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Inspection Summary


Overall summary & rating

Good

Updated 12 January 2016

Coombe House is a residential care home which predominately provides nursing and personal care to older people. The service is registered to accommodate up to a maximum of 16 people. On the day of the inspection 16 people were living at the service. Some of the people at the time of our visit had physical health needs and some mental frailty due to a diagnosis of dementia.

Mrs Gray, the registered person for the service, is also the manager and was responsible for the day to day running of the service. 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. We have referred to Mrs Gray as the registered person throughout this report.

We carried out this unannounced inspection of Coombe house on the 19 November 2015. Our findings were that people were being cared for by competent and experienced staff, people had choices in their daily lives and their mobility was supported appropriately.

People told us staff were; “fantastic,” “caring,” and “marvellous.” They told us they were completely satisfied with the care provided and the manner in which it was given. Relatives told us; “I live 20 miles away, there are a lot of care homes in those miles and this is the one which meets mums need. This is the right one.” They also said; “fantastic care,” “Staff genuinely care,” “We cannot fault the care, nothing is too much trouble” and staff were “Competent and professional.”

Relatives told us they felt their family members were cared for safely in the service. Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person as possible so that they could get to know the persons likes, dislikes and interests. Relatives felt this gave staff a very good understanding of their family member and how they could care for them.

The service had been awarded the Level One Butterfly Service, Quality of Life National Award in 2015. The butterfly system aims to improve people’s safety and wellbeing by teaching staff to offer a positive and appropriate response to people with memory impairment. The services information stated; ‘We have no set routines anyone must follow, every day is different. Our residents can make choices, when to get up, when to go to bed, what to wear, where to sit, what to do to pass the time of day, where to eat meals, which visitors they do/ do not want to see, which daily newspaper they may like to read. The doors of our home are not locked and our beautiful gardens are there to enjoy.’

This philosophy was embedded in staff induction, meetings with managers (called supervision) and in their training. Staff were enthusiastic about this way of working and felt that people responded to this positively. Staff told us they were supported by managers.

The registered person and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the service involved family and relevant professionals to ensure decisions were made in the person’s best interests.

People’s care plans, identified their care and health needs in depth and how they wished to be supported by the service. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all the staff. They were written in a manner that informed, guided and directed staff in how to approach and care for a person’s physical and emotional needs. People that used the service and their relatives told us they were invited and attended care plan review meetings and found these meetings really helpful.

Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Healthcare professionals told us that staff approached them with appropriate referrals, and that they worked well with staff to ensure that treatment was approached in a consistent manner.

People told us staff were very caring and looked after them well. Visitors told us; “Staff are fantastic.” We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a really good knowledge of the people they supported. Peoples' privacy, dignity and independence were respected by staff. At this visit we joined people and staff for lunch. The food was as people and relatives described, ‘delicious’. We saw many examples of kindness, patience and empathy from staff to people who lived at the service.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. We saw staff responded to people promptly and gave people time. Relatives commented staff were always available if they had any queries at any time. Staff felt there were always sufficient staff on duty.

We saw the service’s complaints procedure provided people with information on how to make a complaint. People and relatives told us they had, “No cause to make any complaints” and if they had any issues they felt able to address them with the management team.

The registered person promoted a culture that was well led and centred on people’s needs. People and their relatives told us how they were involved in decisions about their care and how the service was run. The management and running of the service was ‘person centred’ with people being consulted and involved in decision making. People were empowered by being actively involved in decision making so the service was run to reflect their needs and preferences.

There was a management structure in the service which provided clear lines of responsibility and accountability. There was a clear ethos at the service which was understood by all the staff. It was very important to all the staff and management at the service that people who lived there were supported to be as independent as possible and to live their life as they chose. The registered person had an effective system to regularly assess and monitor the quality of service that people received and was continuously trying to further improve the quality of the service.

Inspection areas

Safe

Good

Updated 12 January 2016

The service was safe. People felt safe living in the service and relatives told us they thought people were safe.

Staff knew how to recognise and report the signs of abuse. They knew the correct procedures to follow if they thought someone was being abused.

People were supported with their medicines in a safe way by staff that had been appropriately trained.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs.

Effective

Good

Updated 12 January 2016

The service was effective. People were positive about the staff’s ability to meet their needs. Staff received on-going training so they had the skills and knowledge to provide effective care to people.

The registered person and staff had a good understanding of the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

People were able to see appropriate health and social care professionals when needed to meet their healthcare needs.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences.

Caring

Good

Updated 12 January 2016

The service was caring. Staff were kind and compassionate and treated people with dignity and respect.

Staff respected people’s wishes and provided care and support in line with their wishes.

The registered person used creative steps to support people in their service and their families.

Responsive

Good

Updated 12 January 2016

The service was responsive. People’s care needs had been thoroughly and appropriately assessed. This meant people received support in the way they needed it.

People had access to meaningful activities that met their individual social and emotional needs.

Visitors told us they knew how to complain and would be happy to speak with managers if they had any concerns.

Well-led

Good

Updated 12 January 2016

The service was well-led.

Staff said they were supported by management and worked together as a team, putting the needs of the people who used the service first.

The registered person had a clear vision for the service and encouraged people, relatives and staff to express their views and opinions. The registered person led by example and expected all the staff to carry out their role to the same standard.

There was an ethos of continual development within the service where improvements were made to enhance the care and support provided and the lives of people who lived there.