We found the service had appropriate arrangements in place for the management of medicines.
Medicines were kept securely and safely.
Staff administered medication safely and recorded the administration of medicines accurately.
There were protocols in place for people who required their medication on an "as required" basis to support staff in administering that medication consistently.
People we spoke with told us they liked living at Coombes House. One person said, "I like it here." In early 2012 Solihull Council informed people that a decision had been made to close the home in early 2014. We saw staff were supporting people to make choices about the most appropriate placements to move to. Two people told us about their new homes and the visits they had made to check they were going to be happy there.
People's care plans provided staff with information about how they were to support people in a way they preferred. The care plans ensured risk was managed consistently and safely. We saw people were offered a variety of activities through the day. One person said, "I've done exercises. I have had a really good day today."
We looked at how the service managed medication. Medication management was not sufficiently robust to ensure medicines were always administered safely to people.
There were sufficient numbers of staff to meet the care and support needs of the people who lived there.
Records were kept securely, were well organised and information was easy to find.
Coombes House has 18 bedrooms, 15 with their own en-suite shower room. It is a large building with a separate day service provided in part of it.
There was a warm, welcoming atmosphere within the home. People we spoke with were generally positive about living there. They enjoyed telling us about activities within the home and trips to the theatre, disco and bowling. One person told us, "It is like one happy family. I like living here."
We saw comfortable and relaxed interactions between the people living at Coombes House and staff. There were enough staff to support the needs of the people living there. One person told us, "The staff are very attentive. Very reliable."
People had care plans that provided staff with information as to how people liked and needed to be offered support. Some changes in care needs and associated risks had not clearly been identified and recorded in care plans. We saw people were referred to external health professionals where necessary.
People were encouraged to provide input into how the service was run through weekly residents' meetings.
People were being supported to make decisions about their future care.
People had health action plans and the home worked hard to help them to get the specialist health care that they needed. People had care and support plans for workers to follow and these were supported by some assessments of the risks that their condition presented.
Not all plans had been reviewed and updated in response to substantial changes in peoples needs. This meant that not all risks were being managed in an agreed way. We saw that permanent care workers and managers knew people well and treated them with respect and kindness. The home was relying heavily on agency and bank staff. We spent two hours in the communal rooms on the day that we visited and saw that agency staff did not know the individual needs of people who used the service.
The building was warm and well lit. People held keys to their own bedrooms. The food was cooked on the premises and was nourishing and healthy. People were supported to eat as independently as they were able. We asked one person whose care we followed if they were happy living at the home. They smiled and nodded.