Coombes Wood House is registered to provide accommodation and personal care for up to 36 older people. Coombes Wood House provides care to people with dementia, physical disabilities and mental health conditions. Any nursing care that is required is provided by community nurses. The service was inspected on 20 and 21 December 2016 when there were 32 people living there.

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 con

We, the Care Quality Commission (CQC), received information of concern relating to the care and welfare of the people who lived in the home. We visited the home to check the people who lived there were kept safe and that their care and welfare needs were being met.

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.

Coombes Wood House is a care home for up to 36 people. At the time of the inspection there were 36 people living there. It provides care and support to older people who have dementia and/or a physical disability. At the time of the inspection most of the people living at the home were living with dementia. When we visited there was a registered manager in post.

On the day of the inspection we saw people were well cared for and their needs were met in a timely fashion. Relatives told us the staff were: "good" and "caring." They told us staff knew their relative’s needs well.

Professionals were positive about the support given at Coombes Wood House. One commented: "It’s very nice, they do a good job."

Staff received the support and training they needed in order to carry out their duties to a good standard.

Management of the home was good and we found there was a positive relationship between staff and management.

Audits in place had failed to identify errors in the Medication Administration Record Sheets, (MARS). This meant people could be at risk associated with the unsafe administration of medication.

We found the service was meeting the requirements of the Deprivation of Liberty Safeguards.

On the day of the visit we found that people’s consent had been obtained for care and treatment provided to them by the service. During our observations we saw staff asking people for their consent to undertake an activity. For example we saw care workers ask people where they would like to go after they had eaten their lunch.

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.

We visited Coombes Wood House to follow up on two compliance actions from the last inspection. We found that the home had taken appropriate action.

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.

People who live in the home told us that they felt well treated and were happy with the staff at the home. Comments included “Staff are very kind, I love living here”, “food is very good” and “staff always come when called”. A relative told us they were “more than happy” with the quality of care their relative received. They also said that staff “do individual care, they listen and try to communicate” and “staff have always made me welcome and feel part of the family”. Laughter and appropriate use of affection was heard and seen throughout the visit.

All those we spoke with confirmed that they were satisfied with the quality of care and attention they receive at Coombes Wood House. However, none could recall being involved in planning how they wished their needs to be met or in any reviews of care.

We asked people about the ability of the staff to provide the care and support they needed.

Their responses included, “There is a good staff team here”, another “ they all do their best and a relative told us they had been visiting for more than two years and “haven’t had anything to complain about”.

We asked people whether there were enough staff to meet their needs. We were told that staff were usually available when they needed them. One person told us “you can’t have enough staff, but staff mostly get things right”.

We were given examples of choices that people were given such as what time they get up, where they eat, and how they spend their time. Five people we spoke with told us they did not have anything to complain about and said that if they did the owner or head of care were at the home each day to sort things out.