Archived: The Limes Also known as previously Fullerton House College

The Limes is a ‘care home’ that provides care and support for up to 12 younger adults who have learning disabilities or autistic spectrum disorder. At the time of the inspection 2 people were using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service demonstrated they were meeting the underpinning principles of Right support, right care, right culture.

Right Support

The provider made sure there was a culture of person-centred care and support. People and those important to them were involved in planning their care. People received support based on respect and inclusivity. Staff understood how to protect people from poor care and abuse. Staff encouraged and enabled people to take positive risks. The Limes provided an environment and service that was safe, and people told us they felt safe living there. People lived in their own flats and had been supported to personalise their homes.

Right Care

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing People received person-centred care, which promoted their privacy, dignity and human rights. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff enabled people to access specialist health and social care support. The service worked with people to plan for when they experienced periods of distress, so their freedoms were restricted only if there was no alternative. There were enough suitably recruited and trained staff to support people to enjoy full and active lives.

Right culture

The culture was open, honest and positive. Staff valued and acted upon people’s views. The provider had a clearly defined vision and values which staff understood and followed. Staff knew their responsibilities and were confident to report any concerns to the provider. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 June 2021).

Why we inspected

The inspection was prompted in part due to concerns received about how the provider was safeguarding people. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection people were at risk of harm from this concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Limes on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Limes is a care home providing accommodation for up to 12 people, with learning disability and autism. The home is purpose-built accommodation provided in four shared flats with facilities. At the time of the inspection there were six people living in the home.

People’s experience of using this service and what we found.

We found the provider had effective systems in place to safeguard people from the risks associated with abuse. There was effective assessment and management of risk. Staff were recruited, trained and deployed appropriately and effectively to ensure people’s needs were met. People were protected from the risk and spread of infection and people’s medicines were managed safely.

There were effective systems of governance, monitoring and review, with good evidence of provider oversight to ensure the service was working to the provider’s expected standards. There was evidence that feedback from people who used the service and their relatives had been sought and acted upon in positive ways. There was an emphasis on improving the service to ensure it was person centred, and service user led. There was evidence of staff working in partnership with other agencies. This helped deliver individualised care and supported people’s access to other healthcare and social care services.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The setting was community based and people were able to access their local community, nearby shops and services.

Right care:

• Care and support was person-centred and promoted people’s dignity, privacy and human rights. People were supported in the least restrictive way and education and learning was promoted.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service were leading confident, inclusive and empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published April 2020).

Why we inspected

We received information of concern in relation to two other services run by this provider. These included concerns to people’s safety, staff culture and governance. A decision was made for us to inspect and examine those risks at all of the provider’s ASC locations, to see if these concerns were repeated. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Limes on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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The Limes is a residential care home providing personal care for up to 12 people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The college accommodation is bigger than most domestic style properties. It is registered for the support of up to 12 people. At the time of the inspection eight people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design. The accommodation was separated into four, three bedroomed flats, each with separate facilities. It fitted well into the school campus.

There had been a period when the service had not always consistently applied the full range of the principles and values of Registering the Right Support and other best practice guidance. The principles and values of Registering the Right Support ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

However, once the provider was made aware of the shortfalls, the management team worked to an improvement plan to ensure the outcomes for people reflected the principles and values of Registering the Right Support. This was by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's experience of using this service and what we found

People told us they were very happy with the support they received.

The provider had made improvements to ensure people were protected from abuse and any risks associated with people’s care were well managed. The provider had also made improvements to make sure people received their medicines safely. There were systems in place to ensure the safe management and supply of medicines were effective and did not place people at the risk of harm.

The provider had made improvements to make sure people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had made improvements to make sure staff received the training and support they needed to fulfil their roles and responsibilities. Support staff were familiar with people's preferences and needs. They were committed to promoting people's privacy, dignity and independence and supporting them to make choices. People who used the service spoke positively about the staffs’ caring approach.

The provider regularly asked people and their relatives their views about the care and support the service offered. At the time of the inspection there was a positive, open and supportive culture in the service and staff felt well supported, listened to and valued. The provider had made improvements in the management oversight and audits used to monitor the safety and quality of service delivery and staff performance. This was effective in driving improvements to the service people received. Although, there was still some work to be completed, and there was a need to ensure the improvements were well embedded into practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (report published April 2018).

