Archived: Coombes Wood House

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We identified some areas of the building that needed attention, and policies and procedures that were out of date.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.

The service was last inspected on 3 April 2014 when it met the requirements that were inspected.

One of the registered providers was also registered as manager of the service. A ‘care manager’ was employed to oversee the day to day management of 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.

People’s needs were met by ensuring there were sufficient staff on duty. During the inspection we saw people’s needs being met in a timely way and call bells were answered quickly.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. People were supported to maintain a healthy balanced diet and people told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals. One healthcare professional told us staff had “tried everything” to help relieve one person’s distress.

People received individualised personal care and support delivered in the way they wished and as identified in their care plans. People’s care plans contained all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed.

People and their relatives were supported to be involved in planning and reviewing their care. However, a recent survey had highlighted not all relatives knew about care plan reviews. The management team had made plans to ensure everyone who wanted to be involved could be. Relatives told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

People’s needs were met by kind and caring staff. Visitors told us “Staff are wonderful” and “Very caring staff.” We saw an email that a relative had sent to the service. It read “Seeing her being fed by different people and seeing how much she is cared for really warms my heart.” People’s privacy and dignity was respected and all personal care was provided in private.

Not everyone living at Coombes Wood House was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the principles of the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. Each time staff entered the lounge they spoke to people and tried to engage them in conversation. There were regular activities available for people to participate in. These included singing, word games, crafts and gentle exercises as well as outside entertainers. Staff were raising funds to provide extra entertainment for people.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS).

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with people who require care and support.

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

The management team was very open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the team and said they could raise any matters at any time. Staff told us they were able to make suggestions and have them implemented. One staff member said they had suggested an activities organiser had been employed and this had happened.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. Regular audits were undertaken including medicines, care plans and accidents and incidents. We saw that where issues had been identified action was taken to rectify the matters. Records were well maintained.

Health and social care professionals we spoke with were positive about the relationship they had with the service. One told us “We are very fortunate to have them (the service) in the area.”

We considered all the evidence we had gathered under the outcome we inspected. We considered our inspection findings to answer the questions: Is the service safe, caring, responsive, and effective?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them, and from looking at care plans and daily records.

On the day of our inspection visit, 33 people lived in the home. We spoke with three people who lived in the home. We spoke with the Registered Manager, care manager, assistant care manager, three members of staff, and a healthcare professional. Most of the people who lived in the home had dementia and when we spoke with them they were not always able to tell us about their experience. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us or give us their views. We observed non- verbal communication signals such as body language to help us understand people's experience.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us the service had submitted applications where appropriate. Two had been granted and the others were waiting for a decision. The manager knew when an application should be made, and how to submit one.

Is the service caring?

People who used the service told us they were happy with the care and support they experienced at Coombes Wood House. They said: 'they've been looking after me well' and 'staff are very good'.

Staff supported people in a friendly, kind and patient manner. We observed that interactions between people and staff were good and showed staff respected people who lived in the home.

Is the service responsive?

People had regular contact with healthcare professionals such as their GP, District Nurses, physiotherapists, and the mental health team. Records of contact with these professionals were kept and the care plans updated to reflect any advice received.

We observed that people had access to a call bell. People told us staff usually arrived promptly if they had used their call bell.

On one occasion during our inspection visit, we observed staff used the wrong sized handling belt when assisting a person with their mobility. The belt was too big and this meant the handling belt moved up the person's body and may have presented a risk of injury. We spoke with the Lead Senior who was responsible for delivering moving and handling training in the home. They spoke to the staff during our visit and confirmed they had planned a moving and handling training update for the day after our inspection visit. This told us the service took swift action when shortfalls were identified.

Is the service effective?

People told us that they felt their needs had been met. Staff we spoke with demonstrated a good knowledge and understanding of people's needs. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One person had recently moved into the home. Staff told us this person's care plan was developed and reviewed regularly as staff got to know them and their individual needs.

We saw that people's needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. Each person's care plan included detailed personalised information about them. We spoke with people who lived at the home they told us 'it's beautiful here, I am very happy with everything.' Another person told us 'if we want a drink in the middle of the night they will get it for me.' and 'They are very kind here'.

The provider had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated. We saw that people were offered hot or cold drinks several times throughout the day. We observed people eating a nutritious lunch on the inspection visit.

We saw the medication systems in use meant people had their medicines at the time they needed them and in a safe way.

The complaints system had been brought to the attention of people using the service and their relatives. A copy of the complaints procedure in a pack provided by the home, had been given to all people who came to live at the home.

People we spoke with told us they felt involved in their care. The relatives of one person living at the home said 'All staff are patient and kind. They take time to find out how [our relative] likes to be looked after and although it isn't always easy for [our relative] to make choices the staff are always patient and understanding'

We spent forty minutes observing the activity and interactions in the lounge and dining room and saw staff being polite, respectful and kind. We heard friendly banter and affection being mutually shared. We saw no negative interactions.

People were complimentary about the staff and the care they received. They said they felt safe living at the home and that there were enough staff on duty. They knew how to complain and felt satisfied complaints would be dealt with appropriately.

The home was clean, warm and comfortable and people told us they were happy with the standards of cleanliness at the home.

The home had systems and policies in place for the safe management of medication. However not all staff were complying with these which put people at risk of not receiving medication safely.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

You can see our judgements on the front page of this report.