 2008 and associated Regulations about how the service is run.
At the time of inspection there was no registered manager in place. The registered manager had left the service at the end of January 2015. A new manager had then been appointed and had applied to be registered with the Care Quality Commission, followed by a period of absence. An acting manager was appointed in the interim to cover this absence.
People who used the service had different levels of identified needs and received support from staff in relation to these, with some people receiving identified one to one support from designated staff.
People told us they felt included in decisions and discussions about their care and treatment. Staff described working together as a team, how they were dedicated to providing person-centred care and helping people to achieve their potential. Staff told us the acting manager led by example, had a very ‘hands on’ approach and was visible within the service, making themself accessible to all.
We found people lived in a safe environment. Risk assessments were completed to help minimise risks in specific circumstances such as when supporting people in the community or with day to day support within the home.
There were policies and procedures in place to guide staff and training for them in how to keep people safe from the risk of harm and abuse. In discussions, staff were clear about how they protected people from the risk of abuse.
We found staff were recruited in a safe way; all checks were in place before they started work and they received an induction. Staff received training and support to equip them with the skills and knowledge required to support the people who used the service. Training was based on best practice and guidance, so staff were provided with the most current information to support them in their work. There were sufficient staff on duty to meet people’s health and welfare needs.
People’s nutritional needs were met and people were supported to shop for food supplies and were assisted to prepare meals. We saw staff monitored people’s health and responded quickly to any concerns.
The health and social care needs of people were assessed and personalised support plans were developed to guide staff in how to care for people who used the service using the least restrictive options. We saw people received their medicines as prescribed and had access to a range of professionals for advice, treatment and support.
People who used the service were encouraged to make their own decisions. Staff followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.
People participated in a range of vocational, educational and personal development programmes both in the local community at the organisation’s outreach facilities. They also completed activities within the service and were encouraged to follow and develop social interests and hobbies.
There were systems in place to monitor the quality of the service, such as observations of staff practices, audits and surveys. A complaints process was in place which was accessible to people, relatives and others who used or visited the service.
The manager confirmed that they would complete an assessment if capacity to make decisions was in doubt and a best interest meeting would be held.
Comments included, “I like living here and having my independence”, “The staff are really nice; all of them”, and “The staff help us with things we can’t do ourselves, like when we are worried about something” and “We are able to choose our own key worker, but we can go to any of them for anything and they will sort things out.”
People were happy with the care they received and told us they saw a range of health professionals for advice and treatment. Comments included, "If I am ill, I see my doctor.”
We found that staff helped to make sure health and social care was coordinated when provided by a range of professionals.
During a check of medication we found that there was not a fridge in place for the storage of medicines, this meant that there was no separate storage facilities for items that required refrigeration.
We found that all staff employed in the service received regular supervision, training and support to enable them to fulfil the role expected of them.
Appropriate records were maintained of the care people who used the service received and for the running of the service.
We saw detailed records were kept to help staff care for people who used the service. We also saw people were protected from harm due to procedures being in place for staff to follow if they suspected anyone was subject to abuse. People told us they felt safe and would go to the manager if they had concerns or worries.
We saw people were protected from harm by recruitment procedures in place. We also saw that the service offered at the home was audited regularly and people who used the service were consulted about the running of the home.
People told us they were well looked after and that they enjoyed all the holidays, outings and activities arranged. They described some of the concerts they had recently enjoyed and told us all about their holidays. Comments included 'I've been to see Westlife and X Factor', 'On holiday we went to see Buckingham Palace and the Harry Potter school' and 'The hotel was good'
When we spoke with people they told us that they felt safe and the staff treated them with respect. Some of the comments we received included "Yes, I feel safe here. If I had any problems I would speak to Jane, the manager", 'The staff are friendly' and "Everyone is really nice".