Archived: Coombes Wood House

Updated 7 August 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team consisted of one adult social care inspector, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type: Coombes Wood House is a care home without nursing. People in care homes receive accommodation and personal care. 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 will be legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced and started at 07:00am. This was because we wanted to meet the night staff and observe the morning handover between staff shifts to see how duties were allocated for the day.

What we did:

Prior to the inspection we reviewed the information we held about the service and the notifications we had received. A notification is information about important events, which the service is required by law to send us. The registered manager had completed a provider information return (PIR). This form asked the registered manager to give us some key information about the service, what the service did well and improvements they planned to make.

During the inspection we spoke with seven people living at the service, five visiting relatives, the registered manager, the general manager, care manager, seven members of care staff, and the activities organiser. As most of the people living at Coombes Wood House were living with dementia, many were not able to share their experiences of living at the home with us verbally. We spent time during the inspection visits conducting a short observational framework for inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not tell us verbally about their life at Coombes Wood House.

We looked at the care records for three people in detail and sampled other records, such as those for medicines administration, audits and the management of risks. We looked at two staff recruitment files, sampled policies and procedures in use, and reviewed complaints, concerns and notifications sent to us about the service.

Updated 7 August 2019

About the service:

Coombes Wood House is a care home without nursing and is registered to provide accommodation and support for up to 39 older people. Coombes Wood House provides care to people with dementia, physical disabilities and mental health conditions. At the time of the inspection there were 37 people living at the service with one additional person being admitted during the inspection period.

People’s experience of using this service:

There was established leadership at the service, although there had been changes to the management structures recently. We identified concerns over the governance of the service, which the provider took immediate steps to address following taking legal advice. Quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided. However, we found these were not always being operated robustly. We identified concerns with pre-employment checks, safe storage and use of creams, environmental risks, a lack of risk assessments for some health conditions, and staffing issues.

Although immediate action was taken by the service to address the concerns we identified and the impact of them on people was low, the issues we found had not all been identified or managed by the service’s own quality assurance processes. This told us they were not always operating robustly.

We identified some areas of the building that needed attention, and policies and procedures that were out of date. We have also made a recommendation about reviewing the accommodation in the light of best practice for environmental adaptation for people living with memory loss. We saw some instances where communication with people living with dementia could be improved and these were discussed with the registered manager who said they would speak with staff.

People received their medicines as prescribed. We identified some risks associated with long term health conditions were not being assessed, and this was addressed immediately during the inspection. Other risks around people’s care or health were being assessed and managed, for example for falls or pressure ulcers. Following the inspection, the service also removed several expired creams which were left in people’s bathrooms. We did not identify any harm that had come to people, however we have made a recommendation about this.

Systems were in place to safeguard people from abuse, and the service responded to any concerns or complaints about people’s wellbeing. Recruitment processes had not always been followed consistently, but this was addressed during the inspection. This had concerned a short gap on one person’s employment history that had not been explored. Enough staff were in place to meet people’s needs, and staff received the training and support they needed to carry out their role. We identified an occasion when staff were not quickly responsive to people’s needs, and this was discussed with the registered manager and care manager.

People and their relatives spoke well of the service they received from Coombes Wood House. People’s needs, and wishes were met by staff who knew them well.

People received personalised support which met their needs and preferences. People told us the service met their needs and they felt the care given to them was good. People and their relatives were involved in developing the person’s care plans wherever possible, and the service took a positive approach towards risk taking. For example, supporting people to keep mobile, even where they were at high risk of falls, because they recognised the positive effect this had on people’s wellbeing.

Staff spoke positively about people and their work at the service, which they said was a good place to work, with staff working well as a team. Staff told us they would be happy for relation of theirs to be supported at the service.

Systems ensured learning took place from incidents and accidents. Feedback from people using the service was used to develop the service further, for example increasing activities available.

More information is in the full report

Rating at last inspection: This service was last inspected in December 2016, when it was rated as good in all areas and as an overall rating.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

We identified a breach of regulation. You can see what action we have asked the provider to take at the end of this full report.

We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.