The Limes is a residential home that provides care for up to six people who are living with a learning disability. At the time of our inspection there were five people living in the home. At the last inspection, in July 2015, the service was rated Good. At this inspection we found that the service remained Good.

People continued to receive safe care. Safe staff recruitment processes were in place and people were protected from the risk of harm. Enough staff were in place to provide care and support to people to meet their needs. Safe medicine management processes were in place and people received their prescribed medicines safely.

Since our inspection we found improvements had been made in the way the principles of the Mental Capacity Act 2005 (MCA) were used when decisions were made for people who lacked mental capacity to make specific decisions themselves. People were supported to lead a healthy lifestyle with encouragement to maintain a balanced diet. Improvements were needed with regard to staff training, with some staff needing to complete refresher courses in some areas. Staff received regular supervision of their work and were encouraged to develop their roles through gaining relevant external qualifications.

People were treated with kindness, dignity and respect by the staff. People had developed positive relationships with staff which contributed to a positive atmosphere within the home. People’s care records were detailed and personalised which enabled staff to support people in line with their personal preferences. 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 that the provider may receive.

The service continued to be well-led. The registered manager carried out their role enthusiastically and professionally. People, relatives, staff and professionals commenting positively about their leadership. There was a positive ethos and an open culture at the home resulting in an enjoyable working environment for staff and a calm and friendly atmosphere for people living there. Effective auditing processes were in place.

We carried out an unannounced inspection of the service on 21 July 2015. The Limes is registered to accommodate up to six people and specialises in providing care and support for people who live with a learning disability. At the time of the inspection there were four people using the service.

On the day of our inspection there was a registered manager in place. 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.

The risk to people’s safety was reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. People were given the freedom to take risks and their implications were explained to them. Where appropriate people’s relatives and other healthcare professionals were involved in discussions about the care and support provided.

Accidents and incidents were investigated and used to reduce the risk to people’s safety. However, the registered manager did not always review whether recommendations they had made following an accident or incident had been carried out. Regular assessments of the environment people lived in and the equipment used to support them was carried out and people had personal emergency evacuation plans (PEEPs) in place.

People were supported by an appropriate number of staff. 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.

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

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager was aware of the principles of DoLS however they had not made the appropriate applications to the authorising body for all people that required them.

The appropriate legal requirements had not always been followed when decisions were made for people who did not have the capacity to give their consent.

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.

Staff supported people in a kind and caring way. Staff understood people’s needs and listened to and acted upon their views. However on occasions staff did use language or actions that could restrict people’s independence. 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 provided with information about how they could access independent advocates to support them with decisions about their care. Staff understood how to maintain people’s dignity. People’s friends and relatives were able to visit whenever they wanted to.

People were involved with planning the support they wanted to receive from staff and people’s wishes were continually reviewed to ensure they met their current needs. People’s support plan records were written in a person centred way and staff knew people’s like and dislikes and what interested them. 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.

People were provided with the information they needed if they wished to make a complaint.

The registered manager led the service well, understood their responsibilities and was liked and respected by people, staff and relatives. Staff understood was expected of them and how they could contribute to ensuring people received safe and effective care that met their individual needs. People were encouraged to provide feedback and this information was used to improve the service. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided, although the registered manager did not always record when they had reviewed whether the recommendations they had made had been effective.