The Limes

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People received exceptionally effective care. They had exce experiences when they first started living at the service due to how well their support needs and preferences were assessed. The management team were passionate about staying up to date with best practice guidance and empowering and upskilling the staff team to support people in the best way possible. The way the staff and management team worked seamlessly with other services had led to excellent outcomes for people in relation to their health and wellbeing. Staff had a thorough understanding of how to make sure people were at the centre of all the decisions made regarding their support and put people firmly in control of how they lived their lives.

This service scored 100 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The way in which people's need were assessed was exceptional and fully supported people to start living at the service in a positive way. Some people had recently started living at the service and the registered manager told us how they had assessed people’s needs. Assessments focused primarily on people’s individual preferences and support needs and how to maximise their involvement in the assessment process. Staff went out of their way to visit people multiple times in places they currently lived to get to know them and how they liked to be supported. This filtered in to detailed care plans and risk assessments which gave full detail about how best to support people. People living at the service had lived in other services for a long period of time and found transition difficult. However, thanks to the approach of the staff and management team people had settled into the service remarkably well and were happy and comfortable. One relative said, ‘‘We were so worried about [family member] moving to the service but staff went the extra mile to make sure they did not feel anxious, and they have settled in so quickly. Staff made sure they spent lots of time getting to know them before they moved in which really helped.’’ Another relative told us, ‘‘It has been such a different experience for [family member] moving into the service. It has really felt like [staff] are trying to get ahead of any potential issue that might mean [family member] is upset so they are ready to help them straight away. [Registered manager] was involved from the get-go and really drove the whole transition. It has been excellent.’’ The registered manager and staff team continually updated care plans over the first weeks of a person living at the service to ensure any changes were recorded immediately. Staff spoke about how well they had been supported to get to know people and how seamless transitions into the service had been.

The registered manager and provider were passionate about supporting people in line with current best practice such as RSRCRC. They had effectively embedded this into staff practice at the service and the resulting outcomes for people as a result were extremely positive. For example, thanks to the way staff supported people, they no longer needed the help of physical restrictive intervention or medicines when they felt unhappy. This had a substantial positive impact on people’s quality of life. One person was expressing how happy they were. The registered manager showed us evidence this person used to be restricted in numerous ways but had not been since living at the service. A professional said, ‘‘To see how happy and content [person] is, is truly heartwarming. The registered manager and staff team have supported them so well and because they feel so confident and secure, they no longer need [physical restraint]. This is inspiring and what every service aspires too.’’ Relatives told us about the massive positive impact living at the service had for their family member. One person said, ‘‘In the past [family member] would do one thing and one thing only day in and day out. They lived a very sheltered life. Now [staff] support them with lots of different things and know exactly how to help them get the best out of what they are doing. I am so grateful I found [service].’’ Another relative told us, ‘‘When I think of how difficult [family member] used to find life and where they are now, it brings a tear to my eye. [Staff] have opened up their lives to limitless possibilities and they are so much happier as a result. I cannot praise the service enough.’’ Staff told us how the registered manager encouraged them to learn and keep up to date with best practice. One staff member said, ‘‘The training we have is superb. It really helps me to get to grips and understand how people are feeling. Its eye opening to see how people see the world.’’

Without exception, staff told us they enjoyed working together and there was a sense of supporting one another in their job roles to ensure the best possible support for people. A relative said, ‘‘I don’t really feel like they are a staff team but more like a family with how they all work together, and you can see how much this means to [family member].’’ Staff’s comments included, ‘‘It is an excellent and wonderful place to work here. As a team we are all of one mind and that mind is getting the best for the people who live here. We help each other out and we all always give our best so there are never any bad feelings. I have never worked in a place like this.’’ and, ‘‘It is a fantastic team here and we all help each other out. If we try something and it works well or if we have a problem, it doesn’t matter. We share it and work together to make sure people get the best care they can have.’’ The registered manager and staff team linked and worked well other services to support people. The registered manager spoke passionately about how they always ensured they spoke with professionals in other services candidly about what was best for people as they knew they and the staff team knew people best as individuals. For example, the registered manager and staff team spoke with professionals about other alternatives to physical and medical restraints to support people when they felt upset. One professional said, ‘‘It is always a pleasure to work with [service]. They always put people first and work with us to make sure they have the best experiences they can.’’ One person had been supported to access a service and take part in a past time that meant a lot to them. Staff had worked hard to build a relationship with the service and help them understand the persons support needs. This meant a lot to the person who was now happy to be able to take part in this past time on a daily basis.

