Coombe House Residential Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 96 (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 very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people living with dementia.

The registered manager and management team promoted an extremely positive and inclusive culture where person-centred care was the priority. People, their families and staff were empowered to be involved in changes and improvements to the service. People’s relatives told us, “What I love is the homely feel, home from home”, “It’s a nice environment, I have never seen a care home like it” and “Nowhere compares to Coombe and the loving, happy, creative and fun atmosphere that [staff] have created".

Observations throughout the assessment and feedback confirmed staff consistently demonstrated compassion and respect, creating a homely environment where people felt safe and valued.

The provider had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

The registered manager had extensive experience which was shared with the deputy manager and staff. Staff, family members and healthcare professionals were extremely complimentary of the manager and comments included “Absolutely brilliant never worked anywhere like Coombe…its open and free… [Name of manager] is amazing, the love [they have] for here, [Name of manager] knows the people who live here so well. [people] are allowed to be [themselves] which is lovely” and “[Name of manager] is a unique remarkable inspiring loving and very clever person who leads by example and has created the very epitome of a person-centred culture of care”.

The managers exceptional commitment to supporting people living with dementia was recognised locally and they received a 'lifetime award for 'outstanding contribution to care and support' hosted by Cornwall council and Cornwall adult health and social care learning partnership"

All the staff we spoke with told us they felt supported and listened to by both the manager and deputy manager. Team meetings provided staff the opportunity to understand any planned changes within the home, discuss best practice and share what was working well and any challenges.

The leadership of the home ensured people experienced high quality care that is evidence based and from staff that are calm, confident and competent to carry out their role, in a kind and caring manner.

The provider was exceptional at fostering a positive culture where people knew they could speak up and their voice would be heard.

Leaders promoted a culture where speaking up was encouraged, normalised and genuinely valued. Staff confirmed they were always listened to and that issues were acted on promptly, contributing to a workplace where people felt respected, psychologically safe and able to influence improvements.

People using the service and their relatives also told us this open and responsive culture was evident throughout all aspects of support. Relatives of the people living at the home told us, “You can tell the staff enjoy working here” and “Everyone who works there seems to love it”.

The provider had ensured formal and informal methods of providing feedback were available for people, staff, family members and health care professionals to share their experiences and opinions in a way that was safe and without the fear of negative consequences. These included formal surveys, care plan reviews, staff meetings and learning from incidents.

Staff told us the manager and deputy were “Understanding if you have a problem”, “They listen if I need to say anything” and “Approachable and helpful if you have any questions”. During a staff meeting, a discussion was held about the impact of changing to a digital medication administration system. The minutes of the meeting recorded staff were able to share their opinion and jointly decided against the system as it was not considered person centred. This meant staff were involved in any decisions and were able to openly discuss continuous improvement and the potential impact on the people living at the home.

Duty of candour principles were well understood and consistently applied with leaders being honest, apologising where appropriate, and clearly explaining what action had been taken.

The provider strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them.

There was a diverse range of backgrounds, skills and experience within the workforce. The service had an open, inclusive recruitment procedure.

The staff handbook provided staff with information relating to the home and policies for them to carry out their role safely and to advise them of their rights. The manager had ensured staff were able to apply for reasonable adjustments because of childcare. During the assessment staff were seen to be able to attend work after they had taken their children to school and 1 staff member explained they had recently changed their working pattern to ensure a better work life balance.

The provider used digital systems for recording information in people’s care plans and staff training. The management were mindful of staff members learning needs and ensured they were able to complete their training and records. For example, 1 member of staff was dyslexic, and was able to dictate to ensure they could record daily notes and the responses to the online training.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were systems to support the registered manager to identify and address quality concerns and risks to the organisation.

The registered manager had undertaken quality checks which included reviewing incidents and accidents and medication. Outcomes from these audits were discussed and action plans developed to address the areas required.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

The registered manager and staff worked an exceptionally coordinated and proactive way with health and social care professionals They demonstrated exemplary partnership working, they consistently sought out collaboration, shared information openly, and advocated strongly on behalf of people. This meant individuals experienced care that was not just coordinated, but truly integrated, support wrapped seamlessly around their needs.

Professionals consistently praised the team for their knowledge, responsiveness and strong advocacy, describing joint working as highly effective and person‑centred.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The management team was committed to providing high quality care for people living with dementia based on the latest research and best practice. They attended conferences and actively sought opportunities for learning and development. As previously mentioned, research findings relating to hydration and nutrition were reviewed and actions taken to improve the experiences for people.

Best practice was shared both within the home and externally. The manager provided speeches at dementia focused conferences to other care home providers and professionals. Feedback from these events was exceptionally positive and included “It’s so interesting to see what care is out there for people with dementia as so often this is not a good experience for people and their families" and “Learning that fabulous care homes exist and what makes them fabulous". One healthcare professional told us the manager “Is a major influencer, leader and promoter of the very best that dementia care can be in Cornwall and beyond”.

Further information on person centred care was shared locally by the manager once a month which was facilitated by the “Cornwall health team”. A variety of professionals were invited to these learning sessions to promote high quality care across other services.