We inspected the service on 13 October 2016. The inspection was unannounced. The Limes Residential Home is situated in the city of Derby and offers accommodation for to up to 34 people who require personal care. The provider specialises in caring for older people with physical impairments. On the day of our inspection 33 people were using the service and one person was in hospital.

The service had a registered manager in place at the time of our 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 who were able to, were supported to make decisions. However the registered manager and the registered provider did not always know what actions to take if people did not have the capacity to make decisions in line with the principles of the Mental Capacity Act.

People were protected by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People maintained their nutrition and staff were monitoring and responding to people’s health conditions.

People were supported by staff that had the knowledge and skills to provide safe and appropriate care and support.

People lived in a home where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

We spoke with six people using this service and three family members. We also spoke to four staff members.

We found that people were fully involved in discussions about their needs and care. One person said that “anything you want help with, the staff will help.” People told us that they were always treated with respect.

We observed and heard a good level of communication and contact between staff and people using the service. We saw that the care and daily routines were centred around people's individual needs and preferences.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.

We spoke to some people living at The Limes to gather their experiences of the care they were receiving. We were told “I have a few health issues but they look after me though. They will make appointments for me quickly.” Another person said “They really look after me, I am happy here.”

We checked if people were aware of their care plan and were happy it was accurate. One person told us “The staff have been through it with me. It is accurate.”

We spoke to people using the service to gather their opinion on the running of the service. We were told “I take part in the resident’s meetings, they do listen to what we say” and “Yes the service seems to be well run.” Another person added “We see the manager daily and everything is well looked after. I know where to go if there was ever a problem.”

We spoke to some visiting relatives to gather their views on the service. We were told “I received a satisfaction survey recently and filled that in, although I have not heard the results of it.” Relatives also confirmed that they were able to attend the resident’s meeting should they wish to.

People we spoke with told us they understood the way their care and support was to be provided and relatives confirmed they were involved in monthly care reviews and signed relevant documentation.

People using the service appeared relaxed and contented in their surroundings and we saw relationships with staff were friendly and respectful. One person told us “I like living here” and another “The staff are good”. Relatives we spoke with said they were very pleased with the care provided to their family member. One said “I’m very happy with the care here” and another said of their family member “She’s lucky to be here”. People told us they liked the meals. One person told us "The food is marvellous" and another said "The meals are good".

We saw there were procedures in place to safeguard people and that staff training was up to date and ensured staff could meet individual needs. There were systems in place to monitor the quality of the service and people and their relatives were confident that any issues or concerns they had would be sorted out.

External professionals praised the care describing it as very, very good and another said "There's a lot of compassion there".