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Coombe House Residential Home Outstanding

Reports


Inspection carried out on 23 October 2017

During a routine inspection

We carried out this unannounced inspection of Coombe House on 23 October 2017. Coombe House is a residential care home which predominately provides personal care and support. 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. People living at Coombe House had physical health needs and mental frailty due to a diagnosis of dementia. At the previous inspection in November 2015 the service was rated good.

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.

Coombe House is situated on the rural outskirts of Liskeard. It is a historic detached property in its own grounds. There are a range of communal areas. People have their own rooms and personal items including furniture and things that are important to them. The grounds around the house are extremely well managed and designed to provide interest to people living with dementia. This included a range of colourful plants, a summer house and mannequins which are designed to prompt conversation and debate.

The registered person told us the philosophy of the service was to promote person centred dementia care. This included putting people first and tasks second. “We support people to travel the emotional journey. There were no restrictions to daily life. People could 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, and which daily newspaper they may like to read. The doors of the service were not locked and the gardens were there to be enjoyed by people their families and staff.

The service had been awarded the Level One (star) Butterfly Service, Quality of Life National Award for the past three years. This was the highest level a service could receive. 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. A staff member said, “We are so proud of our achievements and it really motivates us all.”

There were numerous examples of how ratios of staff allowed one to one support for people who lived at Coombe House, to take part in activities and follow their interests. We found this had a hugely positive impact on their lives. Comments made by relatives were very positive. They told us, “Just amazing. We are so impressed with the staff and what they do to support [Person’s name]” and “Without a doubt. The staff are just wonderful, caring and compassionate”

We observed staff demonstrated an exceptionally caring, compassionate and kind attitude towards people who lived at Coombe House. Families told us staff were very respectful and spent quality time with their relatives. There were many examples of how the caring approach of staff had a very positive impact on people’s lives. A relative told us, “There is nothing to compare with the quality of care we have received at Coombe House and it has made [Person’s name] last several years with dementia actually peaceful and happy.”

There was a calm and relaxed atmosphere in the service throughout the day of the inspection visit. We observed people had an excellent relationship with staff and staff interacted with people in an exceptionally caring and respectful manner. People were observed moving around the service without any restrictions. Staff were always available but discreet in their presence so people’s personal space was not impacted upon. A staff member said, “The focus is on giving residents the freedom to move around as they wish. It makes such a difference because their attention span is short and changing all the time and by caring for them this makes their lives a lot less stressful.”

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe. These had been developed to minimise the potential risk of harm to people during the delivery of their care. Risk assessments had been kept under review and were relevant to the care provided.

Without exception family members all spoke extremely positively about the service their relative received. They told us that their relative was very safe living at the service and that staff were kind, friendly and treated people in a way they could not have imagined. They told us that the registered provider and staff were always available and approachable. Comments included, “The staff are quick to get on the phone to me if they have any issues with [Person’s name] health and happy to talk to me when I phone them” and “Absolutely wonderful. Keep us up to date with everything that’s going on with [Person’s name].”

There were always enough staff available to ensure people received continuous, attentive and discreet care and support. Staff had all the time they needed to respond to people’s choices as well as meeting their care and support needs in a way that suited the person. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. For example, supporting people to move around the service both inside and out and by having the time to let the people take the lead and control of what they wanted to do, when they wanted to do it. For example, two people wanted to help wash up and one wanted to mop the kitchen floor. Staff supported them to do this and it generated a lot of conversation and laughter. A staff member said, “If you come here in the middle of the night you might find us doing this. That’s how we work. It’s all about the resident and what they want to do when they want to do it.” This was evident throughout the inspection and included in all feedback.

Recruitment checks were carried out to ensure suitable staff were employed to work at the service. Staff were supported by a system of induction, supervision and appraisal. The registered provider worked in partnership with dementia organisations. Staff received training relevant for their role and there were excellent opportunities for on-going training support and development in the area of dementia care. A staff member said, “The training is excellent. It really gives us the skills we need and it’s a totally different approach to the standard dementia care training.”

Management and staff had a good understanding of the underlying principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

The manager used effective systems to record and report on, accidents and incidents and take action when required. These events were reviewed in order to help reduce the risk of them happening again.

People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

The environment supported people living with dementia. For example signage throughout the service showed pictorial images to indicate the rooms function. An activity board was pictorial to support people and the daily menu board showed pictures of the food available each day. In addition to supportive signage the service’s communal and dining areas were full of ‘tactile’ items which people continuously picked up, talked about and moved around. This theme was based upon good practice in dementia care. It was clearly successful through the observations made throughout the inspection.