The registered manager and staff team understood the importance of supporting people to live healthier lives and prioritise people being in control of this aspect of their support. For example, some people had found it difficult to have a varied and healthy diet. This was recognised by the staff team who took positive steps to help people try new things whilst ensuring people were happy to be doing this. For example, staff used pictures and offered healthy options to people multiple times so they could understand what the options were, and staff respected people’s choice to say no if this was the case. One person had been supported to choose and help prepare their favourite meals at home in a healthy way. As a result of this support people were healthier and felt involved in deciding how they were supported with this. People had lost weight, and this had a significant impact on their quality of life. A relative explained, ‘‘It has always been difficult for [family member] to eat healthily. It is a credit to the staff team how they have helped them to eat more healthily and great to see how much better they feel now.’’ The registered manager and support team worked with people to attend health appointments to professionals such as GP’s and dentists. Staff made every effort to support people to feel comfortable and able to attend these appointments. Extra staff support was made available for people to attend appointments. Staff made sure the environment at the appointment was quiet and met peoples sensory support needs and supported people to attend where the appointment was several times to help them become familiar with the environment and to feel comfortable. As a result, people attended their appointments the majority of the time and lived healthier lives as a result. A relative said, ‘‘[Staff] have worked wonders supporting [family member] to go to appointments. They used to find this so hard, and it is fantastic this is no longer the case.’’

One of the provider and registered managers key values was ensuring people were fully involved in any choices or decisions made about their support. People living at the service did not have capacity to make decision in many areas of their support. The staff team were trained to the fullest extent in the Mental Capacity Act (MCA) and knew how to support people in line with its principles. For example, where people lacked capacity, staff still respected their decisions. One staff member said, ‘‘We know people living here may not have capacity to be safe all the time but that does not mean we do not listen and respect their opinions. So long as no harm will come to [person], we must support them to do what they choose. It is the best for the person in the long run.’’ We observed staff asking people for consent to support them in all areas of their support. Staff did this in a quiet and dignified way, and this clearly meant a lot to people as evidenced by the way they responded to staff and went about their daily lives. One person showed us how happy they were to be given a choice of how they wanted to spend their time. It was clear this person was incredibly content and happy. One relative said, ‘‘The key thing the staff do well is make sure [family member] feels in complete control of every aspect of their care. This has made them very happy and familiar with the staff team and as a result they no longer feel so angry and upset all the time. It is great to see them really shine as a person.’’ Where people lacked capacity the registered manager and staff team worked with the person, their relatives, and professionals to make decisions in their best interest. These documents were incredibly detailed and made it explicitly clear what staff needed to do to fully involve the person in any decisions they may lack the capacity to make without support.

One of the provider and registered managers key values was ensuring people were fully involved in any choices or decisions made about their support. People living at the service did not have capacity to make decision in many areas of their support. The staff team were trained to the fullest extent in the Mental Capacity Act (MCA) and knew how to support people in line with its principles. For example, where people lacked capacity, staff still respected their decisions. One staff member said, ‘‘We know people living here may not have capacity to be safe all the time but that does not mean we do not listen and respect their opinions. So long as no harm will come to [person], we must support them to do what they choose. It is the best for the person in the long run.’’ We observed staff asking people for consent to support them in all areas of their support. Staff did this in a quiet and dignified way, and this clearly meant a lot to people as evidenced by the way they responded to staff and went about their daily lives. One person showed us how happy they were to be given a choice of how they wanted to spend their time. It was clear this person was incredibly content and happy. One relative said, ‘‘The key thing the staff do well is make sure [family member] feels in complete control of every aspect of their care. This has made them very happy and familiar with the staff team and as a result they no longer feel so angry and upset all the time. It is great to see them really shine as a person.’’ Where people lacked capacity the registered manager and staff team worked with the person, their relatives, and professionals to make decisions in their best interest. These documents were incredibly detailed and made it explicitly clear what staff needed to do to fully involve the person in any decisions they may lack the capacity to make without support.