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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 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 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.