We carried out a review of the data available to us about Coble House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Coble House, you can give feedback on this service.
Coble House is a residential care home providing accommodation and personal care for up to 52 older people. At the time of this inspection 49 people were using the service, most of whom received nursing care.
People’s experience of using this service and what we found
People were safe living at Coble House. Staff supported people’s health and safety. Risks were identified and reduced. Positive risk taking and independence was encouraged to increase people’s quality of life.
The premises were safe, and the home was clean. Incidents were investigated and reported as required. Lessons learned were shared with staff.
There were enough staff on duty to meet people’s needs. Staff recruitment was safe, and training was refreshed regularly. Regular checks were carried out to ensure staff remained competent.
People’s health and social care needs were thoroughly assessed. Staff delivered care which reflected people’s current needs. Medicines were safely managed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff were very caring and knew people well. They protected people’s privacy and dignity and respected their wishes. People were involved making decisions about their care.
A range of activities were organised to interest people and provide socialisation amongst people, relatives and the local community. People also benefitted from one to one time with staff.
Staff were motivated by the registered manager to provide good quality, person-centred care. The provider’s strong quality assurance process was embedded throughout the service. Provider representatives carried out routine checks to monitor the quality and safety of the service. The provider supported the registered manager to make continuous improvements to the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 5 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about Coble House until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We last inspected the service in July 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.
There was a registered manager in post who has been employed to manage the service since 2009 and was registered with the Care Quality Commission (CQC) to provide regulated activities in November 2011. A registered manager is a person who has registered with the CQC 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.
There were safeguarding procedures in place. Staff were knowledgeable about what action they should take if they suspected people were at risk of harm or abuse. Risk assessments were in place to minimise the risks people faced in their daily lives.
Accidents and incidents continued to be recorded and reviewed. The registered manager analysed these to identify any trends and reported them onto other agencies as required.
People's nutritional needs were met and they were supported by staff to access external health and social care services as required. Oral medicines were managed safely and consistently throughout the home. We made a recommendation about the management of topical medicines. These are prescribed creams applied to the skin.
Robust recruitment procedures continued to be carried out to ensure that staff were suitable to work with vulnerable people. There were sufficient numbers of staff deployed to meet people’s needs. Records confirmed that training courses were delivered to ensure staff were suitably skilled. Staff were supported though a supervision and appraisal system.
The premises were clean and tidy. Checks and tests had been carried out to ensure that the premises were safe and well maintained.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The registered manager told us she had made applications on behalf of most people to restrict their freedom in line with the Mental Capacity Act 2005. All staff demonstrated an understanding of the MCA and worked within its principals.
People were encouraged to makes choices and have control of their lives. Staff supported them in the least restrictive way possible; the company policies and procedures in place supported this practice.
We observed staff interacted positively with people who lived at the home. Staff promoted and protected people's privacy and dignity. There were systems in place to ensure people were involved in the development of their care and support.
Care plans were person-centred and detailed the specific healthcare and support needs of each person. Arrangements for social activities and community engagement met people’s social, emotional, cultural and religious needs.
10 complaints had been received by the service since our last inspection. All of which had been resolved in a timely manner. There was a complaints procedure in place which was shared with people and their supporters.
Audits and checks were carried out to monitor all aspects of the service. Action plans were drafted to highlight any areas which required improvement. The registered manager had comprehensive oversight of the service which they regularly reported onto the provider. The provider also conducted a regular audit on the quality and safety of the service.
Staff told us they enjoyed working at the home and that they felt valued by the registered manager.
This unannounced inspection took place on 15 and 21 July 2015. We last inspected Coble House in June 2014. At that inspection we found the service was meeting all the regulations that we inspected.
Coble House provides residential accommodation and nursing care for up to 52 people, some of whom are living with dementia. At the time of our inspection there were 40 people living at the home, although two people were in hospital.
The service had 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.
Staff knew about safeguarding procedures and what to do if they had any concerns. We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations.
Medicines were generally managed appropriately, with people being given the opportunity to self-medicate where they were able.
