Lime Trees provides accommodation and personal care for up to six people who have a range of needs including acquired brain injury, learning disability or who may be living with dementia. The service does not provide nursing care. At the time of our inspection there were six people using the service. When we last visited the service it was rated good. At this inspection we found the service was outstanding.

A registered manager was in post 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.

People received care which was extremely person centred and responsive to their needs. They were supported and fully engaged in activities that were meaningful to them.

Staff continuously looked for ways to improve care, so people had positive experiences and led fulfilling and meaningful lives. They liaised with professionals to make sure that people’s health care needs were met.

Social interaction and community acceptance was important and opportunities to access and integrate into the local community was a priority.

Staff had an excellent understanding of people's backgrounds and they supported people to pursue their interests and hobbies, try new things and learn new skills.

Peoples’ privacy was respected. Staff supported people to make individual choices on a 'moment by moment' basis.

Staff had a common aim and purpose to achieve positive outcomes for people.

Staff were exceptional at helping people to express their views, so they could understand things from their point of view.

Procedures were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. The registered manager and staff knew of their responsibilities regarding the Mental Capacity Act 2005.

Risks were assessed and control measures were in place, which still enabled people to maintain as much independence as possible. There were sufficient numbers of staff to ensure that people's needs were met.

Recruitment practices ensured that staff were of good character and suitable for their roles, and people were involved in interviewing new recruits.

People were supported to take their medicines safely, if required. Systems were in place to record when medicines were given. When a dispensing error had occurred systems were changed to make sure this did not happen again.

Staff received an induction and on-going training to make sure they had the right skills and knowledge. Staff were well supported and had opportunities to discuss any concerns and training needs they might have.

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.

There were positive relationships between people and members of staff. Staff treated people with kindness and took the time to get to know them and their interests whilst providing their care. Staff involved people in producing their care plans to ensure that care was provided to them in the way they wanted it to be.

A robust quality assurance system was in place and the registered manager looked at ways they could continuously improve the service people received.

Lime Trees provides accommodation and personal care for up to six people who have a range of needs including acquired brain injury, learning disability or who may be living with dementia. The service does not provide nursing care. At the time of our inspection there were six people using the service. When we last visited the service it was rated good. At this inspection we found the service was outstanding.

A registered manager was in post 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.

People received care which was extremely person centred and responsive to their needs. They were supported and fully engaged in activities that were meaningful to them.

Staff continuously looked for ways to improve care, so people had positive experiences and led fulfilling and meaningful lives. They liaised with professionals to make sure that people’s health care needs were met.

Social interaction and community acceptance was important and opportunities to access and integrate into the local community was a priority.

Staff had an excellent understanding of people's backgrounds and they supported people to pursue their interests and hobbies, try new things and learn new skills.

Peoples’ privacy was respected. Staff supported people to make individual choices on a 'moment by moment' basis.

Staff had a common aim and purpose to achieve positive outcomes for people.

Staff were exceptional at helping people to express their views, so they could understand things from their point of view.

Procedures were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. The registered manager and staff knew of their responsibilities regarding the Mental Capacity Act 2005.

Risks were assessed and control measures were in place, which still enabled people to maintain as much independence as possible. There were sufficient numbers of staff to ensure that people's needs were met.

Recruitment practices ensured that staff were of good character and suitable for their roles, and people were involved in interviewing new recruits.

People were supported to take their medicines safely, if required. Systems were in place to record when medicines were given. When a dispensing error had occurred systems were changed to make sure this did not happen again.

Staff received an induction and on-going training to make sure they had the right skills and knowledge. Staff were well supported and had opportunities to discuss any concerns and training needs they might have.

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.

There were positive relationships between people and members of staff. Staff treated people with kindness and took the time to get to know them and their interests whilst providing their care. Staff involved people in producing their care plans to ensure that care was provided to them in the way they wanted it to be.

A robust quality assurance system was in place and the registered manager looked at ways they could continuously improve the service people received.

One person living at Lime Trees did not speak with us but we saw that they were relaxed and happy. We spoke with other people about their life in the home and it was evident that they received appropriate care that met their individual needs.

We saw that staff knew people well and we saw caring interactions between members of staff and people living in the home; staff listened to people, treated them with respect and involved them in making decisions about their care.

People told us they were happy with the environment and their rooms were lovely.

They also said they enjoyed the food at Lime Trees and we saw that their individual nutritional needs and preferences were met.

Staff understood their responsibilities around keeping people safe and we found that care was provided safely and to a good standard. We saw that staff listened to people and responded promptly to their needs. People who completed surveys as part of the home’s quality monitoring process were complimentary about staff. One relative said: “Staff are patient and cheerful. Many thanks” and another stated: “Staff are always kind and helpful.” A health professional stated: “Excellent staff.”

Lime Trees was well managed and there were effective processes to monitor the quality of the service. They consulted with people and took their views into account to make improvements.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff.

People living at Lime Trees had complex needs and some were not able to speak with us. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home. One person was able to talk to us about living in the home and they were happy.

Relatives who returned questionnaires as part of the home’s own quality assurance process were complimentary about the care provided at the home. One relative stated “[Our relative] couldn’t wish for anywhere better.” Another relative said “Staff are always kind and helpful.”

A health care professional who completed the home’s survey made positive comments about the service and stated “We have always had a good working relationship with Lime Trees.”

A relative told us they had chosen Lime Trees after considering a number of other homes. They said they and their relative were happy with the decision and things were working well.

During our inspection we saw that people received good care and that staff treated them with respect.

The people living at Lime Trees were not able to communicate with us verbally. They shared their views through gestures, facial expressions and body language wherever possible. We saw people were relaxed and comfortable with staff and other people using the service.

During our visit we saw that staff asked people’s opinions and treated them with courtesy and respect.

Relatives who completed surveys as part of the home’s own quality assurance process made positive comments about the service their relatives received at Lime Trees. They were complimentary about the care provided, the relaxed atmosphere in the home and the friendly, welcoming staff.

Health and social care professionals who completed surveys said they had good working relationships with the service and praised the standard of care provided by the staff at Lime Trees.