Lime Street

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.

The five questions we ask about services and what we found