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Coombe House Residential Home Outstanding

Inspection Summary

Overall summary & rating


Updated 8 February 2018

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 l

Inspection areas



Updated 8 February 2018

The service remains good. People, who were able to talk with us, told us they felt safe living at Coombe House. Relatives told us they had no concerns about their family member’s safety.

There were suitable procedures in place to protect people from the risk of abuse. Restrictions were minimised so that people were safe but had the most freedom possible.

Staffing levels were good and staff appropriately deployed to provide safe care. Staffing was structured to the needs of the people who lived at Coombe House.

Recruitment and selection processes were robust.

Medicines were managed safely and people were given their medicines as prescribed.



Updated 8 February 2018

The service remains good in providing effective care and support. People received care and support that was based on their needs and wishes.

People’s wellbeing was promoted and people were encouraged to enjoy a most stimulating and meaningful life.

Staff had access to training in dementia care to support them in providing a high standard of care to people.

The management team worked in partnership with dementia organisations to continuously improve and develop care.

Staff used innovative ways to stimulate mealtimes and to increase people’s appetite. This supported people to have a varied and nutritious diet.

The management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.



Updated 8 February 2018

The service was outstanding in providing caring support. Staff were extremely caring, kind, compassionate and treated people with dignity and respect at all times.

People who used the service, relatives and healthcare professionals were positive about the service and the way staff treated the people they supported.

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



Updated 8 February 2018

The service was extremely responsive. People received responsive care which was outstanding in that it supported people to feel part of the local community. Creative ways were found to support people's interests.

Care plans were personalised and people and their families had been involved in developing these. Staff used innovative and individual ways of involving people so that they were consulted, empowered, listened to and valued.

People received care that was flexible and responsive to people’s individual needs and preferences, Staff were creative in enabling people to live as full a life as possible, particularly where their communication and other skills deteriorated.



Updated 8 February 2018

The management and leadership of the service was outstanding. The registered provider had a clear vision and researched and introduced innovative systems to improve people’s quality of life.

There were creative use of staff resources and person centred planning to support people’s well-being.

The registered provider and staff team were approachable and available and willing to listen to people. The registered provider was passionate and dedicated to providing an outstanding service to people.

The service sought the views and experiences of people, their families and the staff in order to continually improve the service.

Staff said they were extremely well supported by management and worked together as a team, putting the needs of the people who lived at the service first. Staff were motivated to develop and provide quality care to people.