There were extremely effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered provider was visible in the service and regularly observed and talked with people to check if they were happy and safe living at Coombe House. Overall satisfaction with the service was seen to be outstanding.

Equipment and supply services including electricity, fire systems and gas were being maintained.

Inspection carried out on 19 November 2015

During a routine inspection

We carried out this unannounced inspection of Coombe House on 23 October 2017. Coombe House is a residential care home which predominately provides personal care and support. 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. People living at Coombe House had physical health needs and mental frailty due to a diagnosis of dementia. At the previous inspection in November 2015 the service was rated good.

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.

Coombe House is situated on the rural outskirts of Liskeard. It is a historic detached property in its own grounds. There are a range of communal areas. People have their own rooms and personal items including furniture and things that are important to them. The grounds around the house are extremely well managed and designed to provide interest to people living with dementia. This included a range of colourful plants, a summer house and mannequins which are designed to prompt conversation and debate.

The registered person told us the philosophy of the service was to promote person centred dementia care. This included putting people first and tasks second. “We support people to travel the emotional journey. There were no restrictions to daily life. People could 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, and which daily newspaper they may like to read. The doors of the service were not locked and the gardens were there to be enjoyed by people their families and staff.

The service had been awarded the Level One (star) Butterfly Service, Quality of Life National Award for the past three years. This was the highest level a service could receive. 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. A staff member said, “We are so proud of our achievements and it really motivates us all.”

There were numerous examples of how ratios of staff allowed one to one support for people who lived at Coombe House, to take part in activities and follow their interests. We found this had a hugely positive impact on their lives. Comments made by relatives were very positive. They told us, “Just amazing. We are so impressed with the staff and what they do to support [Person’s name]” and “Without a doubt. The staff are just wonderful, caring and compassionate”

We observed staff demonstrated an exceptionally caring, compassionate and kind attitude towards people who lived at Coombe House. Families told us staff were very respectful and spent quality time with their relatives. There were many examples of how the caring approach of staff had a very positive impact on people’s lives. A relative told us, “There is nothing to compare with the quality of care we have received at Coombe House and it has made [Person’s name] last several years with dementia actually peaceful and happy.”

There was a calm and relaxed atmosphere in the service throughout the day of the inspection visit. We observed people had an excellent relationship with staff and staff interacted with people in an exceptionally caring and respectful manner. People were observed moving around the service without any restrictions. Staff were always available but discreet in their presence so people’s personal space was not impacted upon. A staff member said, “The focus is on giving residents the freedom to move around as they wish. It makes such a difference because their attention span is short and changing all the time and by caring for them this makes their lives a lot less stressful.”

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe. These had been developed to minimise the potential risk of harm to people during the delivery of their care. Risk assessments had been kept under review and were relevant to the care provided.

Without exception family members all spoke extremely positively about the service their relative received. They told us that their relative was very safe living at the service and that staff were kind, friendly and treated people in a way they could not have imagined. They told us that the registered provider and staff were always available and approachable. Comments included, “The staff are quick to get on the phone to me if they have any issues with [Person’s name] health and happy to talk to me when I phone them” and “Absolutely wonderful. Keep us up to date with everything that’s going on with [Person’s name].”

There were always enough staff available to ensure people received continuous, attentive and discreet care and support. Staff had all the time they needed to respond to people’s choices as well as meeting their care and support needs in a way that suited the person. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. For example, supporting people to move around the service both inside and out and by having the time to let the people take the lead and control of what they wanted to do, when they wanted to do it. For example, two people wanted to help wash up and one wanted to mop the kitchen floor. Staff supported them to do this and it generated a lot of conversation and laughter. A staff member said, “If you come here in the middle of the night you might find us doing this. That’s how we work. It’s all about the resident and what they want to do when they want to do it.” This was evident throughout the inspection and included in all feedback.

Recruitment checks were carried out to ensure suitable staff were employed to work at the service. Staff were supported by a system of induction, supervision and appraisal. The registered provider worked in partnership with dementia organisations. Staff received training relevant for their role and there were excellent opportunities for on-going training support and development in the area of dementia care. A staff member said, “The training is excellent. It really gives us the skills we need and it’s a totally different approach to the standard dementia care training.”

Management and staff had a good understanding of the underlying principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

The manager used effective systems to record and report on, accidents and incidents and take action when required. These events were reviewed in order to help reduce the risk of them happening again.

