Lime Tree Manor Residential Home provides care and support for up to 110 older people, some of whom may be living with dementia. At the time of our inspection there were 107 people living at the service.

At the last inspection in March 2015, the service was rated Good.

At this inspection we found the service remained Good.

The service has a registered manager. 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.

Quality monitoring systems and processes were used to drive improvements in the service. However the systems in place did not always effectively identify where action needed to be taken.

People felt safe in the service. Staff were knowledgeable with regards to safeguarding peoples and understood their responsibilities to report concerns. There were effective safeguarding procedures in place and staff had received safeguarding training.

Potential risks to people’s health, safety and wellbeing had been identified. Personalised risk assessments were in place that gave guidance to staff on how individual risks to people could be minimised. Medicines were stored appropriately, managed safely and audits completed.

There were sufficient numbers of staff on duty to meet people's needs. Staff recruitment was managed safely and robust procedures had been followed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

Staff were well trained and completed an effective induction programme when they commenced work at the service. Staff were supported in their roles and received regular supervision and appraisals. Staff were positive about the training and support they received.

People were supported to make decisions about their care and support. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

People were supported to make choices in relation to their food and drink and a varied menu was offered. People's health care needs were being met and they received support from health and medical professionals when required.

People and their relatives were complimentary about staff. They told us staff were kind, considerate and respectful. People's privacy and dignity was promoted throughout, their care and consent was gained before any care was provided.

People's needs had been assessed and care plans took account of their individual needs, preferences and choices. Care plans and risk assessments had been regularly reviewed to ensure that they were reflective of people's current needs.

People were encouraged and supported to participate in a range of activities and received relevant information regarding the services available to them.

The service was led by a registered manager who was visible and approachable. People, relatives and staff spoke highly of the registered manager and their ability to manage the service.

People, relatives and staff knew who to raise concerns with and there was an open culture. People and their relatives were asked for their feedback on the service and comments were encouraged.

Lime Tree Manor Residential Home provides care and support for up to 110 older people, some of whom may be living with dementia. At the time of our inspection there were 107 people living at the service.

At the last inspection in March 2015, the service was rated Good.

At this inspection we found the service remained Good.

The service has a registered manager. 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.

Quality monitoring systems and processes were used to drive improvements in the service. However the systems in place did not always effectively identify where action needed to be taken.

People felt safe in the service. Staff were knowledgeable with regards to safeguarding peoples and understood their responsibilities to report concerns. There were effective safeguarding procedures in place and staff had received safeguarding training.

Potential risks to people’s health, safety and wellbeing had been identified. Personalised risk assessments were in place that gave guidance to staff on how individual risks to people could be minimised. Medicines were stored appropriately, managed safely and audits completed.

There were sufficient numbers of staff on duty to meet people's needs. Staff recruitment was managed safely and robust procedures had been followed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

Staff were well trained and completed an effective induction programme when they commenced work at the service. Staff were supported in their roles and received regular supervision and appraisals. Staff were positive about the training and support they received.

People were supported to make decisions about their care and support. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS).

People were supported to make choices in relation to their food and drink and a varied menu was offered. People's health care needs were being met and they received support from health and medical professionals when required.

People and their relatives were complimentary about staff. They told us staff were kind, considerate and respectful. People's privacy and dignity was promoted throughout, their care and consent was gained before any care was provided.

People's needs had been assessed and care plans took account of their individual needs, preferences and choices. Care plans and risk assessments had been regularly reviewed to ensure that they were reflective of people's current needs.

People were encouraged and supported to participate in a range of activities and received relevant information regarding the services available to them.

The service was led by a registered manager who was visible and approachable. People, relatives and staff spoke highly of the registered manager and their ability to manage the service.

People, relatives and staff knew who to raise concerns with and there was an open culture. People and their relatives were asked for their feedback on the service and comments were encouraged.

The inspection team was made up of two inspectors. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with all said that they felt safe living at the home. People told us that they felt their privacy and dignity were respected. We saw evidence that care plans were person centred and risk assessments had been undertaken to help minimise the risk to people living at the home. The manager had regularly undertaken un-announced night visits to ensure that people were safe in the home.

The provider had an infection control protocol that staff followed, which ensured that the home was kept clean. There were systems in place to reduce the possibility of cross contamination within the laundry area of the home.

Is the service effective?

We looked at the care records of eight people who lived at the home. We found these provided details of what support people needed. However, we noted that the care plan did not show peoples preferences on whether they were supported by a male or female carer. People told us that they were happy with the care that they had received. One relative told us, “they felt reassured that they could entrust their relative into the care of staff at the home”.

