Lime Lodge is a residential home that provides care for up to nine people, who have a learning disability. At the time of our inspection there were eight people living in the home. At the last inspection, in December 2015, the home was rated Good but with a rating of Requires Improvement for the question, ‘Is the service safe?’ At this inspection we found the overall rating for the service remained Good, and the rating for the ‘Safe’ question had improved from Requires Improvement to Good.

People received safe care and processes were in place to reduce the risk of people experiencing avoidable harm. Window restrictors were not in place in two bedrooms on the first floor, which posed a risk to people’s safety. This was rectified immediately. Sufficient numbers of staff were in place to meet people’s needs, although the induction processes for agency staff members needed reviewing and formalising. Safe medicine management processes were in place and people received their prescribed medicines safely.

The principles of the Mental Capacity Act 2005 (MCA) were adhered to when decisions were made for people who lacked the ability to make specific decisions themselves. People were supported to lead a healthy lifestyle with encouragement to maintain a balanced diet and where needed, to lose weight. Staff were well trained, received regular supervision of their work and felt supported by the registered managers to develop their roles. People’s day to day health needs were met.

Staff were kind, caring and showed genuine empathy and compassion when supporting people. People were treated with dignity and respect and their right to privacy was respected. There was a positive and friendly atmosphere within the home with people encouraged to do as much for themselves as possible.

People were able to lead their lives how they wanted and were supported to take part in the activities that were important to them. People’s support records were detailed and provided staff with the information needed to support people effectively. People were provided with an ‘easy read’ complaints process that supported people living with a learning disability. Effective systems were in place to manage any complaints the provider may receive.

The service continued to be well-led. The registered managers were well liked and they carried out their roles in a dedicated and caring manner. People, staff and the management all interacted well which resulted in a positive environment. Staff enjoyed working at the home. Effective auditing processes were in place.

We carried out an unannounced inspection of the service on 2 December 2015. Lime Lodge is registered to accommodate up to nine people and specialises in providing care and support for people who live with a learning and/or physical disability. At the time of the inspection there were eight people using the service.

On the day of our inspection there was a registered manager in place, however they were not present during the inspection. 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 were supported by staff who had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. Risk assessments were in place to identify the risks to people’s safety however some of these had not been reviewed since August 2015. Accidents and incidents were investigated thoroughly although the CQC were not notified of one incident when we should have been. Regular assessments of the environment people lived in and the equipment used to support them were carried out, however people did not have personal emergency evacuation plans (PEEPs) in place.

During the inspection there were enough staff to support people safely, although some relatives felt on occasions the service has been short staffed. Appropriate checks of staff suitability to work at the service had been conducted prior to them commencing their role. People were supported by staff who understood the risks associated with medicines. People’s medicines were stored, handled and administered safely, although protocols explaining when staff should administer a certain type of medicine were not recorded in people’s medicine administration records.

People were supported by staff who completed an induction prior to commencing their role and had the skills needed to support them effectively. Reviews of the quality of staff members’ work were conducted.

The registered manager had ensured they recorded how the principles of the Mental Capacity Act (2005) had been applied when decisions had been made for people. However we did find a small number of examples where assessments may have been required that had not been completed.

The deputy manager was aware of the principles of DoLS and had made the appropriate applications to the authorising body for all people that required them.

People were weighed regularly and where a risk to their health as a result of their weight had been identified, support from external health care professionals was requested. People were supported to follow a healthy and balanced diet. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

People who used the service and their relatives felt the staff supported them or their family member in a kind and caring way. Staff understood people’s needs and listened to and acted upon their views. Staff responded quickly to people who had become distressed.

People were provided with the information they needed that enabled them to contribute to decisions about their support. People were not provided with information about how they could access independent advocates to support them with decisions about their care. Staff maintained people’s dignity. People’s friends and relatives were able to visit whenever they wanted to.

People’s care records were written in a person centred way. People and their relatives where appropriate, were involved with planning the care and support provided. People were encouraged to do the things that were important to them and they were supported to take part in activities individually and collectively with the people they lived with. The complaints procedure was referred to but was not available in the home. However people and their relatives felt able to make a complaint and felt it would be acted on.

People spoke highly of the registered and deputy managers. The deputy manager understood their responsibilities and how they contributed to the development of the service. Regular meetings were held with staff to ensure they understood what was expected of them. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided.

At the time of this inspection there were seven people living at Lime Lodge.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

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

This was an unannounced inspection. We spoke with two people who used the service. We also spoke with the manager and three members of staff. We looked at written records, which included copies of people's care records, staff personnel files and quality assurance documentation.

Is the service safe?

We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents, which enabled them to deliver appropriate and safe care.

We found the home to be warm and clean. The accommodation was suitable to meet the needs of people living there. People were protected by safe and effective recruitment processes.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Is the service effective?

People we spoke with were satisfied with the care and support they received. This was consistent with positive feedback reported in the provider's own annual quality assurance survey. People were given information and support to help them understand the care and support available to them and were encouraged to increase their independence.

Is the service caring?

We spoke with two people who used the service. Due to their communication needs we were not able to have extended conversations with them. We were not able to speak with some of the other people. One person said to us, "The staff are nice. I like the staff." We asked another person if they were happy living at the home. They nodded and replied, "Yes."

There was a calm atmosphere throughout the home and a good rapport between staff and the people who lived there. We witnessed the care and attention people received from staff. All interactions we saw were respectful, kind and friendly and staff were attentive to people's needs. People were treated with dignity and respect.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Where people did not have the capacity to give consent, we found the provider acted in accordance with legal requirements.

Care plans and risk assessments were regularly reviewed.

Is the service well led?

Staff said that they felt well supported by the manager and they were able do their jobs safely. The manager had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

As part of this inspection we observed people living at the home, spoke with three staff members and the registered manager. We looked at numerous records including people’s care records, staff records, and records in relation to the management of the service.

Our observations showed that people were comfortable, well kempt and were being supported in a homely environment. People’s bedrooms had been decorated according to their personal taste and we found that people were involved in all aspects of the running of home wherever possible. The provider may find it useful to note that some areas of the home were starting to look dated and some people’s bathrooms were grubby.

We found that staff treated people with dignity and respect and demonstrated a genuine rapport with the people who used the service. Staff we spoke with had a good understanding of the needs of people who used the service and were positive about their role.

We found that people’s independence and community involvement had been promoted by the service and that people’s individual wishes had been respected.

We looked at the records of three people who used the service and found care had been planned and delivered appropriately with regard to people’s health, safety and welfare.

The service had arrangements in place to respond to allegations of abuse; however we found evidence that the service had not always protected people from the risk of abuse. This was because the service had not recognised and appropriately responded to incidents where a person using the service was harmed.

Staff had been appropriately screened to ensure they were appropriate to work with vulnerable people and had received a thorough induction.

There was a robust system in place to monitor the quality of service people received.