Lime Court Care Home is a purpose built care home that provides personal care and support for up to 44 older people some of whom may be living with dementia. There were 38 people using the service at the time of our inspection. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff had been safely recruited and there were sufficient numbers of staff on duty to meet people's needs in a way which met their preferences and promoted their independence. People told us they felt safe. Staff had received training in the protection of adults and knew what action they should take if they suspected or witnessed abuse.

Medication was administered by staff who had received training to do so. Sufficient numbers of staff met people’s needs.

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 support this practice. The service worked well with other professionals to ensure that people's health needs were met. People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. Staff were well trained and attentive to people's needs.

Some elements of the environment required updating and the registered manager provided information that this was planned. We have made a recommendation about improving the environment for people living with dementia.

The staff were caring. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them.

Records we reviewed showed people and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and when there was a change in care needs. People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

People could choose the activities they liked to do. The provider had arrangements in place to respond appropriately to people's concerns and complaints.

Systems were in place to monitor and improve the quality of the service. Audits of the premises helped ensure the premises and people were kept safe.

Further information is in the detailed findings below.

Lime Court provides accommodation and personal care for up to 44 older people, some living with dementia.

There were 37 people living in the service when we inspected on 25 April 2016. This was an unannounced 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.

There were procedures and processes in place to ensure the safety of the people who used the service. Risk assessments provided guidance to staff on how risks to people were minimised. There were appropriate arrangements in place to ensure people’s medicines were stored and administered safely.

Staff were available when people needed assistance, care and support. Recruitment processes checked that staff were suitable to work in the service and people were safe.

Staff were trained and supported to meet the needs of the people who used the service.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were provided with personalised care and support which was planned to meet their individual needs. People, or their representatives, were involved in making decisions about their care and support.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.

As part of our inspection we spoke with two people in depth about their care and treatment at the service. We also spoke with six other people briefly about their experiences of using the service. We spoke with two relatives, the manager, the area development manager and five staff working at the service. We observed people receiving support and looked at the support plans for six people.

Below is a summary of what we found.

Is the service safe?

People who we spoke with told us that they felt safe and they liked the staff. One person said, “I like it here. The staff are nice.” Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm. People were also protected from the risk of abuse as staff showed that they had received training in this area and were clear about their responsibilities to recognise and report any concerns.

Relatives we spoke with said they were confident to raise any concerns or complaints they had with the manager.

The provider had a system in place to demonstrate that they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care under the Mental Capacity Act (2005). The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone’s behalf is recorded, including the reasons why it has been made, how the person’s wishes have affected the decision and how they were involved in the decision making process.

Is the service effective?

People we spoke with told us, and our observations confirmed, that people were happy living at Lime Court. The majority of staff we spoke with told us they enjoyed their job. It was clear from our observations, and from our conversations with staff and the manager, that staff knew people’s needs well.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People were provided with a choice of suitable and nutritious food and drink.

Support plans in people’s care records gave staff detailed guidance about the ways in which each person preferred to be supported.

Staff worked closely with professional health staff to ensure that people’s needs were met by staff with the most appropriate knowledge, skills and experience.

There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

Is the service caring?

We saw that people related well with the staff who treated them with kindness and in a friendly manner. One of the staff we spoke with said, “I really enjoy working here.” We observed that people’s individual requests were listened to and that staff spoke to people and responded to them in a respectful way. One person said, “The staff are kind.” One person’s relative said, ”My family member is very happy here. Everything is excellent.”

Is the service responsive?

People’s care and support needs were regularly re-assessed by the management team and the staff at the service. Support plans included people’s preferences and their likes and dislikes to ensure that care and support were provided in a way they wanted them to be. We saw that when people’s health needs and nutritional health needs changed, staff were able to respond to their needs to ensure an appropriate response.

Is the service well led?

The majority of staff told us they felt well supported by the management team. One person said, “The manager is firm but fair. They are approachable and you get a positive response from them.” The staff we spoke with told us they were trained to do their job.

People we spoke with who lived in the service, and relatives, told us they felt the service was well-managed. The provider had effective quality assurance and audit systems in place to monitor all aspects of the service and ensure improvements were made where necessary.

We inspected Lime Court on 05 November 2013.

During the inspection we were given positive comments from people receiving care. One person told us: "The staff are really friendly and approachable."

Staff members obtained consent from the people they were caring for before any care was provided. We saw that staff spoke kindly to people living at Lime Court and there was a calm, happy, and relaxed atmosphere.

People were protected against the risks associated with medicines because arrangements were in place to safely manage medicines.

We looked at the systems in place to support staff to deliver care and treatment safely and to an appropriate standard.

The processes and systems used by the provider ensured records were accurate, appropriate and well maintained.

We used a number of different methods to help us understand the experiences of people who used the service, as some of the people using the service had complex needs which meant they were not able to tell us their experiences. Where people were unable to provide a response or tell us about their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Lime Court to be positive.

We observed that staff members were polite and attentive towards people who used the service, in particular those people with no or limited verbal communication. We saw that staff made good eye contact with people that were unable to communicate and used touch, such as holding people's hands or stroking their upper arm to reassure them when they reached out to staff.

People told us they were satisfied with the level of care and support they received at Lime Court. One person told us "It's lovely here they cannot do enough for you."

Feedback about the service from the relatives we spoke with was positive and the comments they made to us during the inspection were relayed back to the manager. They told us that staff were kind, approachable, listened to their views, provided good care and were always available. One relative said "I trust the staff to do their job of looking after my relative and they do it very well".

People with whom we spoke told us that they were happy living at Lime Court and received good care. We saw that the people who used the service and staff got on well together, the staff were respectful, patient and kind. Relatives with whom we spoke told us "My X is well looked after here and I know that the staff keep X safe and comfortable."