We carried out a review of the data available to us about Coombe House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Coombe House, you can give feedback on this service.
Coombe House is a residential care home providing personal and nursing care to 12 people who have a learning disability. Coombe House accommodates 12 people in one adapted building which is set over two floors.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people, 12 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.
People’s experience of using this service
People told us they felt safe and well supported. Relatives confirmed they felt their family member was safe. Staff had a good understanding in how they protected people from harm and recognised different types of abuse and how to report it. Potential risks to people had been identified and staff had consistent knowledge in how to reduce the risk of harm. There were enough staff on duty to keep people safe and meet their needs. People’s medicines were managed and stored in a safe way. Safe practice was carried out to reduce the risk of infection.
People’s care continued to be assessed and reviewed with the person and their relative or advocates involved throughout. People were supported to have a healthy balanced diet and were given food they enjoyed. Where people required a specialised diet, this was in line with external healthcare professional’s advice and in line with best practice. Staff worked with external healthcare professionals and followed their guidance and advice about how to support people following best practice. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff cared for people in a kind and considerate manner. People were treated with respect and their dignity and privacy was maintained. Staff helped people to make choices about their care and the views and decisions they had made about their care were listened and acted upon.
People’s care was delivered in a timely way, with any changes in care being communicated clearly to the staff team. People were supported and encouraged to maintain their hobbies and interests. People and relatives had access to information about how to raise a complaint.
People and their relatives were happy with the way the service was run. The registered manager was visible in the home, listened and responded to those who lived in the home and the staff who worked there. The culture of the service was an open and transparent. People and relatives were listened to and had the opportunity to raise their suggestions and ideas about how the service was run. Staff worked well as a team and were supported by the provider to carry out their roles and responsibilities effectively, through training and regular contact with the registered manager. The checks the registered manager and provider made ensured the service was meeting people’s needs and focused upon people’s views and experiences.
Rating at last inspection
The last rating for this service was Good. The last report was published 24 May 2017.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People continued to receive care in ways which helped them to remain as safe as possible. There was enough staff to provide support to people to meet their needs. The registered manager was in the process of recruiting additional staff, so people would have more opportunities to do things they enjoyed at the time which was right for them. People were protected from the risk of harm and received their prescribed medicines safely.
The care that people received continued to be effective. Staff received training linked to the needs of people who lived at the home. People made day to day decisions about their care and staff sought people's consent before helping them. Support was available to people if they needed help making key decisions about their life. People were supported to stay well and had access to health care services and enjoyed their mealtime experiences.
People had built strong and caring relationships with the staff who supported them and were encouraged to make their own choices and maintain their independence. People were treated with dignity.
People and their relatives’ views and suggestions were listened to when their care planned. No complaints had been made since our previous inspection, however, systems were in place to promote and manage complaints. Relatives we spoke with knew how to raise any complaints or concerns.
People, their relatives and staff were encouraged to make any suggestions to improve the care provided and develop the home further. The registered manager worked with people, their relatives and other organisations in an open way so people would enjoy the best well-being possible. Regular checks were in place to assess and monitor the quality of the service.
This inspection took place on 27 November 2014 and was unannounced.
The service provides a residential service for people requiring nursing or personal care. Accommodation for 12 people with Learning Difficulties or who are on the Autistic Spectrum is provided. There were 12 people living at the home when we visited and there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
People told us they felt safe and relatives told us they felt their family members were safe. Staff were also able to tell us about how they kept people safe. During our inspection we observed that staff were available to meet people’s care and social needs. People received their medicines as prescribed and at the correct time and medication records (MARS sheets) were accurate and up to date.
People’s privacy and dignity were respected. Families told us their relatives received consistent care.
The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. At the time of our inspection no one had a (DoLs) application in place.
We found that people’s health care needs were assessed, and care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment. Advice and guidance to support their health needs was sought when needed.
People were sufficiently supported to eat and drink to keep them healthy. People had access to a range of snacks and drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided.
Staff were provided with training through a variety of methods and were able to demonstrate how they had benefitted from the training by supported people, with a clear understanding of what was required to care for someone safely without in any way restricting their freedom. The registered manager told us that all staff received training and training requirements were regularly audited.
People were positive about the care they received and about the staff who looked after them. This was supported by the records we reviewed and our observations throughout the day. People’s care and activities provided were tailored to their individual needs and preferences and staff responded positively to meeting those needs. Staff and relatives told us that they would raise concerns with the nursing staff, senior staff or the registered manager and were confident that any concerns were dealt with.
The provider and registered manager made regular monthly checks to monitor the quality of the care that people received and looked at where improvements may be needed. The manager demonstrated accessibility for people and her team by regularly popping out of her office and chatting to people. Relatives told us that care and communication from staff was consistent and open.
We looked at care plans for four of the people who lived at the home. They covered a range of needs and had been reviewed regularly to ensure that staff had up to date information. There were also detailed assessments about the person's health so that staff could support people to keep healthy and well. All the staff we spoke with had knowledge of the needs of the people who lived there.
People who lived at the home were supported to make choices around the care they received. A relative told us: 'They (staff) are always so good at giving people choice'.
We saw that staff helped and supported people. We saw that people received care that met their individual needs.
We found that medicines had been appropriately stored and administered.
People lived in a clean environment and the provider had reduced the risk of the spread of infection.
We saw a variety of activities for people to get involved in that were focussed on individual needs as well as group activities.
Care workers were visible throughout our inspection and were on hand to provide care and support to people. We saw care workers consistently supporting and providing comfort and positive interaction. We found people were supported to move around the home. We observed a variety of personal interaction such as music, light therapy, baking and conversation. We found care workers respected people as individuals and knew a lot about their personal preferences.
People's changing needs were regularly assessed and reviewed with the delivery of care in line with any amendments to care plans.
People were safeguarded as the provider had taken steps to ensure any potential instances of abuse could be identified and reported. Care staff we spoke to told us they felt supported by the manager and provider to take the appropriate action where required.
The provider had a system in place to make sure care workers had the required levels of training to meet people's individual care needs. Care workers told us they assisted people who had communication difficulties in making a complaint
Many of the people who lived at Coombe House were not able to tell us much about their experience at the home due to their communication difficulties. We pathway tracked the care of three people and looked at how their care was provided and managed.
We saw that staff at Coombe House looked after people well and wrote down what help everyone needed. Staff said they were trained to help them understand how to meet people's needs and give the support they needed.
We saw that staff interacted with people who used the service in a friendly, courteous and respectful manner. Staff demonstrated they were aware of people's care and support needs.
We saw that people were very relaxed and at ease with staff and within their home environment. The atmosphere was calm and homely and the home was clean and tidy.
Staff told us they worked well as a team and that they received support from the registered manager.
We found that people who lived at Coombe House received effective, safe and appropriate care, treatment and support that met their needs.
Annual reviews had been carried out to obtain the views of people who used the service, other stakeholders, staff and people involved with providing care for people at Coombe House. These reviews recognised achievements and identified where improvements were needed in a formal, structured way.