The provider had undertaken capacity assessments where it was deemed that people were not able to make decisions about their care and treatment. Although the provider had not made any applications to the local authority in respect of Deprivation of Liberty safeguarding (DOLs), the provider had a clear protocol in place for dealing with Deprivation of Liberty safeguarding.

Is the service caring?

During our inspection we saw that staff were supporting people to undertake tasks. People we spoke with all stated that staff were caring and helpful. A relative we spoke with said “the staff are so kind, caring and patient with our relative”. A service user we spoke with said “I don’t worry about anything since I came to live here”. Another person told us they enjoyed the gardens and being able to sit out in the sunshine.

Is the service responsive?

People we spoke with all told us that they did not have to wait long for staff to respond to their call for assistance once they had pressed their call buzzer. They felt that staff had attended to their call in a timely manner. We also observed staff assisting people over lunch and noted their interactions were responsive and appropriate.

Is the service well-led?

The service had a robust quality assurance system in place. Audits had been undertaken in a number of areas and were addressed in a timely manner. Records were being stored in a secure way and were easily accessible. Managers had appropriate processes in place to ensure the service ran smoothly in respect of leadership, management and governance of the organisation which assured the delivery of high-quality person-centred care, supports learning and innovation, and promoted an open and fair culture.

People we spoke with were generally complimentary about the service and the care provided. A person described the staff as 'very nice people'. This was echoed by another person who said, "Staff are very good and caring." Another person said, "We love it here. I have no complaints."

People said that they were given a choice of activities and a choice of menu. A person we spoke with said that they had been involved in residents' meetings, where they had discussed the menu and the activities. Another person commented, "The staff listen and give you whatever you want. If you are hungry, you can have sandwiches. There is plenty of fruit available for you to help yourself." During our visit, we noted a selection of fruit and jugs of soft drinks available in each of the lounges and communal areas.

A person remarked that the food served was 'very good'. We noted that the menu planning had reflected the diverse needs of people, and had accommodated their requests and preferences. People we spoke with confirmed that staff showed them respect, and took account of their likes and dislikes. This was echoed by another person who commented, "Everything has gone very well. Staff discuss with me what I like, and they got me to sign my care plan."

When we had conversations with people who live in Lime Tree Manor on the 12 January 2012 they told us that they felt that they were involved with decisions about their own care and that their wishes and preferences were taken into account in the way that it was provided day by day.

All of the people living in Lime Tree Manor that we talked with told us that they were treated with respect by care staff and that they felt able to talk to them freely about any concerns they might have.They confirmed that there are regular meetings of people living in Lime Tree Manor and the management team and that they can raise any matters they want to then.

Those people we spoke with who were able to discuss the details of their care confirmed that they knew about their care plans and most of them told us that they were involved in reviews of their care. Those that were not sure how involved they were personally with their own care plans indicated that they preferred their relatives to deal with them on their behalf.

Although we did not specifically speak to people living in Lime Tree Manor about safeguarding people from abuse, none of those people we did have conversations with raised any concerns about their well-being or safety and in a survey carried out by Wilton House Limited in late August 2011 all of the fifty two people living in Lime Tree Manor who responded said that they felt 'secure' and that staff were always on hand to assist them.

On this occasion we did not specifically speak to people living in Lime Tree Manor about supporting staff although they all told us that they felt that they received a high standard of care from the care staff.

People who live in Lime Tree Manor confirmed that they were asked to give their views about their care experience in surveys that are conducted regularly by Wilton House Limited. They also told us that they can attend regular residents' meetings where they are able to raise issues like the quality of food and other matters about the routines of the home.Each of the people we spoke to also told us that they felt able to talk to care workers or the management team about any concerns they might have at any time.

We visited this home over two days and spoke with 18 people living in the home, three visitors, and eleven staff and looked at the care plans and records for seven people.

One person told us "I like it here; I wouldn't be anywhere else". Another told us "I can't praise the staff enough; they are so polite and helpful". A third person said "I like it here and I am happy here. The food is good".

One visitor told us "I am happy with the care here and have no reason to complain."

Generally people appeared well groomed but we found that not all of the people's needs had been reflected in sufficient detail in their care plans.

We found that the home had not always identified and responded appropriately to minimise the environmental risks in the premises, especially where people had a dementia.

On the two days of our visit, the home had enough skilled staff on duty.

The home had an effective system in place to respond to complaints.

The home did not have a robust system in place to store people's confidential information appropriately.