The Limes

Updated 2 April 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

This service provides personal care to people living in their own flats in a supported living complex.

The service had a manager registered with the Care Quality Commission. This means that when a registered manager is registered, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that there would be staff in the office to support the inspection.

What we did before inspection

In planning our inspection, we reviewed information we had received about the service since the last inspection. This included checking any notifications (events which happened in the service that the provider is required to tell us about). We also used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service and one relative about their experience of the care provided. We also spoke with two members of care staff, the registered manager, the area manager and a paramedic.

We reviewed a range of records. This included three people’s care records and medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from management to validate evidence found, including amended procedures. We received this information.

Updated 2 April 2020

About the service

The Limes' is a domiciliary service operated by 'Methodist Homes' in a large purpose built complex that includes 'Westbury Grange' care home. The domiciliary support service provided by staff from 'The Limes' enables people to live independently in their own flats within the complex and not as residents within the separately registered and inspected care home. The Limes is a collection of individual and two person flats numbering 50 flats in all. The total capacity of the site is 87 with 37 two bedroom flats. At the time of our inspection nine people were receiving personal care.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People felt safe with staff from the service. Care plans and risk assessments provided guidance for staff to follow to reduce risk to people’s safety.

Staff understood how to protect people from the risk of harm and understood potential signs of abuse. People and relatives were involved in assessments of potential risks to safety and in identifying measures to keep them safe. Staff went through a recruitment process so that the provider only employed suitable staff, though the system needed some action to ensure it was fully robust.

People said they received their prescribed medicines. There were a small number of records with gaps in dosages to be supplied, which the registered manager was following up. People were protected from the risk of infections through good staff working practices. Staff numbers were inconsistent. During the inspection staff schedules were reviewed to ensure even staff deployment across the service. Staff undertook induction training that supported them to have the knowledge and skills to do their job well and effectively to meet people’s needs.

People were provided with care and support that ensured they had good nutrition and hydration. They had access to healthcare that maintained their health and wellbeing.

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

Staff knew people well. People had developed positive friendly relationships with staff which helped to ensure good communication and support. Staff respected people’s privacy and dignity and encouraged people to be as independent as possible.

People or their representatives were involved and consulted when making changes to how their support was provided. Staff knew and understood the needs of the people using the service and care was provided based on their assessed needs. Staff were responsive to changes in people's needs to ensure people received help to maintain their health and well-being.

People knew how to raise any concerns or make a complaint. The provider had a policy and procedure which involved investigation and solutions to put things right. This provided information about how these would be managed and responded to.

Systems were in place to monitor the quality of care and support people experienced through quality assurance systems and processes to drive improvements in the service though this needed to be made more robust.

People, a relative and staff spoke positively about the management and leadership of the service. People said staff were very friendly and caring, and they had good relationships with them. The service worked in partnership with external agencies to ensure people achieved good outcomes from their care and support.

Rating at last inspection:

The last rating for this service was good. The inspection report for this inspection was published in November 2017.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk