We undertook this unannounced inspection of Coombe Hill Manor on 21 June and 6 July 2016. This was the first Care Quality Commission (CQC) inspection of the service since they were registered with us in June 2014. Coombe Hill Manor is a care home that can provide nursing, personal care and support for up to 104 older people. The service has a specialist dementia care unit known as ‘Augusta’ which can accommodate and care for up to 24 people. At the time of our inspection 94 people were living at the home.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
Staff actively encouraged and used innovative ways to keep people active and to support them to pursue a wide range of meaningful activities within the home and in the wider community. The provider had introduced ‘OOMPH’ and ‘Namaste’ programmes to help older people and people living with dementia improve their quality of life through gentle exercise, stimulating the senses and social activity sessions.
In addition, Staff ensured people were not socially isolated. Leisure and educational facilities and services that people might be able to access only if they went out of the home had been recreated inside the home for people who may not be able to access the wider community. For example, we saw there was a fully operational cinema showing a rolling programme of films chosen by people living in the home, a salon-bar, a well-stocked library and a games/internet/computer area.
Care plans had been developed for each person using the service, which reflected their specific needs and preferences for how they were cared for and supported. Staff were each provided with a handheld care monitoring device which contained an electronic version of people’s care plans. This ensured that each care staff could easily access a person’s care records if they were not sure about how to care for the person, such as if the person’s needs have changed or they have been off for a few days or on annual leave.
People’s needs were reviewed at least every 60 days and any change that may be needed to the care and support they received was included in their care plans and automatically reflected on the electronic device. This helped to ensure that staff had easy access to the most up to date information about people’s needs.
Management and staff were very motivated and committed to ensuring that people had the best possible care. The staff provided people with positive care experiences and ensured their care preferences were met.
The management team demonstrated a strong commitment to providing people with a safe, caring and quality service. The management structure showed clear lines of responsibility and leadership and managers understood their roles. The provider had developed effective governance systems and there was a strong emphasis placed on continuous improvement of the service. Where the need for improvement was identified, the provider took appropriate action to make the necessary changes. Managers used learning from near misses, incidents and inspections to make improvements that positively enhanced people’s lives.
People told us they were happy living at Coombe Hill Manor. We saw staff looked after people in a way which was kind and caring. Feedback we received from people using the service, their relatives and community health care professionals supported this. Staff spoke with people in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand.
People felt safe living at the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. The service managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies. We saw the premises and garden were wheelchair accessible and had been suitably adapted with grab rails and passenger lifts to enable people to move freely around the home. The provider ensured regular maintenance and service checks were carried out at the home to ensure the building was safe.
Staff had built caring and friendly relationships with people. We observed people and staff engaging in friendly conversations. There were sufficient staff to meet people’s needs, and staffing levels were flexible to provide people with the support they required. People told us there were always staff around and if they needed any assistance a staff member came to support them promptly. We observed staff spending time with people in communal areas.
Staff were clear about their roles and responsibilities. People received care from staff who received effective training and good support from the management team. This provided them with the knowledge, skills and confidence to meet people's needs in a person centred way. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications.
People were encouraged to maintain relationships with people who were important to them. There were no restrictions on visiting times and we saw guests were welcomed by staff People were also supported to be as independent as they wanted and could be.
People were supported to make choices and to have as much control as possible over their life’s. Consent to care was sought by staff prior to any support being provided. People were involved in making decisions about the level of care and support they needed and how they wanted this to be provided.
Staff were aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. Managers understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.
People were supported to keep healthy and well. Staff ensured people were able to access community health and social care services quickly when they needed them. Managers and staff worked closely with other health and social care professionals to ensure that people were supported to receive the health care that they needed. People received their medicines as prescribed and staff knew how to manage medicines safely.
There was strong emphasis on the importance of good nutrition and hydration and a commitment to providing people with what they wanted to eat and drink. There was an excellent choice of meals, snacks and drinks.
The service had an open and transparent culture. They proactively sought the views of people, relatives, visitors, staff and other healthcare professionals about how the care and support people received could be improved. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. Although there were very few complaints and concerns raised the provider had a positive approach to using them to improve the quality of the service.