Coombe House Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding.

This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 88 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There was a proactive culture of analysis and identifying improvement opportunities. Accidents and incidents were recorded and analysed to identify areas of learning or how practices could be amended to reflect people’s individual needs.

The registered manager ensured any learning from incidents was shared promptly with the staff team. Regular staff meetings were held, to look at lessons learned and any improvements needed to existing practice. Staff knew people very well and recognised early signs of potential distress and mitigated risks through regular positive intervention.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

Assessments to identify people’s needs before they moved into the service were completed by the management team. One person was admitted from another care home, the registered manager explained they had taken significant time to get to know the person during the assessment and had met with the person and their family in their previous placement.

Staff knew and demonstrated an in depth understanding of people's needs. Health and social care professionals were contacted immediately when required to offer support and guidance.

People, their relatives, and other professionals were involved in planning how people’s care and support would be provided. Multi-disciplinary meetings were held to discuss safe care and treatment pathways for people, and staff knew when to refer to specialist services for support.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People’s relatives told us they could raise concerns to staff and the registered manager and were confident actions would be taken.

All incidents in which there may have been a risk of harm were acted upon straight away and staff managed these situations calmly.

The provider ensured staff received safeguarding training to recognise signs of abuse and how to escalate concerns.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure call the Deprivation of Liberty Safeguards (DoLS) which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We found the registered manager and staff ensured people’s capacity to make decisions was assessed. Where people lacked capacity, any restrictions imposed to keep them safe, such as the use of sensors to alert staff, were in people’s best interest and the least restrictive option available.

Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority for authorisation and any conditions imposed were met. One person’s relative explained they had been “Very involved in that process”.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

People were supported to take positive risks to promote independence. The home’s environment was designed to promote independence and minimise restrictions.

The registered manager promoted a safety culture in which they told us people were “not locked up” and were free to carry out activities and tasks that replicated what the person may have completed before living with dementia.

All the people living at the service were able to walk around freely. The front door was not locked and allowed people to access the extensive gardens and outside spaces. One person’s relative told us “[Name of person] has the freedom to walk out whenever they want in a secure environment. [Name of person] can go into the kitchen at any time. It’s that freedom that I appreciate most”.

The registered manager ensured people’s relatives were aware there were risks associated with people being free to access the service grounds. Following a recent review, a relative had written to the service and stated they "Are fully aware this will occasionally expose [relative] to the risk of injury. However, the general improvement in health [they] experienced whilst living with you is far more important".

During the assessment we observed people were able to move around without restriction and entered the kitchen to make a hot drink, assist with meal preparation and cleaning as they wished. Staff, including gardening and domestic staff, were aware of the risks and ensured any potentially dangerous equipment was appropriately secured when not in use.

Care records informed staff about risks associated with people’s health and wellbeing and the action they needed to take to mitigate identified risks. One person had a health condition that resulted in incidents where the person may suddenly fall. The care plan fully directed staff on the actions they should take to reduce the risk of injury.

The provider was fully aware of all potential risks in the care environment and controlled them well so people could live their lives to the fullest. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was safe, clean, and homely, with regular checks on fire safety, water quality, and equipment. People lived in a home which was personalised, well maintained and met their needs. Equipment was regularly serviced and risk assessments were regularly reviewed. This ensured the provider monitored the risks to people, managed and mitigated concerns when people’s needs changed. Personal Emergency Evacuation Plans (PEEPs) were tailored to individuals should people need to be evacuated in an emergency.

The provider had completed detailed risk assessments for the environment which included best practice information to support the decision-making process.

The potential risk of harm for people accessing the garden and grounds through unlocked doors, were comprehensively considered and included the risk of sun exposure. As a result, a large pergola was built to provide people with shelter whilst enjoying the garden. Research and guidance was also used to inform people’s risk assessments which stated the benefits provided “More opportunity to move about, maintains mobility and actually decreases the risks of falls” and recorded information provided by a consultant psychiatrist whom had stated “International studies have found that time spent out of doors, even in the rain, is more powerful than the highest doses of anti-depressants".

To ensure people had the freedom to move around in the least restrictive way, the provider had recently installed cameras (CCTV) covering the driveway. Each person’s relative had been written to and provided with a clear rationale as to why and how this information would be used and stored. The system had the ability to take pictures of any person seen walking down the driveway in order to show who it was and what they were wearing. This meant that people could be easily identified and guided back home if required.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The registered manager told us, and we observed, staffing was deployed with exceptional flexibility, shaped entirely around people’s individual needs and preferences. This meant staff were readily available at the times people wanted support, enabling them to choose what they wished to do and when they wished to do it.

Relatives were confident the service was well staffed and told us, “Staff are always available” and “Everyone who works there seems to love it and enjoys working there”. Staff said, “There is enough staff, it is good. You can’t have too many staff. We agree what each staff member will do and then it works pretty well. Like a well-oiled machine” and “There are enough staff. It is absolutely amazing I would want to come here”.

Staff were recruited safely and had the knowledge and skills to meet people’s needs. Staff had received training in a broad range of topics including specific training to enable them to meet people’s individual needs and ensured people received safe care.

The service employed a variety of people to cover different roles such as deputy manager, carers, cooks, housekeeping staff and gardeners. Each member of staff provided support to people who lived at the service in a unique way and understood what people needed. Records showed planned staffing levels were routinely achieved and the staff team reacted flexibly during periods of unexpected staff absence to ensure people’s safety.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and staff worked throughout the day to ensure all areas remained tidy.

Staff had been trained in infection prevention and control. Personal protective equipment (PPE), such as gloves and aprons, was discreetly stored around the home and staff used these when required and washed their hands immediately after use.

Cleaning schedules were designed to ensure all areas of the home and equipment was regularly cleaned.

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff always involved people in planning, including when changes happened.

People received their medicines safely from staff who had received specific training to carry out the task. Managers and staff monitored the impact on people from changes in medicines and ensured regular communication with health professionals and relatives which ensured people’s treatment met their needs. The registered manager and a healthcare professional explained frequent reviews of medications were carried out to ensure people did not take unnecessary medication.

During the assessment we heard staff contact the GP to request a review of medication for 1 person who had recently moved in. The person acquired specialist medication using a private prescription service. The registered manager discussed this particular medicine with the senior staff team, and they considered how this medicine could be provided safely with the best interests of the person as their main priority. There was a clear plan to involve the person, their relative and healthcare professionals in decision making.

Some people were prescribed medicines on an ‘as required’ basis. Personalised protocols gave staff clear guidance about how each person would express the need for these medicines and included specific strategies staff could deploy to support the person prior to administering medicines.

We observed medication being provided to people in a calm and relaxed manner. People received their medication as they preferred, and staff asked how the person was feeling and if they were in any pain.

Medication was stored safely in people’s rooms and medication which required stricter controls such as controlled drugs, were held securely. The controlled drugs register showed procedures had been followed and during the assessment we found the amount of medication tallied with the records.