The Limes

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were protected by a consistent and effective approach to safeguarding, whilst positive risk-taking was promoted to support independence and recovery. Patients were fully involved, and the service was open and transparent when things went wrong.

The environment was safe, clean, well equipped, well maintained, and fit for purpose. Staff assessed and managed risks to patients and themselves effectively and understood how to protect people from abuse. Staff worked effectively with other agencies to safeguard people. Staff used systems and processes to safely prescribe, administer, record, and store medicines, and they managed patient safety incidents appropriately to support ongoing recovery and rehabilitation.

We have not awarded this service a score for Safe.

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

Staff were proactive and had a consistent approach to safety and learning. Staff reported all incidents including near misses, and any alleged incidents through an electronic incident reporting system. Anyone who witnessed an incident completed an incident report promptly, and staff confirmed this occurred consistently.

Learning from incidents were regularly discussed during morning meetings and handovers and reviewed through clinical governance processes. Staff gave examples of learning following safeguarding concerns. For example, incidents of risk-taking behaviours during community leave, which led to collaborative working with external partners to reduce the risk of repeated occurrences. One staff member told us, “We always learn lessons from incidents, and always have incident reviews. Learning is shared throughout our teams, and it helps us to improve.”

Staff felt confident, and safe to raise concerns and participated in regular debriefs following incidents. Patients were supported through debriefs when required. Staff also attended regular incident, and risk overview meetings. This resulted in practical improvements in risk monitoring and management, ensuring patient safety whilst promoting independence and rehabilitation goals.

Patient’s felt supported and reassured during referral, admission, transfer and discharge processes, which helped to lessen anxiety during times of change. Staff gave patient’s information about what to expect from their care and treatment in a variety of formats to suit their individual communication needs.

Staff and leaders explained that the service had effective systems in place that ensured safe admissions, transfers of care and discharge planning, and reviewed referral documentation carefully. Staff understood the importance of robust admission processes, as this ensured the referred patient was appropriate for the service and their needs could be met. Leaders promoted the importance of early planning and communication across teams.

Staff followed a structured process where they completed a comprehensive admission process when patients came into the service, this involved the patient as much as possible and was reviewed regularly. Discharge planning involved co-ordination between services. For example, community mental health and community forensic mental health teams to ensure safe and supported transitions and ongoing care and support. Staff were focused on achieving discharges in a timely manner wherever possible. Communication during transitions was effective, and with the patient’s consent, families were able to book additional appointments with the responsible clinician and service managers for updates and support.

The service worked collaboratively with external organisations to improve access and transitions between services. Staff worked collaboratively with community teams to plan and facilitate care. Staff facilitated access to post-discharge support, including community mental health teams, local authority 117 aftercare and community mental health crisis teams. treatment and support were tailored to meet each person’s individual needs. Staff managed safety during transition to and from the service which effectively promoted recovery, rehabilitation and independence.

Patients felt safe, as staff worked with them effectively to understand what being safe meant for each individual person and the best way to achieve this. Staff focused on improving patients’ lives and supported them in their right to live free from abuse, discrimination and avoidable harm. Staff raised safeguarding concerns promptly. The service had two safeguarding leads on site, and an organisational safeguarding team who offered advice, and support when required. One patient told us, “I feel safe, staff are always around. I know I can go to staff anytime I need to if I don’t feel great about something.”

Staff completed mandatory safeguarding training and understood what to report, how to report and how to escalate concerns. They protected patients from avoidable harm and discrimination, including those with protected characteristics under the Equality Act 2010. Staff identified adults at risk and worked effectively with external agencies, such as social workers and the local authority safeguarding team when required.

Leaders ensured staff had the knowledge, support, and confidence to act appropriately and promptly to safeguard the patients they cared for. One staff member told us “You always think about the right way to support the patient, and in a way that they understand, and makes sense to them. Always considering individual vulnerabilities.”

The service had effective safeguarding systems, policies, and procedures in place that upheld patients' human rights and promoted a culture of safety. No safeguarding referrals had been made in the 3 months prior to our assessment.

Patients felt involved in discussions about their risks and appreciated how staff maintained safety whilst promoting autonomy and recovery. We reviewed 6 risk management plans and found they were person-centred with obvious patient and family involvement and were reviewed in line with organisational policy. Staff worked with patients to understand and manage risks; risk matrixes and risk assessments were completed in the first 24-hours of admission and used recognised tools such as the Historical, Clinical, Risk Management-20 in conjunction with the structured assessment of protective factors for violence risk (SAPROF). SAPROF assessed the patient’s protective factors for violence risk ensuring care was safe, supportive, and recovery focused.

Staff assessed and managed risks to patients and themselves, followed best practice guidance and built meaningful therapeutic relationships with patients which enabled them to anticipate and de-escalate any potential incidents promptly. Staff also completed risk assessments when patients engaged in 1 2 1, group or social activities to ensure safety while promoting engagement. Staff participated in the organisations “Therapeutic management of Violence and Aggression” training, which supported safer, recovery-focused care. Patients were involved in developing and reviewing care and risk management plans and participated in multidisciplinary team meetings (MDT)

The service had a least restrictive practice lead. Staff promoted least restrictive practices, as they recognised the positive effect on the patient’s recovery, independence, and quality of life. Teams across the service discussed reducing restrictive practices regularly at meetings and held internal audits to ensure they were meeting their own expectations.