Why we inspected

This was a planned inspection based on the previous rating. Although, there were concerns received about a failure of staff and managers to recognise and report safeguarding concerns. Other concerns included lack of staff training, and a lack of opportunities for people to engage in meaningful activities. A decision was made for us to examine those risks as part of the inspection. We have found evidence the provider has made improvement. However, further improvement was necessary.

We have made a recommendation about the review of the provider’s overall governance and oversight. Please see the Well Led section of the full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in November 2015 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going 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.

People received inclusive, caring and mindful support from staff who knew them well and whose main aim was to support people to have the kind of life they wanted, while keeping them as safe as possible.

Staff were knowledgeable about safeguarding people and were able to explain the procedures to follow should any concerns be raised. Potential risks to people's safety were clearly identified and reflected in their support plans. Incidents and accidents were monitored and action was taken to reduce risks to people. People received their medicines safely and as prescribed.

Environmental risks were assessed and managed appropriately, but some areas of the service required redecoration or repair. These had been identified by the registered manager and action was being taken to address them.

A thorough recruitment procedure helped to make sure the correct staff were employed to support people. There were enough staff on shift to ensure that people had their needs met in a timely manner and could take part in community activities. Staff received the training and support they needed to meet people's needs and develop their skills and knowledge.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff monitored people's health and welfare needs and people had been referred to healthcare professionals when needed.

People were fully involved in planning the support they needed and how they spent their day. This included menus and shopping for their chosen meals, which were prepared in their flat either by themselves or with assistance from staff. Support files provided clear guidance to staff on people’s needs and their daily routines and preferences.

Staff knew people well and were aware of their history and preferences. Their privacy was respected and they were treated with dignity, kindness and compassion. People were supported to maintain relationships with people who were important to them.

Staff spoke with passion and commitment about supporting people to develop their skills and meet their full potential. We found they had worked consistently to help individual people get over their fears and develop new skills and abilities.

People accessed social activities and education which was tailored to their individual needs and interests. They spoke positively about the activities and social events they took part in and about how they had been supported to develop their confidence, skills and knowledge.

There were systems in place to enable people to share their opinion of the service provided and raise concerns if necessary, which were listened to. The registered manager and care team demonstrated a commitment to continually improve the service and used lessons learned to take the service forward. We also saw audits and checks were regularly undertaken to make sure company policies had been followed and the premise was safe and well maintained.

Further information is in the detailed findings below.

Fullerton House College is a specialist residential college, offering education and care for up to 52 weeks per year, for young people aged 19 and above. The service provides support for young people with complex needs including behaviour that may challenge and a learning disability, often in association with autism. Each person had their own small house, with a garden.

There was a registered manager at the service at the time of the 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 and associated Regulations about how the service is run. Although the registered manager was relatively new in post, they had worked for the Hesley Group for 17 years and was familiar with the needs and preferences of the people who used the service.

We saw the staff were friendly and kind and people who used the service were relaxed in their company. They understood people’s needs and treated them with respect. We saw that, in addition to attending college people participated in a range of activities, which were based on their interests, were meaningful and promoted their independence. This was within the service and, out in the community.

People who used the service indicated that they felt safe. People’s plans included areas of risk and reflected the risks, and the changes in their lifestyles and needs as they have developed towards adulthood. People’s medicines were well managed and records were accurately maintained.

People’s files included assessments and plans of care and support, and were individualised. The staff we spoke with were very knowledgeable about the people who used the service, could clearly describe their history and preferences and were aware of how to support people.

We found the service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who may not be able to make important decisions themselves.

The service had arrangements in place for recruiting staff safely and there were sufficient staff available to provide people with one to one staffing, to respond to people’s individual needs and to keep people safe. Staff were provided with regular supervision and appraisal for development and support

People had access to a range of health care services to help maintain their health. It was clear that people were supported to buy and cook things they liked, and people told us they enjoyed the meals.

People told us they could speak with staff if they had any complaints, or concerns and they would be listened to.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure procedures to maintain safe practice were adhered to. Incidents were assessed and monitored to try to prevent and reduce potential recurrences or similar incidents.

People and their relatives were asked their opinion of the quality of the service and their feedback used to help improve the service.