People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

The environment supported people living with dementia. For example signage throughout the service showed pictorial images to indicate the rooms function. An activity board was pictorial to support people and the daily menu board showed pictures of the food available each day. In addition to supportive signage the service’s communal and dining areas were full of ‘tactile’ items which people continuously picked up, talked about and moved around. This theme was based upon good practice in dementia care. It was clearly successful through the observations made throughout the inspection.

There were extremely effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered provider was visible in the service and regularly observed and talked with people to check if they were happy and safe living at Coombe House. Overall satisfaction with the service was seen to be outstanding.

Equipment and supply services including electricity, fire systems and gas were being maintained.

Inspection carried out on 5 July 2013

During a routine inspection

There were 13 people living in the home on the day we visited Coombe House Residential Home. The office had been moved to the lower ground floor and the office was being turned into a single bedroom.

During our inspection we were not able to speak to many people who used the service due to their level of dementia. We spoke with the deputy manager and the senior care worker on duty about the care and support they provided.

We saw staff helped people in a discreet manner and spoke to people with respect.

We saw care plans were detailed and directed staff as to the care and support people needed. They had been regularly reviewed. We saw they were developed and reviewed with the person using the service and /or their relatives where appropriate.

People were offered a variety of nutritious meals and had access to drinks at all times.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We saw there were staff support systems in place. Most of the statutory training was up to date. Staff had the chance to receive training in areas relevant to their role.

The records were generally kept securely. They were well organised and detailed.

Inspection carried out on 2 October 2012

During an inspection to make sure that the improvements required had been made

We spoke to three people who lived at Coombe House, comments included, “staff are nice”, “it’s a lovely walk round the garden” and “staff are very good, some you like more than others”.

One person told us the place can be “a bit samey sometimes”. Another person told us the “food is nice”. One relative told us, “best place X could be” and “a home for people not an organisation”.

Two members of staff told us there were lots of training opportunities and because the 'person at the top' was enthusiastic, it just made the staff the same.

The registered manager/provider told us “we work hard to involve families”.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care and people experienced care, treatment and support that met their needs and protected their rights.

People were protected from the risk of infection because appropriate guidance had been followed and people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 27 March 2012

During a routine inspection

We spoke to five people who lived at Coombe House, five relatives who were visiting at the time, and six staff members who worked at the home including the registered manager. On 2 April 2012 we spoke to two relatives on the telephone and a GP.

During our visit to Coombe House we spoke with the registered manager of the care home.

At the time of our inspection there were 13 people living in the care home.

People who lived at Coombe House said they were happy living in the home. Comments from people included “staff here are very good”, “if they know you want something they do it as soon as possible”, “staff are easy to get on with”, “a very nice place”, “they listen to your problems”, “they are very respectful with personal care needs”

We observed interactions between the staff and people who lived in the home and saw that staff were friendly, compassionate and respectful to the people they supported.

People talked to us particularly about the meals and the dining experience provided in the home. The registered manager and the staff ensured that all meals were a “special experience”. One person commented “you can ask for choices, pick anything you want”. People said they were supported to make decisions about their personal care needs. One person said that “they are very good at taking you to the GP and chiropodist”. People received their medicines when they needed them. People’s medication and records were stored securely in their individual bedrooms. One member of staff shared with us that they felt that this was more personal to people rather than administering medications in a communal environment.

Relatives we spoke to commented “this is a wonderful place the care is fantastic”,” it is one big family”, “the care home is superb”, “no complaints at all”, “nothing is ever too much of an effort for them”. Of the seven relatives, five spoke to us about their frustrations with the laundry system. Comments included, “clothes go missing I have complained about it in the past”, “it drives me crazy”, “I have seen Dad wearing other peoples clothes”, “I can’t keep on spending money”, “there are other peoples clothes in the wardrobe”, “if they could only get the laundry sorted out”.

People who lived at Coombe House as well as relatives told us that if they had a complaint or concern that they would approach the staff or the registered manager.

During our visit to Coombe House we looked around the communal parts of the care home, the main garden and eight bedrooms. We found that all the bedrooms were warm and most of them contained many personal possessions. Window restrictors on windows which should be fitted to ensure peoples safety from heights were missing from some of the bedrooms.

We looked at staff training records and spoke with staff at Coombe House about the training they had received to enable them to do their jobs. We found that staff had received training related to essential areas of their work.

Reports under our old system of regulation (including those from before CQC was created)