We carried out an unannounced inspection on 2 May 2017.

The Limes is a residential care home that provides care for up to 40 older people who live with dementia, physical disability and mental health. Accommodation is on two floors connected by a lift. There are communal lounges on both floors and a dining room on the ground floor. People using the service have access to a garden. At the time of our inspection 37 people were using the service.

At our last inspection in October 2014, the service was rated ‘Good’. At this inspection we found that the service remained ‘Good’ for being safe, effective, caring, responsive and well-led.

People continued to receive safe care. All staff, including care workers and domestic staff knew how to recognise and report any signs that people were abused or at risk of abuse.

The provider had assessed risks relating to people’s care to help them to remain safe whilst encouraging them to be as independent as they wanted to be. The provider had procedures in place for staff to report concerns and for those concerns to be investigated and acted upon.

Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. People were supported to receive their medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision and training that they required to work effectively in their roles. People were supported with their nutritional and health needs and were supported to access health services when they needed to.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People developed positive relationships with the staff that were caring and treated them with respect, kindness and dignity.

People had care plans in place that were focused on them as individuals. This allowed staff to provide consistent support in line with people’s personal preferences.

People’s needs were met in line with their individual care plans and assessed needs. Staff understood people’s needs and provided care and support that was tailored to their needs. This included providing people with stimulating and meaningful activities.

People and their relatives felt they could raise a concern and the provider had systems to manage any complaints that they may receive.

The provider had effective arrangements for monitoring and assessing the quality of care people experienced. These included seeking and acting upon the views for people who used the service, their relatives, staff and health professionals who visited the service.

Further information is in the detailed finding below.

This inspection took place on 2 October 2014 and was unannounced.

The Limes is a residential care home which specialises in caring for adults with dementia, learning disabilities, mental health conditions, physical disabilities and sensory impairments. The service is registered to accommodate up to 40 people. Thirty nine people used the service at the time of our inspection.

A registered manager was 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 and associated Regulations about how the service is run.

People who used the service told us they felt safe. People were protected from harm and abuse because the provider had safeguarding procedures that staff understood and used. Staff knew how to identify and report any concerns they had about people’s safety. People’s plans of care contained risk assessments of activities associated with people’s care which reduced the risk of them experiencing harm.

Enough suitably trained staff were on duty to meet the needs of people using the service. The provider had robust recruitment procedures that ensured as far as possible that only people suited to work at the service were employed.

People were supported to receive their medications at the right time. The service had safe arrangements for the management of medicines.

People were cared for and supported by staff who had received relevant training that enabled them to understand and meet their needs. Staff understood how the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) applied to people who used the service. MCA and DoLS set out the requirements for ensuring that decisions are made in people’s best interests when they are unable to do this for themselves.

People were supported to have sufficient to eat and drink throughout the day and people’s dietary needs were met and their food preferences respected. People were supported to maintain their health. The service had arranged for regular visits by a doctor, district nurses and other health professionals to attend to people’s health needs.

Staff treated people with dignity and respect. Staff had developed caring relationships with the people they supported. The service involved people and their relatives in decisions about their care and support. People had access to independent advocacy services if they needed them.

People’s plans of care contained information about their individual needs. Staff referred to plans of care and provided care in line with those plans. People were encouraged to share their experience of the service with staff and knew how to raise any concerns. People’s views had been acted upon.

The registered manager had a clear vision about what they wanted the service to achieve. That vision was understood and supported by staff. People using the service, their relatives and staff were involved in developing the service.

The registered manager understood their responsibilities and demonstrated a commitment to continually improve the service The registered manager was supported by senior managers. There was an effective procedure of analysing and monitoring the quality of the service.

We spoke with six people who used the service, five members of staff, one visitor to the service and one visiting health professional. We also reviewed six care records.

We spoke to a visiting health professional and asked them their views on the quality of care. Their response indicated they felt the care given was of a high quality. They told us: “The care given to the person I am visiting is positive and refreshing. They have blossomed since coming here”.

We spoke with the manager who explained that the provider had recently inspected the premises and had initiated a refurbishment plan. We noted that this work was in progress and several carpets and some flooring had been fitted in the last few weeks and the outside area was to be modernised in the near future.

We spoke with a number of staff and asked them if equipment was easily accessible and in good working order. Their responses indicated that there was enough equipment for them to fulfil their duties and meet the needs of the people who used the service.

We asked the staff we spoke with to describe to us how supported they felt. Their responses indicated that since the appointment of the new manager they were very well supported. One member of staff told us: “We previously had very little support. We have already had a meeting with the new manager, which was very reassuring. The future is much brighter now."

We spoke with seven people who used the service, one visitor to the home, two visiting health professionals and eight members of staff. We also reviewed five care records.

We observed good interaction between staff and the people using the service and saw choices being given to people and verbal agreement gained before carrying out care.

Staff demonstrated they understood the concept of ensuring care plans were current and care needs accurately recorded in the care records. However we were unable to corroborate this was happening in practice as the care records reviewed did not demonstrate a consistent approach to the documentation and monitoring of care need assessments.

We observed a member of staff carrying out the medication round. They were observed administering medication discreetly and at a pace that suited the individual.

We randomly selected three days within the month of June 2013 and confirmed that the number of staff on all shifts matched the staffing level standard. One member of staff we spoke with told us that the use of agency staff had dramatically diminished over the last few months.

A member of staff explained to us a two hourly walk round of the premises was conducted by a senior member of staff. The walk round consisted of observational checks on personal care, staff interaction, activities, general atmosphere and the environment.