About the service: Lime Tree House is registered for 10 beds and provides nursing care and accommodation for people with a learning disability and /or mental health needs. On the day of our visit 9 people were living at the home.

People’s experience of using this service:

People were protected from the risk of harm by staff who understood their responsibilities to safeguard people. The risk of people acquiring an infection, was minimised by the infection control procedures in place. Risks were assessed and managed and people were supported to lead full lives by taking reasonable risks. People were supported to take their medicines in a safe way. Recruitment checks were undertaken, to determine the suitability of new staff and protect people that used the service.

People were supported to make decisions about what they ate, to ensure the meals met their preferences and dietary needs. Drinks were available to people throughout the day. Where people were unable to independently make specific decisions regarding their care; assessments were undertaken to determine the support they needed with these decisions. This ensured people were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. People and their representatives were involved in their care to enable them to receive support in their preferred way. People had access to healthcare services and received coordinated support, to ensure their preferences and needs were met.

People were supported to take part in social activities of their choice, both in and out of the home to enhance their well-being. Information was available in an accessible format to support people’s understanding. People maintained relationships with their family and friends and were encouraged to give their views about the service. This included raising any concerns they had. There were systems in place to monitor the quality of the service and drive improvement.

More information is in the full report below.

Rating at last inspection: Requires Improvement (report published 7 September 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we saw that improvements have been made.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 3 August 2017 and was unannounced. This meant that the staff and provider did not know that we would be visiting.

Lime Tree House is a nursing home for up to 10 people living with a learning disability or mental health needs. At the time of our inspection nine people were living at the service.

Risks associated with people’s needs had not been fully assessed and planned for. Where changes occurred these were not picked up on and care plans were not always amended to reflect this need. Whilst some risks posed by the environment had been assessed and were monitored, window restrictors were not in place and a risk assessment had not been completed. The registered manager took immediate action to address this.

The storage and management of medicines were found to be safe. Some minor concerns were identified that included one medicine which had not been dated when opened and some gaps in recording people’s preferences for taking medicines. Not all people’s preferences of how they wished to take their medicines had been recorded. The registered manager took immediate action to address these issues.

People’s rights under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were not fully protected. Some staff lacked a clear understanding of the principles of this legislation and how to apply it.

People’s needs were assessed before admission to Lime Tree House. Care plans were developed with people and their relatives and others, where appropriate. This ensured staff had the required information to meet people’s individual needs. Staff were observed to be responsive to people’s needs, routines and interests. Some care plans lacked specific information and guidance for staff and staff reported they were struggling with new documentation that had been introduced. This was discussed with the management team and action was taken to address this.

Staff were aware of their role and responsibility in protecting people from avoidable harm. They had attended appropriate safeguarding training and had policies and procedures to support them.

Staffing levels were sufficient, flexible and regularly reviewed to ensure they were appropriate. Safe staff recruitment checks were in place and used effectively to ensure that staff employed at the service were suitable.

Staff received an appropriate induction, ongoing training, support and opportunities to review their work. People’s nutritional needs had been assessed and planned for and they were supported to maintain good health and access primary and specialist healthcare services.

Staff were kind, caring and sensitive in their approach towards the people they supported. Staff understood people’s diverse needs and had developed positive relationships with people they supported. Staff demonstrated empathy and good communication skills. Independence was promoted and privacy and dignity respected.

People, relatives, staff and external professionals were positive about the leadership of the service. The vision and values of the service was clearly known, understood and demonstrated by staff. There were systems and processes in place that monitored the quality and safety of the service. People, relatives, staff and external professionals received opportunities to share their experience about the service and people had access to the complaint policy and procedure.

Where some issues were identified during our inspection visit the management team were quick to respond. The management team were positive and committed in continually driving forward improvements and had an ongoing development plan to support them to achieve this.