We carried out a review of the data available to us about The Coombe House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Coombe House, you can give feedback on this service.
We found the following examples of good practice.
People were well supported by staff to have telephone and internet contact with their family and friends. The service facilitated in person visits in a manner which minimised the risk of infection spread, including outside visits, and visits using patio doors in ground floor rooms. A visitor's room fitted with a floor to ceiling Perspex screen and intercom, enabled families and friends to visit people who lived in the home in person.
Plans were in place to isolate people with COVID-19 to minimise transmission. The service had good supplies of personal protective equipment that were readily available in stations throughout the service.
Visitors were asked screening questions and to wash their hands with soap and water at an external sink when they arrived.
Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and residents were regularly tested for COVID-19. The building was clean and free from clutter.
Staff ensured people’s welfare had been maintained and they had sufficient stimulation, such as themed crafts, quizzes and staff had brought some of their own pets in to visit.
The Coombe House is a care home (without nursing) which is registered to provide a service for up to 24 people who require assistance with personal care. The service currently offers a service to 22 people whose needs are related to old age. The service offers 20 single occupancy rooms and two double bedrooms across the two storey main house and the attached annexes.
At the last inspection, on 18 and 23 December 2015, the service was rated as good in all domains. This meant that the service was rated as overall good. At this inspection we found the service had improved to outstanding in two domains and therefore had improved to an overall rating of outstanding.
Why the service is rated outstanding.
The service was exceptionally responsive and strove to meet people’s needs, wishes and lifestyle choices. It was flexible and readily adapted to meet people’s changing, diverse and complex needs. It was extraordinarily person centred and people were seen and responded to as individuals. Activity programmes were creative and designed to meet people’s preferences and choices. Menus were created to offer diverse foods that were healthy. Care planning was individualised and regularly reviewed ensuring people’s needs were met continuously.
The registered manager was extremely experienced, respected and highly thought of by staff, families and other professionals. She and the management team ensured the service was exceptionally well-led. The registered manager and the staff team were committed to ensuring they offered people the very best care possible and that people were as involved as possible in running the service. The quality of care the service provided was constantly assessed, reviewed and improved by the provider and registered manager.
People were protected from all forms of abuse by a trained and knowledgeable staff team. Staff were trained in safeguarding people and knew what action to take if they identified any concerns. The service continued to identify individual and environmental risks. Action was taken to reduce these risks, and a comprehensive account was provided of what action to take should the risk occur.
People continued to be supported by good staffing ratios, which were reviewed and increased as needed. The management supported staff and assisted people on a daily basis. Staff were able to meet people’s specific needs safely. Robust recruitment systems were implemented to ensure as far as possible, that staff were safe and suitable to work. People were supported to take their medicines correctly by trained and competent staff. Where people were able to self medicate, they were appropriately assessed and assisted to remain independent.
A well-trained staff team remained able to offer people effective care. They met people’s diverse needs. Care plans were kept up to date ensuring people’s current and changing health and emotional well-being needs were met. The service worked very closely with health and other professionals to ensure they offered individuals the best care in the most effective manner.
People continued to be 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 supported this practice.
The caring, committed and enthusiastic staff team continued to meet people’s needs with compassion, kindness and respect. They ensured they promoted people’s privacy and dignity and communicated with them effectively. Measures were taken to ensure records were maintained confidentially.
This inspection took place over two days on 18 and 23 December 2015, and was unannounced.
The Coombe House is a care home that offers accommodation for people who require personal care. Although registered to provide a service for up to 24 people, the location currently provides facilities to 22 people whose needs are related to old age. There were 20 single occupancy rooms, and 2 double bedrooms.
The home is required to have a registered manager. The manager has been in post since June 2013. 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 2008 and associated Regulations about how the service is run.
Staff knew how to keep people safe. They were aware of the reporting structures and the need to report concerns promptly. They were familiar with procedures clearly outlined in training as well as the service’s own policies and procedures. Comprehensive processes for recruitment of staff were in place to ensure suitable employment and the protection of people against the risk of abuse. Sufficient staffing numbers of highly trained and experienced staff were provided by the service to ensure the needs of people were met. A rolling training programme was in place, which focused on providing the company’s mandatory training as a minimum standard, with additional supporting, academic qualifications and training offered.
Good caring practice was observed over both days of the inspection. People and their relatives said they were very pleased with the support and care provided. They advised that they were involved in the development and reviewing of their plans of care. These were well documented, detailing individual preferences well and reflective of the person’s needs. Risk assessments specific to the person were contained in files, with guidance on how to manage these risks should they occur.
Outstanding responsive practice was illustrated during the course of the inspection. The service went above and beyond in trying to respond to people’s needs. Where people were unable to access the community for activities that they enjoyed, the community was brought to them. We found numerous examples of this, observing three different activities, specifically designed to engage people collectively. Relatives provided further examples of how the service had exceeded their expectations in responding to the needs of the people.
Staff and people reconfirmed observations of good communication. The service offered an open door policy, giving people, staff and visitors the opportunity to speak with management at any time. People told us that they were treated with respect, at all times. Staff always ensured they preserved people’s dignity when working with them.
People were supported by a team of staff who were competency checked prior to being given responsibility for the administration of medicines. Medicines were kept and managed securely. During the inspection we were unable to find protocols for the administration of PRN (as required) medicines, these were discussed with the manager, and we were assured that these would be written up, as described to us during the inspection.
People who were unable to make particular decisions for themselves, had their legal rights protected. Best interest decisions were clearly visible in careplans when people were unable to make decisions for themselves or lacked the capacity.The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The DoLS provides protection legally for people who are vulnerable or may become deprived of their liberty.
The quality of the service was monitored by the provider. Feedback was obtained from people, visitors, families and stakeholders and used to improve and make any relevant changes to the service.
A good range of activities and entertainment was provided in the home as well as some outings. People's spiritual needs were provided for. The people and relatives we spoke with were happy with the care, support and activities provided. One relative said they were 'very happy' with the home and another described the staff as 'lovely'. One of the people supported said the staff were 'excellent' and another said 'I have confidence in the staff'.
People enjoyed the meals provided and could influence the menu through the resident's meetings.
The premises met the needs of the people the home admitted, who tended to have relatively low needs in terms of mobility. Adaptations had been made and equipment provided to support people in this as they became frailer.
Staff completed a recognised induction process and received a range of care training to equip them for their role. Ongoing supervision and performance appraisals were provided, and regular staff meetings took place to discuss issues.
The management sought the views of the people supported and their families about the care provided. Complaints and issues raised in resident's meetings were addressed, showing that the home responded to the people it supported.
Appropriate activities were provided and arrangements were in place to address people's spiritual needs. People were happy with the meals provided and enjoyed the activities available. People in the home were complimentary about the owners and staff. One person said she had visited three other homes and had found this one to be the friendliest. She added that the staff and owners listen and said that 'things get sorted out here'.
The staff recruitment system was thorough and the required records were retained. Staff had an appropriate induction and received ongoing support and training.
People in the home were aware of the complaints procedure. The people with whom we spoke had not raised any complaints but were satisfied they would be listened to if this were necessary.