Coombe House Residential Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding.

This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People were enabled to make choices for themselves and staff ensured they had the information they needed. We observed staff adapting care plans to reflect changes to people’s needs and routines. The care plans were person centred and specific to individual needs, choices, likes and dislikes. People and their family members were involved in the care plan development and review processes, their input was valued and acted upon.

Staff had excellent knowledge of the people who lived at the home including their communication styles and needs. This enabled staff to provide person centred care which met people’s changing needs and preferences. Healthcare professionals spoke very highly of the home and were complimentary of the person-centred approach. Professionals’ comments included, “[The manager] leads by example and has created the very epitome of a person-centred culture of care” and “It’s a wonderful home”.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The provider worked with other services, to ensure people received continuity of care. Examples included community nurses, GPs, and a consultant psychiatrist. Details of this support was recorded in people’s care records.

Staff rotas were designed around continuity of care for people which meant people were supported by a consistent team of staff.

Where changes were needed, staff acted promptly and worked with professionals to review risks and adapt support. This helped ensure people’s needs were understood and responded to in a timely and coordinated way. A Relative told us, “They emailed me yesterday as [name of person] had a bit of an issue. They keep me well informed and are completely transparent about everything” and “When [name of person] was poorly with a chest infection they kept me informed. It was such a relief that [they] were there, and I didn’t have to worry”.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff explained options in ways people could understand, using plain language and visual aids where needed. People and relatives told us they knew how to raise concerns and felt confident action would be taken. All the people we spoke with were positive about the home and stated they were kept informed.

Menu boards displayed on the dining room tables, clearly described what was available at each meal in both a written and pictorial format.

The manager and deputy described that during a recent pre assessment at another care home, the staff in that service were unable to meet the needs of a person due to their behaviour. The manager had taken time to get to know the individual’s needs, likes and preferences. When the person moved into Coombe House Residential Home staff immediately identified the person was hard of hearing and could not hear staff. The person was able to write and therefore staff acquired a writing board. The person settled in quickly and enjoyed communicating with staff and was able to join in activities and regained control over their life.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

There was a complaints policy, and we found complaints were recorded and investigated. Information about how to complain was on the provider’s website and shared with people when they moved into the service. Relatives told us they knew how to complain but said they, “Had never had any concerns” and “Staff are always available”.

Feedback was gained in a variety of ways including by listening to the people who lived in the home, suggestions from visiting healthcare professionals and from people who visited the home. There had been some negative feedback from people about the quality of a service received from an external service provider. The manager spoke with people and staff and took action to replace the company to ensure people received a good service.

A survey was sent to people’s relatives to gain an understanding of both their experiences of the care but also how the relative had felt about the admission process. This was to improve the service for people living there but also to gain a deeper understanding of the lived experiences of family members going through the process of finding a suitable care home for their loved one who was living with dementia. The survey found people would have benefited from being able to talk about what was happening and how they felt.

Changes had been made because of the feedback and learning shared with relatives. Specific issues had been discussed with individual respondents and plans developed with the aim of further enhancing people’s and relative’s experiences who are moving into the home. These plans included providing support to people who were on the ‘waiting list’ to live at the home and offer support in the local community by arranging weekly social events such as afternoon tea.

Staff recognised and took action when people required additional reassurance or individual approaches to communication. This showed staff understood and respected people’s different ways of expressing views.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

We observed people had access to equipment to in line with their assessed needs. The home’s layout allowed people to move freely using mobility aids. Outside areas were well maintained and designed to allow people to move independently between different areas.

The management and excellent culture of the home ensured that regardless of people’s dementia diagnosis, they had the same access to healthcare and services as everyone else. This included being referred to health care professionals quickly if they became unwell, ensuring medicines were reviewed by the GP and psychiatrist, and arranging appointments for people, for example, with chiropodists and district nurses.

Care plans detailed people’s equipment requirements to promote their independence. There were adapted facilities such as hoists, toilet and bathing equipment, and adapted chairs to support people to overcome physical challenges.

Staff had completed training in equality and diversity. We observed staff treating people as unique individuals, using their preferred name. The home had received feedback from a paramedic that stated they were, “Struck by the residents happiness, contentment and respect and how incredibly well they were cared for” and described the atmosphere as peaceful and joyful and the staff as truly dedicated. Another healthcare professional said, “Having seen Coombe House, it shows me what the gold standard for care should look and feel like".

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

The manager told us that everyone deserved high quality care and the staff worked hard to ensure people had a good quality of life. They stated, "We are always trying to think outside the box to make things work for people".

The service shared information and experiences with health professionals to enable them to minimize their impact on people’s wellbeing. The service had identified that community nursing uniforms caused 1-person significant distress. As a result, they had engaged with the community team and made arrangements for these professionals not to wear uniforms while visiting the service. This ensured the person consented to medical interventions and reduced any potential stress for this person.

The service had recognised that singing helped another person to relax when supported or medical interventions were required. This information had been shared with the hospital prior to a recent planned admission. However, hospital staff had not recognized the importance of this information and had experienced significant challenges supporting the person. Staff for Coombe House had visited the person in hospital, demonstrated their techniques which had enable the person to receive treatment. These practices had subsequently been adopted by the hospital team when supporting this person. The staff team’s skills and willingness to share learning and best practice both supported people’s wellbeing and helped demonstrate best practice to partners in the care system.

One relative had written a book about their experience of Coombe House. The book contained poems and pictures of the person at Coombe house and stated, "Every time I go through the gates…. it’s like entering another world”. Feedback from the relative given to the manager stated that they and their loved one had rekindled their relationship due to the exceptional care and support at Coombe house.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

Staff discussed future options sensitively and revisited conversations when people and/or the relatives were ready. The information available was detailed, person centred and truly reflected people’s choices to be supported in their home where possible. The management of the home also considered individual requests from external partners when a person was at the end of their life, this was discussed amongst the staff and family, and a decision was made in the persons best interest to ensure the person’s wishes were respected.

The service demonstrated a thoughtful and person‑centred approach to end‑of‑life care. The registered manager and staff told us how they had supported a person with dignity and respect, ensuring their wishes and preferences were honoured.

During the assessment we observed family members being made to feel welcome and valued whilst visiting. Staff ensured the visitors were comfortable and arranged for additional chairs to be provided next to the person’s bed so they could hold hands and spend time together in a quiet and calm environment. The relative explained that whilst the person was, “nearing the end” the care had been, “Amazing, it could not be better, wonderful in every way and very unique”. A funeral director provided positive feedback of the support the service provided to peoples’ families. Their comments included, “Bereaved families always tell us how wonderful the staff are”.

Staff were also supported through these distressing times and offered opportunities to discuss how they felt and what had happened. This compassionate approach ensured that both the person at the end of their life, and those who were grieving afterwards, received the emotional support and continuity they needed.