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Inspection carried out on 19 November 2015

During a routine inspection

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 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)