Background to this inspection
Updated
13 November 2020
The inspection
This was a focused inspection to follow up on shortfalls found at our last inspection. The service was also placed in Special Measures following our last inspection. During the inspection we also completed an infection prevention and control assessment.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
Combe House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the agency is run and for the quality and safety of the care provided.
Notice of inspection
This was an announced inspection. We announced the inspection the day before we visited to discuss the safety of people, staff and inspectors with reference to the COVID-19 pandemic.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. This was because this was a focused inspection following up on what we found at our last inspection.
We reviewed information we had received about the service since the last inspection.
During the inspection
We spoke with two people who used the service and four relatives about their experience of the care provided. We spoke with three members of staff including the registered manager and care staff.
We reviewed a range of records. This included three people’s care records and medicines records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We asked the manager to provide us with evidence of audits and their overarching improvement plan.
Updated
13 November 2020
About the service
Combe House is a care home which provides personal care and accommodation to people with a learning disability, epilepsy or Autism. At the time of our inspection, six gentlemen were living at Combe House.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
People’s experience of using this service and what we found
We found improvements at the service since our last inspection. The new registered manager had created a positive atmosphere within the service and was continuing to drive improvement. However, relatives gave us mixed feedback on the service. This was mostly in relation to staffing levels and how well staff knew people.
Risk assessments in relation to keeping people safe were robust and support plans detailed. This all helped to ensure people received appropriate care by staff.
People told us they felt safe living at Combe House and that staff helped them if they needed it. People said staff assisted them with their medicines and they could speak to staff if they were worried or concerned about anything. Where people had an incident or accident these were responded to and action taken to prevent further accidents.
Changes had been made to the service during the pandemic to help reduce any spread of infection. We had no concerns about the infection prevention and control practices of staff.
The registered manager had an open-door policy and staff told us they felt supported and valued by them. They said they could approach the registered manager and they felt listened to.
A range of audits were completed to ensure people received a good level of care. People and staff were asked for their input into the running of the service and the registered manager worked with external agencies to respond to people’s needs. Relatives said communication between the service and them had started to improve.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was Requires Improvement (report published 10 December 2019).
At this inspection we found improvements had been made to the service in response to the shortfalls found. As such, the ratings in the Safe and Well-Led key questions have been changed. However, further work was needed to help ensure people were receiving the level of care they deserved.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 8 October 2019. At that inspection we awarded the service a Requires Improvement rating as we found repeated shortfalls from our previous inspection and we felt people may not be receiving safe care.
The service was placed in Special Measures following our inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
At this inspection we reviewed the key questions of Safe and Well-led only and this report covers our findings in relation to these key questions.
The ratings from the previous comprehensive inspection for key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Combe House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.