The Limes

Updated 14 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 10 January 2018 and was unannounced. Two adult social care inspectors undertook the inspection.

Prior to the inspection, we contacted local authority commissioners and the safeguarding team to gain their views about the service. We looked at notifications that the provider had submitted to the Care Quality commission (CQC). Notifications are forms, which the provider has to submit to us by law. They tell us how the provider manages incidents and accidents for people in their care. We also looked at the 'Enter and View' report completed by Healthwatch. The 'Enter and View' report identifies areas of good practice and makes recommendations for improvements.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection, we talked with three people who used the service, the provider, the registered manager and three members of staff. After the inspection, we spoke with three relatives and two health care professionals to gain their views of the service provided.

We completed a tour of the building and we observed how staff interacted with people in the communal areas of the service. We looked at two people’s care records and three medication administration records (MARs).

We reviewed how the service used the Mental Capacity Act 2005, to ensure that when people were assessed as lacking capacity to make their own decisions, best interest meetings were held to make important decisions on their behalf.

We looked at the recruitment, supervision and training records for two members of staff and we saw documentation and records relating to the day-to-day running and management of the service. These included accident and incident records, maintenance certificates, meeting minutes, audits and complaints.

After the inspection, we asked the registered manager to send us further information regarding risk assessments and supervision records. We also requested the contact details for people’s relatives. This information was received by the requested time, which helped us to make a judgement about the service.

Updated 14 March 2018

The Limes is a residential home registered to provide care and accommodation for up to nine younger adults with a learning disability and/or autism. It has several communal areas including a lounge, dining room, games room and two kitchens. There are nine bedrooms; seven with en-suite and two within a self-contained flat, accessible by stairs. The home has a secure outside space, is located close to local amenities and overlooks a park.

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.