The Limes

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – This means we looked for evidence that the provider involved patients and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question Good. At this assessment, the rating has remained Good. This meant patients were respected and valued as individuals; and involved as partners in their care.

Staff demonstrated consistent commitment to privacy, dignity, and person-centred care, responding sensitively to each patient’s individual needs. They empowered them to understand, manage, and make informed choices about their care and treatment, actively involving them in care planning, assessment of risk, and treatment decisions wherever possible. Staff also anticipated patients’ needs well and regularly sought feedback to improve care quality and treatment outcomes.

Families and carers were fully engaged, informed, and supported, with staff promoting a culture of partnership, respect, and collaboration. Staff monitored and audited patient and carer involvement, which ensured care met their expectations. Patients and their loved one’s feedback demonstrated that staff provided care that was not only kind and empathetic but also measurable, responsive, and consistent in impact, reinforcing a positive culture throughout the service.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

Patients were involved in their care and treatment planning. They felt staff saw them as individuals, with their own personal preferences and wishes. One patient told us, “The staff are very, very good. They talk to me and spend time with me, and we always have a laugh.” Staff built relationships with patients which were based on openness, honesty and trust. Staff supported them when in distress, and they responded promptly, with kindness and compassion. Staff audited patient involvement, which ensured engagement remained meaningful, effective, and met the individual patient’s needs.

We observed interactions between staff and patients throughout our visit. Staff demonstrated a person-centred culture, and provided kind, compassionate and dignified care. Staff maintained a consistently caring approach and always acted with professionalism and empathy, reflecting a positive and caring culture. Staff gave an example of how they had supported a patient to maintain their dignity after they had lost weight and their clothing no longer fitted them. Staff encouraged and supported the patient to buy new clothing which preserved their dignity and respect.

Patients’ information was treated confidentially and shared only when needed, and with their consent. Staff communicated in ways patients understood, adapting their approach to meet individual needs. Where appropriate families were involved in care planning and decision-making, reflecting staffs’ commitment to person-centred care. Staff raised concerns about disrespectful, discriminatory, or abusive behaviour without fear of reproach, and felt supported to uphold dignity, respect, and compassion in all aspects of their work.

Observations, and patient and staff feedback provided strong evidence of a culture in which kindness, compassion, and dignity were embedded across the service. Staff were motivated, empathetic, and proactive in their care and approach, which fostered trusting relationships and consistently met expectations.

Patients were encouraged, and supported to be actively involved in their care, and treatment, with information delivered in ways they could understand and was regularly reviewed with them. Staff supported patients to make choices and decisions about their care, empowering them to participate as fully as possible. One patient told us, “I’m never made to do anything I don’t want to do. All the patients are different, and we like to do different things. We always get a choice, and that’s important.”

Care and treatment plans demonstrated personalised goals, independence and recovery focused care planning. Patients were treated as individuals, with care tailored to meet their personal needs, and preferences. Staff were responsive when anticipating patients’ needs and amended care to ensure each patient was supported to achieve their own best possible outcomes.

The service promoted equality, diversity, and inclusion (EDI) among staff and patients. EDI mandatory training was completed in staff’s induction and repeated throughout their employment. Training and awareness fostered an inclusive and supportive culture. EDI principles were embedded and enhanced patient’s experience, promoted dignity, respect and understanding across the service.

Staff were aware of the patients’ religious or cultural needs prior to admission. A multi-faith room was available, and staff regarded the religious and cultural needs of patients as a priority. Staff supported patients to visit local places of worship and also arranged both escorted and unescorted leave for patients to visit places of worship in their local areas. Staff also welcomed religious and cultural leaders to the service to spend time with patients if this was requested.

Information about treatment, rights, and complaints was provided in accessible, personalised formats, including easy-read materials in different languages, and audio prompt when required. Staff encouraged the involvement of advocates, and ensured patients had timely access to all required communication resources whenever needed.

Patients felt confident, informed, and empowered to make decisions, and choices about their care. Staff supported them to make their own decisions about their treatment and amended approaches to reflect individual needs and preferences. Patients’ rights were explained effectively, using a range of communication methods, ensuring that patients understood, made informed decisions, and were fully involved.

Staff encouraged and supported involvement, independence, choice, and control wherever possible. Patients were involved in all aspects of their care, and staff explained decisions made in their best interests clearly. Staff promoted skill-building and self-management, in preparation for discharge. Care plans evidenced patient involvement in decision-making and demonstrated clear goal setting and independence-focused care planning.

Staff supported patients to maintain important relationships and community connections. Family visits were supported, and staff were flexible to meet individual need. The service had its own transport and used this to support people to have escorted home leave, and visits with family and friends. One staff member told us “Whenever we can, we make sure that patients get home to see their families, as we know how important this is. We have taken patients all over the country to see their loved ones, literally, from Newcastle to London, it really is wonderful.” Staff also transported patients’ families and friends to the service for visits, if the patient didn’t have the appropriate leave or their relatives didn’t have the means to attend independently.

Staff promoted maintaining, or re-establishing community links and prepared patients for safe and independent engagement with family and local services. One patient told us, “Staff always help me to stay in touch with my family and friends. The visits are really flexible, and they even take you home for visits.”

Staff promoted independence and recovery, providing opportunities for patients to take part in activities that built skills, confidence, and resilience. Activities were focused on skill development, vocational training, community engagement, and supporting autonomy and long-term recovery, such as external groups located within the patient’s local community. Patients could access community-based activities that supported autonomy, health, and wellbeing.

