Lime Street

Updated 16 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We visited the service on 15 January 2019 and the inspection was unannounced. We do this to ensure the provider and staff do not know we are coming. The inspection team consisted of one adult social care inspector.

Before our inspection we reviewed all the information we held about the service. We also examined notifications received by the CQC. Notifications are changes, events or incidents that the provider is legally obliged to send us within the required timescales. We contacted professionals in local authority commissioning teams, safeguarding teams and Healthwatch. Healthwatch are a consumer group who champion the rights of people using healthcare services.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spent time speaking with four people who used the service. We observed interactions between staff and people who used the service throughout the inspection. We spoke with five members of staff: the registered manager, the senior carer on duty, another carer, the deputy manager and the operations manager. We looked at three people’s care records, risk assessments, medicines records, staff training and recruitment documentation, quality assurance systems, meeting minutes and maintenance records. Following the inspection we contacted three relatives and one health and social care professional.

Updated 16 February 2019

The inspection took place on 15 January 2019 and was unannounced. We previously inspected 21 Lime Street - Learning Disability and Autism ('21 Lime Street') in May 2016, at which time the service was rated outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

21 Lime Street is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

21 Lime Street accommodates a maximum of eight people with a range of mental health needs. The service is split across two floors. Nursing care is not provided. There were eight people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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 registered manager was also responsible for the management of the provider’s other small service nearby and was supported by a deputy manager.

People who used the service gave extremely positive feedback about how staff were patient and respectful with them. External professionals provided positive feedback and relatives gave exceptional praise to staff.

All staff interacted inclusively and engagingly with people. The culture of the service was completely focussed on people’s individualities and their contribution. The service worked flexibly and innovatively to ensure people who used the service felt at home and as in control as they wanted to be of how the home was run. This was consistent across all levels of staffing and had a demonstrably positive impact on people’s wellbeing and quality of life.

Activities provision remained exceptional, with people encouraged to pursue individual interests or partake in the many and varied group activities. The registered manager continued to use their love of music and multimedia projects to engage people in hobbies and projects they found fulfilling.

Links with the local community had strengthened and again had an extremely positive impact on people’s ability to make new connections and contributions, and to reduce the risk of social isolation.

The registered manager, their deputy, the operations manager and all staff interacted extremely well with people who used the service and staff. The culture remained extremely open, inclusive and the atmosphere was welcoming. This had been sustained over a number of years and ensured people were fully a part of the home they live in, and the community they were a part of.

People felt safe and were supported by knowledgeable staff who knew how to minimise the risks they faced. Risk assessments were in place and were specific to people’s individual needs and circumstances.

The care service was managed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Medicines management and administration practices were safe, with staff trained appropriately and their competence assessed. Staff demonstrated a good knowledge of people’s medicinal needs and liaised well with external professionals.

Staffing levels were appropriate to the needs of people who used the service and rotas were planned in advance. Agency staff were not used.

All staff understood their safeguarding responsibilities and were committed to making sure people were safely cared for.

Training, induction and support were effective. Training ensured staff had the core skills required. Staff told us they were well supported.

People had a choice of meal options and had been encouraged to try healthy alternatives such as salad. External advice had been sought to better support people’s nutritional requirements.

People were supported to have maximum choice and control of their lives in the least restrictive way possible. Staff had received training in the Mental Capacity Act (2005) and consent was evident in care planning and through day to day interactions.

Care plans were detailed and ensured staff and anyone visiting the service would have a clear picture of people’s current needs. Care plans were regularly reviewed.

There had been no complaints but people who used the service were clear they knew how to complain and to whom, if they needed.

Audits of core processes were in place and the registered manager demonstrated a sound awareness of areas of recent good practice. They were aware of their responsibilities with regard to making appropriate notifications to CQC.