Staff adapted communication methods to ensure patients understood their care and treatment. Staff completed hospital, and communication passports for patients with an identified need. They supported patients to provide feedback through community meetings and ensured access to services, such as Independent Mental Health Advocacy. Staff followed clear policies for observation levels, placing new admissions on the appropriate level of observations based on assessed risk whilst maintaining a least restrictive approach.

Patient’s felt the environment was safe. One patient told us, “There’s always plenty of staff about, there’s even one on garden duty to make sure anyone outside is okay.” Staff maintained clean and well-equipped environments that promoted and supported the safe delivery of care. Equipment was audited, maintained, stored securely and used appropriately.

There was a security nurse on each shift who completed regular security and safety checks of the environment, this ensured there were no unidentified risks, including ligature risks, any concerns were fed back at shift handover meetings and addressed promptly. Staff carried personal alarms and radios, and patients had access to nurse call systems throughout the environment to ensure they could request assistance, or support if required. CCTV and convex mirrors were situated throughout the service in mitigation of potential blind spots.

Staff were visible and available throughout the environment, and a staff member was allocated to zonal observations of the garden area, which ensured safety was maintained. Facilities, equipment, and technology supported staff to deliver safe and effective care, and staff considered how environments could keep people safe from psychological harm as well as physical harm, including attention to sexual safety and sensory needs.

Patients felt safe and supported by staff, and described staff as well-trained, attentive, responsive, and professional. Leaders maintained safe and effective staffing levels to deliver person-centred care. Leaders calculated the required numbers of staff and adjusted them daily to meet the needs of the patients and the service. patients received consistent support, and their needs were met effectively. It also ensured meaningful engagement was available on a regular basis.

The appropriate employment checks were completed prior to staff starting work. When necessary, organisational bank staff were used to maintain safe staffing levels, with the vast majority of bank staff being regular to the service, and familiar with the environment and patients. The service maintained adequate medical cover day and night, with an on-call doctor, pharmacist and manager being available, and able to respond promptly in cases of emergency.

Staff achieved 100% compliance with mandatory training, supervision and appraisals. They reported that training was tailored to their development needs, including recovery and rehabilitation-focused approaches, and risk management. Staff at all levels were encouraged and supported to complete additional training in areas of interest which were relevant to the service type, for example, enhanced trauma work. All staff completed a comprehensive induction. Staff had regular structured supervision, and managers addressed poor performance appropriately. Staff accessed regular breaks, and rest periods in a purpose-built staff hub that was situated separately to the care environment.

Staff were experienced, skilled, and received ongoing training relevant to their roles. Regular supervision, annual appraisals, and opportunities to further develop skills and knowledge, ensured competency and effective delivery of care.

Policies and guidance supported the supervision process and promoted professional development. Staff had the training, support, and resources needed to meet the needs of their patient’s and provided recovery focused care, rehabilitation and promoted independence.

Patients felt confident in the infection prevention and control (IPC) measures in place and were assured that staff were taking appropriate precautions to protect them from the risk of infection. One patient told us “The cleaners are lovely: they’re always around keeping the place nice. They always make time to have a chat too.”

Staff adhered to infection prevention and control principles and consistently followed handwashing protocols, used personal protective equipment (PPE), and cleaned equipment in line with guidance. We observed all environments to be clean and well-maintained. Cleaning records evidenced areas were cleaned regularly. Staff followed the appropriate handwashing and infection control procedures and had a clear understanding of their roles in maintaining a clean and safe environment. Hand sanitising stations were situated throughout the service.

Processes were in place for assessing and managing infection risks. Infection, prevention and control procedures aligned with current national guidance. Infection control audits were conducted regularly, and any concerns were addressed. Identified risks were shared appropriately with external agencies, staff, patients, and visitors to the service. Staff had an infection, prevention and control team for advice, and support. There were clear roles and responsibilities for infection prevention and control, and staff received ongoing training in line with best practice guidance.

Staff explained medicines clearly to patient’s, which ensured that they felt safe, informed, involved and supported in decisions about their treatment. Patients were supported to make decisions, and staff actively supported understanding and promoted choice, encouraging patients to take responsibility for managing their medicines safely. Some patients were supported to self-administer medicines in readiness for rejoining their communities. Patients who self-administered medicines without supervision, signed a contract and consented to take their medicines appropriately. Patients stored medication securely in their rooms with the appropriate safety measures, and regular monitoring in place from staff, which ensured medicines concordance, and patient safety.

Medicines were managed in a safe and effective way, and clinic rooms were fully equipped with accessible resuscitation equipment and emergency medicines, which staff checked regularly to ensure preparedness for any emergency situation. Staff adhered to best practice and national guidance, including storage, recording, administration and disposal of medication. Staff completed training and competency assessments before administering any medicines. Medicines, including controlled drugs were stored securely and appropriately. A pharmacist completed regular audits and advised of actions needed when required. Managers monitored findings from audits, shared alerts, and addressed any required actions through clinical governance meetings. Staff completed medicines reconciliation and maintained up-to-date records to ensure continuity of care when patients were discharged or transitioned between services.

Medicines were regularly reviewed in multi-disciplinary meetings, and patients were involved in decisions about their medicines wherever possible with preferences and capacity documented in care plans. Staff monitored the effects of medication on physical health, particularly for patients prescribed psychotropic medicines, in line with guidance. They reviewed as required (PRN) medicines regularly which ensured patient’s behaviour was not inappropriately controlled by medication.