Archived: Combe Lea Community Resource Centre

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Combe Lea Community Resource Centre, on our website at www.cqc.org.uk.

Combe Lea Community Resource Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Combe Lea Community Resource Centre provides care and accommodation for up to 30 people. On the days of the inspection 30 people were living at the home. The home was over two floors, with access to all floors either via stairs or the lift. All bedrooms have en-suite facilities. Gardeners Row was on the first floor and was a unit for people living with dementia. Willow on the second floor was for older people who were physically frail.

At the last inspection the service was rated as Requires Improvement. At this inspection we found that improvements had been made within the service. All of the four previous breaches had now been met.

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 2008 and associated Regulations about how the service is run.

The provider had failed to take action required following a fire service inspection. The provider had not made improvements needed to the fire systems at the service. The registered manager had notified the provider who had placed it on the corporate risk register. We have notified the fire brigade of this.

People were protected from the risk of infection because staff followed the correct procedures in respect of laundry and avoiding cross infection. However, we noted the laundry baskets were broken and identified this as a potential risk. The provider sent evidence that new baskets had been ordered following the inspection.

The service had received an award after being nominated by a person’s relative. The provider had a video clip of the relative talking about the service on their website. People and their relatives were complimentary about staff. We observed staff interacting with people with warmth and kindness. It was evident staff knew people, their histories and preferences. People’s independence was promoted where possible and staff protected and respected peoples’ dignity.

Care plans were person centred and gave staff clear information about people’s likes and dislikes. We observed staff ensuring everybody received attention and were supported to do things they liked.

Staff were confident about identifying and reporting any suspected abuse and the provider’s procedures were followed if any concerns were identified.

People had clear risk assessments to guide staff how to keep them safe and staff followed this guidance. People had clear assessments in place to ensure their health needs, nutrition and skin condition was monitored. Staff liaised with health professionals to maintain peoples’ wellbeing and to address any new health concerns.

Staff were trained, experienced and supervised. There were enough staff to meet people’s care needs and they carried out their tasks with kindness and discretion. Staff supported people in line with the Mental Capacity Act 2005.

People received their medicines in the way they preferred to take them and medicines were stored and disposed of safely.

People, their relatives and staff were positive about the registered manager and told us they were visible and approachable.

The registered manager had implemented a comprehensive governance system which had identified areas of the service which needed improvement. Where improvements needed had been identified these were followed up and checked by the registered manager.

There was a registered manager for the service. 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.

At the last inspection in June 2015, we asked the provider to take action to improve some areas of the service. This was in relation to the system for managing people’s medicines that was not fully safe. People’s personal care needs were not always identified. Care plans did not always show how to support people in a way that met their needs. We had also found that the system of supervision to support staff effectively in their work was not up to date. There was also a lack of meaningful activities for people to take part in.

The provider had made some improvements in relation to providing social and therapeutic activities.

Some improvements had been made in relation to care records. Care plans had more detail and were more informative about people’s care and support needs. However, some assessments, that identified what level of support people needed had not been completed or regularly reviewed. This meant there was a risk that staff may not know what peoples current needs were or how to support them.

Improvements were needed in relation to the safe storage of some medicines. Some medicines had not been stored securely. Staff supervision was still not being provided regularly to all staff. Some staff had had recent one to one meetings with a supervisor but there were gaps of up to six months when staff were not being formally supervised. This meant staff were not consistently guided and supported to fulfil their job roles effectively.

The majority of staff told us that they felt distant from the management of the service .They said the registered manager was kind and helpful when they did see them. However, staff said they did not see the registered manager on a regular basis.

Although quality audits identified shortfalls in the service such as medicines storage being unsafe actions had not been taken to address these matters.

The staff knew people they looked after well and were aware of their likes, dislikes and personal circumstances. However, we found that the guidance and information provided about people's backgrounds, life histories, cultural and religious beliefs was not always detailed or fully completed. This information is useful in ensuring staff see each person as a unique individual.

Staff understood their responsibility to protect people from avoidable harm and potential abuse and knew how to report concerns. There were processes in place to ensure that staff were trained to care for people and suitable to work within a caring environment.

We found that people were given their medicines safely at the times that they needed them. Medicines were reviewed regularly by their doctor to make sure they were still suitable.

People had their needs met by enough staff. There was some use of agency staff and ‘bank’ staff who work for the provider. These are staff who work at the service on an occasional basis. The provider had a recruitment and retention strategy in place to employ and keep more staff.

People said that they liked the food and we saw they were offered choices at each mealtime to help them decide what option they wanted. People spoke highly of the staff team that supported them. They told us that they were kind and that they worked hard.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. The staff asked for consent before carrying out care

There were detailed mental capacity assessments specific to areas of each individual’s daily life in place. These protected the rights of people who did not have the mental capacity to make informed decisions.. For example, certain people sometimes declined any assistance with personal care despite needing staff support.

Staff were caring and courteous toward the people they supported and had built up close and caring relationship’s with them. We saw staff supported people in a way that ensured that privacy and dignity were respected. Staff provided people with explanations and information so they could make choices about aspects of their lives.

People were encouraged to be included in deciding how they wanted to be supported with their care needs. The families and other representatives of people were involved in decision-making. This was when it was felt to be in the best interests of the people concerned.

People were supported by a team of trained staff. The majority of staff had been on training that was specific to understanding the needs of older people. The staff had also attended a variety of other regular training in health and safety topics .This helped them to improve and develop their skills and competencies.

People and those who represented them were supported to be able to complain and make their views known. The provider sought the views of people and their families. Feedback about the home from people and others involved in their care was positive.

During this inspection, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw four support plans and there was evidence that people's right to consent was recognised. People we spoke with said 'I try to be as independent as possible, staff help with what I can't do', 'if I want something done I ask and it gets done' and 'I can change my mind'.

One person told us 'my key worker does anything I want her to'. Another person said 'we're really looked after'. People said they felt staff treated them respectfully; everyone said they felt safe in the home and one person said 'I've been very happy here'.

People we spoke with said that their opinions were listened to and that 'there's a form comes round every so often'.

One visitor we met told us: 'the place is perfect and I have no concerns'. Another said: 'I don't think we could have picked a better home'.

All the people we talked with said they enjoyed the food. They said they were given a variety of meals and could choose them each day. They said they were able to ask for something different if they did not like what was on the menu that day.

We observed care delivered by the care staff. People were treated with patience and kindness. People were treated with dignity and respect. We observed that the care plans detailed the care needs of the people at the home. We saw that an assessment about people's mental capacity had not been completed.

Staff told us that they had received all necessary training. The home has a system in place to monitor the quality of care and support provided at the home.