We carried out an unannounced inspection at Lime Tree House on the 3 August 2017. At the last inspection the service was rated outstanding in caring and good all other domains. This meant the service was rated good overall.

Lime Tree House provides both short term and long term residential accommodation for people (who prefer to be referred to as patients) who follow Christian Science practice. People are supported by Christian Science Nurses (CSN’s) who are non medical nurses trained in healing through Christian Science practices. The nurses have completed an in depth Christian Science nursing programme and were qualified in spiritual healing to enable them to support people in line with their beliefs and Christian Science practices. At the time of the inspection the service supported five people.

There was a registered manager at the service. 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.

Without exception the feedback we received about care people received was excellent. Relatives told us how the service had made a difference to people’s lives and people had become more independent with the caring and patient support they had received from staff.

People’s religious beliefs and practices were considered throughout the support provided, which was an important part of people’s daily lives and this was promoted and respected by all staff.

People’s independence was promoted throughout the support provided and the positive support staff provided had enabled people to regain their independence in line with their wishes and agreed outcomes.

People were supported to spend their time in a way that promoted their health and spiritual wellbeing, which was important to them.

The registered manager was highly regarded by people, relatives and staff and led the staff by example. The values of the service were promoted and understood by staff. The registered manager monitored the service and had a clear overview of people’s needs. There was clear evidence that the registered manager strived to make improvements to ensure people received high quality care and support.

The provider also had a good overview of the service because they were kept informed of any issues by the registered manager and supported areas of improvements that were put forward by the registered manager.

The registered manager encouraged and supported staff to gain further knowledge and experience through extensive training in Christian Science practices and staff received regular updates which ensured people received safe and effective care that met people’s needs.

People’s risks were planned and managed in a way that promoted their independence whilst keeping people safe from harm.

People were protected from the risk of abuse because staff had a good understanding of the signs of abuse and their responsibilities to report any concerns.

We found there were enough suitably recruited and qualified staff available to meet people’s needs. Staff received intensive induction and further training to ensure that they were confident to provide support to people.

People’s nutritional risks were managed and monitored and people were supported to access health professionals to maintain their health and wellbeing.

People were supported to consent to their care. Plans had been implemented to ensure that if people lost the ability to consent the care provided was in line with their future wishes and they would receive care in their best interests.

People and relatives knew how to complain and complaints were dealt with in line with the provider’s policies.

We carried out an unannounced inspection at Lime Tree House on the 3 August 2017. At the last inspection the service was rated outstanding in caring and good all other domains. This meant the service was rated good overall.

Lime Tree House provides both short term and long term residential accommodation for people (who prefer to be referred to as patients) who follow Christian Science practice. People are supported by Christian Science Nurses (CSN’s) who are non medical nurses trained in healing through Christian Science practices. The nurses have completed an in depth Christian Science nursing programme and were qualified in spiritual healing to enable them to support people in line with their beliefs and Christian Science practices. At the time of the inspection the service supported five people.

There was a registered manager at the service. 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.

Without exception the feedback we received about care people received was excellent. Relatives told us how the service had made a difference to people’s lives and people had become more independent with the caring and patient support they had received from staff.

People’s religious beliefs and practices were considered throughout the support provided, which was an important part of people’s daily lives and this was promoted and respected by all staff.

People’s independence was promoted throughout the support provided and the positive support staff provided had enabled people to regain their independence in line with their wishes and agreed outcomes.

People were supported to spend their time in a way that promoted their health and spiritual wellbeing, which was important to them.

The registered manager was highly regarded by people, relatives and staff and led the staff by example. The values of the service were promoted and understood by staff. The registered manager monitored the service and had a clear overview of people’s needs. There was clear evidence that the registered manager strived to make improvements to ensure people received high quality care and support.

The provider also had a good overview of the service because they were kept informed of any issues by the registered manager and supported areas of improvements that were put forward by the registered manager.

The registered manager encouraged and supported staff to gain further knowledge and experience through extensive training in Christian Science practices and staff received regular updates which ensured people received safe and effective care that met people’s needs.

People’s risks were planned and managed in a way that promoted their independence whilst keeping people safe from harm.

People were protected from the risk of abuse because staff had a good understanding of the signs of abuse and their responsibilities to report any concerns.

We found there were enough suitably recruited and qualified staff available to meet people’s needs. Staff received intensive induction and further training to ensure that they were confident to provide support to people.

People’s nutritional risks were managed and monitored and people were supported to access health professionals to maintain their health and wellbeing.

People were supported to consent to their care. Plans had been implemented to ensure that if people lost the ability to consent the care provided was in line with their future wishes and they would receive care in their best interests.

People and relatives knew how to complain and complaints were dealt with in line with the provider’s policies.

There were only four patients receiving care on the day of the inspection, we sampled three care records, spoke to staff and patients.

Patients told us: “I like all the people here. I’m happy” and “The night nurse checks in on me every couple of hours, if I am awake and need anything like shutting my window they help. You can always ask for a drink and they will bring you a drink. I’m comfortable and warm.”

We saw policies and procedures were in place to ensure patients were cared for appropriately, including privacy and dignity, and moving and handling. We observed staff respecting patients' privacy and dignity during our inspection. During our inspection we observed positive interactions between staff and patients; staff had a clear understanding of patients’ needs and were kind and respectful.

All members of staff we spoke with understood the principles of obtaining consent, including issues relating to mental capacity.

We discussed with staff on the day of our visit their understanding of and training in protection of vulnerable adults and children. The staff were able to demonstrate a clear understanding of their roles and responsibility to safeguard patients.

We found Lime tree house to be bright, clean, airy environment. We saw all areas had been cleaned to a high standard including communal areas, and patient’s en-suite facilities.

Lime Tree House was a converted bungalow which provides Christian Science Nursing care for up to four people (who prefer to be referred to as patients). Building work was in progress at the home to increase the number of bedrooms, office space and staff rooms.

Lime Tree House provided holistic, religious, non medical Christian Science nursing care.

We found a bright, clean, airy, homely environment. All patient rooms were en-suite and situated on the ground floor.

We found that nursing care was delivered by Christian Science nurses who have completed an in depth nursing programme and are all named in the Journal of Christian Science. They were supported by a Christian Science practitioner.

People we spoke to told us: "I am very well looked after here, they address my every need, nothing is too much trouble for them".

"We are such a close team we get on well together and all work for a common purpose our patients".

People using this service told us that they were happy and well cared for. They said that their privacy and dignity was respected and they were able to make choices about how they lived their day to day lives.

Some comments we received from people living at Lime Tree House were:

“Privacy and dignity is definitely respected.”

“We do get choices, the staff are very good”.

“Absolutely I am well cared for”.

“The meals are very nice”.

“The food is good, the chef speaks to us regularly about what we like. She is very good and really looks after us and the staff”.

“Snacks and drinks are available on request”.

“I feel safe here, the staff are very nice”.

“The staff are well trained”.

As part of this review process we contacted Trafford Local Involvement Networks (LINks). LINKs are groups of individual members of the public and local voluntary/community groups who work together to improve health and social care services. They gather the views of local people and use them to influence how health and social care is commissioned and delivered. No concerns were raised by LINKs.