This inspection took place over two days on 18 and 23 December 2015, and was unannounced.
The Coombe House is a care home that offers accommodation for people who require personal care. Although registered to provide a service for up to 24 people, the location currently provides facilities to 22 people whose needs are related to old age. There were 20 single occupancy rooms, and 2 double bedrooms.
The home is required to have a registered manager. The manager has been in post since June 2013. 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 2008 and associated Regulations about how the service is run.
Staff knew how to keep people safe. They were aware of the reporting structures and the need to report concerns promptly. They were familiar with procedures clearly outlined in training as well as the service’s own policies and procedures. Comprehensive processes for recruitment of staff were in place to ensure suitable employment and the protection of people against the risk of abuse. Sufficient staffing numbers of highly trained and experienced staff were provided by the service to ensure the needs of people were met. A rolling training programme was in place, which focused on providing the company’s mandatory training as a minimum standard, with additional supporting, academic qualifications and training offered.
Good caring practice was observed over both days of the inspection. People and their relatives said they were very pleased with the support and care provided. They advised that they were involved in the development and reviewing of their plans of care. These were well documented, detailing individual preferences well and reflective of the person’s needs. Risk assessments specific to the person were contained in files, with guidance on how to manage these risks should they occur.
Outstanding responsive practice was illustrated during the course of the inspection. The service went above and beyond in trying to respond to people’s needs. Where people were unable to access the community for activities that they enjoyed, the community was brought to them. We found numerous examples of this, observing three different activities, specifically designed to engage people collectively. Relatives provided further examples of how the service had exceeded their expectations in responding to the needs of the people.
Staff and people reconfirmed observations of good communication. The service offered an open door policy, giving people, staff and visitors the opportunity to speak with management at any time. People told us that they were treated with respect, at all times. Staff always ensured they preserved people’s dignity when working with them.
People were supported by a team of staff who were competency checked prior to being given responsibility for the administration of medicines. Medicines were kept and managed securely. During the inspection we were unable to find protocols for the administration of PRN (as required) medicines, these were discussed with the manager, and we were assured that these would be written up, as described to us during the inspection.
People who were unable to make particular decisions for themselves, had their legal rights protected. Best interest decisions were clearly visible in careplans when people were unable to make decisions for themselves or lacked the capacity.The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). The DoLS provides protection legally for people who are vulnerable or may become deprived of their liberty.
The quality of the service was monitored by the provider. Feedback was obtained from people, visitors, families and stakeholders and used to improve and make any relevant changes to the service.