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Inspection carried out on 26 February 2020

During a routine inspection

About the service

The Limes' is a domiciliary service operated by 'Methodist Homes' in a large purpose built complex that includes 'Westbury Grange' care home. The domiciliary support service provided by staff from 'The Limes' enables people to live independently in their own flats within the complex and not as residents within the separately registered and inspected care home. The Limes is a collection of individual and two person flats numbering 50 flats in all. The total capacity of the site is 87 with 37 two bedroom flats. At the time of our inspection nine people were receiving personal care.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

People felt safe with staff from the service. Care plans and risk assessments provided guidance for staff to follow to reduce risk to people’s safety.

Staff understood how to protect people from the risk of harm and understood potential signs of abuse. People and relatives were involved in assessments of potential risks to safety and in identifying measures to keep them safe. Staff went through a recruitment process so that the provider only employed suitable staff, though the system needed some action to ensure it was fully robust.

People said they received their prescribed medicines. There were a small number of records with gaps in dosages to be supplied, which the registered manager was following up. People were protected from the risk of infections through good staff working practices. Staff numbers were inconsistent. During the inspection staff schedules were reviewed to ensure even staff deployment across the service. Staff undertook induction training that supported them to have the knowledge and skills to do their job well and effectively to meet people’s needs.

People were provided with care and support that ensured they had good nutrition and hydration. They had access to healthcare that maintained their health and wellbeing.

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.

Staff knew people well. People had developed positive friendly relationships with staff which helped to ensure good communication and support. Staff respected people’s privacy and dignity and encouraged people to be as independent as possible.

People or their representatives were involved and consulted when making changes to how their support was provided. Staff knew and understood the needs of the people using the service and care was provided based on their assessed needs. Staff were responsive to changes in people's needs to ensure people received help to maintain their health and well-being.

People knew how to raise any concerns or make a complaint. The provider had a policy and procedure which involved investigation and solutions to put things right. This provided information about how these would be managed and responded to.

Systems were in place to monitor the quality of care and support people experienced through quality assurance systems and processes to drive improvements in the service though this needed to be made more robust.

People, a relative and staff spoke positively about the management and leadership of the service. People said staff were very friendly and caring, and they had good relationships with them. The service worked in partnership with external agencies to ensure people achieved good outcomes from their care and support.

Rating at last inspection:

The last rating for this service was good. The inspection report for this inspection was published in November 2017.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligen

Inspection carried out on 9 October 2017

During a routine inspection

The Limes’ is a domiciliary service operated by ‘Methodist Homes’ in a large purpose built complex that includes ‘Westbury Grange’ care home. The domiciliary support service provided by staff from ‘The Limes’ enables people to live independently in their own flats within the complex and not as residents within the separately registered and inspected care home. The Limes provides a service for up to 45 people and is purpose built over two floors. At the time of our inspection four people were receiving personal care.

At the last inspection, the service was rated Good.

At this inspection on 09 October 2017 we found the service remained Good.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and knew how to report abuse, protecting people from avoidable harm. People had risk assessments in place to enable them to be as independent as they could be whilst being kept safe. There was sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service to ensure all staff employed at the service were suitable for the role.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Some people were supported to administer their own medication.

Staff received a comprehensive induction programme and a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported by the manager and had regular one to one time for supervisions and annual appraisals.

Staff gained consent before supporting people with their care. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005. People were able to make choices about the food and drink they had, and staff gave support when required. People were supported to access a variety of additional health professionals when required.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People were given choices about their day to day routines and about how they wanted their care to be delivered. People’s privacy and dignity was maintained at all times.

People’s needs were assessed before they were provided with a care package and the care plans reflected how their needs were to be met. Records showed that people and their relatives were involved in the assessment process and the on-going reviews of their care. There was a complaints procedure in place to enable people to raise complaints about the service.

People and staff were positive about the new manager and staff told us they felt well supported. A variety of quality audits were carried out, which were used to drive improvement and allowed people and staff to express their views about the delivery of care.

Inspection carried out on 22 September 2015

During a routine inspection

This inspection was carried out on 22 September 2015 and was announced.

The inspection was carried out by one inspector.

‘The Limes’ is a domiciliary service operated by ‘Methodist Homes’ in a large purpose built complex that includes ‘Westbury Grange’ care home. The domiciliary support service provided by staff from ‘The Limes’ enables people to live independently in their own flats within the complex and not as residents within the separately registered and inspected care home. At the time of our inspection nine people were using the service.

Some people in the complex were receiving domiciliary support from other regulated agencies external to 'The Limes', but these agencies are subject to their own separate inspection.

There was a registered manager in post. 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 felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient staff, with the correct skill mix, to support the people with their needs.

Effective recruitment processes were in place and followed by the service.

People were assisted with ordering and taking their own medication.

Staff received a comprehensive induction process and on-going training. They were supported by the registered manager and had regular one to one time for supervisions.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff always gained consent before supporting people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were very knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were supported to access a variety of health professionals when required.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well.

People had been involved in the planning of their care and support.

People’s privacy and dignity was kept at all times.

People were supported to follow their interests.

A complaints procedure was in place and accessible to all. People knew how to complain.

Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Inspection carried out on 2 October 2013

During a routine inspection

When we inspected there were only a few people living independently in the flats that required varying levels of support with their personal care. With their prior agreement we met and spoke with five people in their own flats who received domiciliary support with their care needs. We asked them to tell us about their experience of receiving a service and they all confirmed they were very happy with the quality of the care and support provided by the domiciliary care staff. Their comments included; �Having the help we need means we can live in our own flat. They do a really good job.�

We found that the domiciliary support people received was provided by competent and appropriately trained care staff. We saw that the agency office was efficiently organised and managed so that people consistently received a safe, reliable, and effective service as and when they needed it.