Staff empowered patients to develop skills and confidence. The service had a therapy kitchen where staff assessed patient’s living skills in readiness for transition to more independent living. After assessment of progress and risk, some patients had their own door fobs which allowed them to access areas of the hospital independently.

Staff promoted a real work opportunities initiative. Patients were supported to engage in the process of applying for positions of paid work within the service, for example, housekeeping, outdoor maintenance of the zen garden and pet care for the services cat. Staff assisted patients in preparing a CV, completing applications, and attending interviews. The successful candidates received regular supervision, and a weekly wage whilst in the role. Real work opportunities empowered personal independence and built upon existing real-life skills in preparation for patients rejoining their communities.

The service collaborated with local education providers to support independence and learning. Courses included English, Mathematics and functional skills. The occupational therapy team provided personalised timetables for patients based on individual need, such as, shop and cook, community activities, public transport travel training, building confidence and community skills, budgeting skills and road safety awareness. Community assessment trackers were in place to track progress, and were adapted to each patient’s individual needs, preferences, and capabilities.

Staff supported people’s physical health alongside their mental health. When needs were identified and assessed, staff provided specialist adaptive equipment such as mobility aids to people who needed them. Accessible bedrooms with en-suite wet rooms, and accessible bathrooms were available to support people’s independence. By providing personalised support, practical tools, and a consistent caring and empowering culture, staff enabled patients to have genuine involvement and maximise their independence, supporting rehabilitation in readiness for community living.

Staff helped patients access educational and vocational opportunities, such as training courses within their local communities, and supported skill development to enhance independence. For example, patients with a keen interest in gardening and horticulture were supported to attend a local farm and allotment project where they built upon existing knowledge and learned new skills which aided them with their continued recovery, support and treatment in readiness for them rejoining their communities. Staff planned visits and leave flexibly while ensuring that care remained safe and consistent.

Staff responded promptly and effectively identified any patient in need or distress. They were alert, observant and recognised changes in patient’s presentations and the dynamics of the environment. Staff responded quickly to maintain the wellbeing of patient’s and to mitigate any potential risks. Patients were confident in approaching staff with any issues or concerns and did so without hesitation knowing they would be listened to and supported. One patient told us “I think the staff are well trained and they listen. I’m happy to go to staff whenever I need to, nothings ever a bother to them.”

Staff used various forms of communication to help patients to express themselves and seek support whenever they needed it, for example, text prompt to audio information technology. The service also had an effective working relationship with advocacy services, with an advocate attending site regularly to support patients and their families to communicate their needs. Staff built open and meaningful relationships with people which helped them anticipate needs and provide proactive rather than reactive support. Throughout our visit staff consistently responded quickly and effectively to the needs of patient’s.

Staff were trained in de-escalation techniques, calm, supportive approaches that reduced stress, anxiety, and distress. Staff supported patients to manage challenges independently and encouraged them to use coping skills, strategies and self-regulation. Managers, and their staff worked hard to reduce restrictive practices, giving patients more independence, more opportunities for community leave, and greater involvement in everyday life. We reviewed patients care records, and found evidence of up-to-date hospital, and communication passports for patients who needed them.

When the ward alarms sounded, staff responded promptly to identify the patient’s needs and additional staff arrived quickly to offer support. Staff used effective de-escalation techniques to reduce the need for physical intervention if a decline in mental or physical health was identified, people became distressed, or if emotions became dysregulated. Through effective support and responsive planning, patients made consistent progress, reduced their risks, and were well prepared for increased community engagement and potential discharge.

Leaders supported their staff and ensured they had access to a comprehensive range of wellbeing resources to ensure the safe and effective delivery of person-centred care. They encouraged regular breaks and promoted a culture where staff felt valued, supported and able to speak freely. Staff described leaders as available and approachable. One staff member told us, “Managers are always there for all of us, they’re genuinely caring and can’t do enough for you. We have all had times when we have needed support and it’s always there, 100% fab!” In response to the cost-of-living crisis, the manager held a free entry weekly raffle, and the winning staff member received a food hamper. The manager also supported staff on an individual basis and supported them with everyday essential items.

Managers provided a staff hub for breaks and rest periods. The staff hub was a separate building on site, and provided a space for staff to relax, watch TV, take a shower and prepare meals. The staff hub also had reclining furniture and a massage chair. Meals were also free for staff when they were on shift, and they often sat with patients and enjoyed their meals together.

Managers promoted staff recognition across all care teams and had a monthly colleague appreciation initiative. Each staff member voted anonymously for a colleague who they felt had gone above and beyond in carrying out their role and for modelling behaviours essential to delivering person-centred, high-quality care.

The organisation provided comprehensive staff wellbeing resources and offered a wide range of benefits. These included access to a 24/7 employee assistance programme, counselling and bereavement support, a dedicated organisational wellbeing team, occupational health, freedom to speak up service and human resource team. The service also provided paid monthly wellbeing time, and each staff member received a card, and a day’s paid leave for their birthdays. The psychology team supported staff with reflective practice sessions and debriefs and were also available on an ad-hoc basis when required. Managers facilitated flexible working patters for staff, around health needs, or caring responsibilities.

Managers supported staff to develop their skills and careers, with service managers holding regular staff engagement sessions. Appraisals and supervisions included discussions about career progression, and staff had opportunities to take on new responsibilities, and apply for training. Staff received training focused on recovery orientated practice, community reintegration, and promoting autonomy. Managers demonstrated a strong commitment to supporting and enabling their workforce. By looking after staff health and wellbeing, making every effort in maintaining safe staffing levels, and recognising and developing staff, leaders enabled them to confidently deliver high-quality person-centred care.