Risk assessments were in place and these were regularly reviewed and updated as changes occurred. The service had emergency contingency plans in place. The plans detailed what staff would do in particular emergencies. Accidents and incidents were recorded and monitored for trends and checked through regular audits of the service.
There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.
Staff had the skills and training required to adequately support the people in their care. Staff felt supported and received suitable and regular supervision and yearly appraisals.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and DoLS. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. Applications to the local authority had been made where a DoLS was required and there were three authorisations in place. We observed people consenting before support was commenced.
People told us they enjoyed the food and refreshments at the service. People received enough support if they needed it and special diets were available for the people who required them.
Access and appointments to healthcare professionals were made available to people who asked or for those who needed additional support.
People and their relatives and visitors told us staff were very caring. We observed warmth and kindness shown to people throughout our inspection.
People’s dignity, privacy and respect were maintained by staff. We saw staff being discreet and remembering to speak quietly when asking people about supporting them with personal care when in the company of others.
Care was planned and regularly reviewed to ensure it met people’s needs.
A good and varied programme of activities was available for people to choose from should they have wished to participate. The home had an activity coordinator who was well liked and ensured there was a full range of different entertainments for people to enjoy.
We saw a copy of the provider’s complaints policy and procedure and people knew how to make a complaint if they needed to. The provider had also received many compliments about the support provided by the staff to people in their care. People had a choice of what they had to eat or what they wanted to do.
Meetings were held for people and their relatives and also for staff and all concerned had a chance to air their views and improve quality. Surveys were also completed to support this process.
The provider had systems and procedures in place to monitor the quality of the service provided. When issues or shortfalls were identified, corrective actions were taken.
We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
This is a summary of what we have found.
Is the service safe?
The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.
We saw risk assessments had been completed for people who were assessed as being at risk of falls.
We saw people were safe and protected from abuse. Staff demonstrated to us an understanding of the types of abuse and how they should be reported. All staff had received training in the safeguarding of vulnerable adults and whistleblowing.
The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place and the manager and deputy manager had received training in the Mental Capacity Act 2005 (MCA) and DoLS.
We saw there were sufficient members of suitably qualified and experienced staff on duty to meet people's needs.
Is the service effective?
People were treated with respect and dignity. People who used the service were asked about the support they received and if they understood their rights. They were given the information they needed to make an informed decision about their care.
People we spoke with were aware of their rights and what to do if there were any problems. One person told us, 'I understand my rights. I can do anything I want'.
Is the service caring?
People's preferences, interests and needs were recorded in people's care records. Staff were able to give examples of these when we spoke to them and displayed a good knowledge of the people living at the home and what their likes or dislikes were.
People's health and care needs were assessed with them and they were involved in this process.
Is the service responsive?
There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.
We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.
Is the service well led?
We saw there was a registered manager in place at the service. The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.
The service had a quality assurance system in place that included the use of surveys from people who used the service.
People told us they were happy with the care and support they received at Coble House. One person told us, "Oh, they look after you really well here. The girls (staff) are nice." Other comments included, "They organise me" and "I think they look after me well".
We found that people were cared for in a manner which ensured their safety and welfare. We witnessed positive interactions between people and staff, and we saw that people's care needs were met. Both people and their relatives told us they were happy with the care they received.
We found that the management of medicines was appropriate and people were protected against the risks associated with medicines.
People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes.
We found that people's care needs was assessed and care was planned. We observed staff interactions with people that were considerate, respectful and polite. However, we identified some shortfalls in relation to nursing care assessments and delivery of care that may have put people's health and welfare at risk.
We identified shortfalls in respect of the management of medicines which meant that people's health and welfare was put at risk.
We found that there were enough suitably skilled and qualified staff on duty to met people's needs safely and appropriately.
We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager.
We found that people were involved in the planning of their care and they said their privacy and dignity was respected.
We found that people's care and support needs were appropriately assessed and their care was planned. They received care safely, and to an appropriate standard.
People said they felt safe when in receipt of care and we found that staff were aware of their responsibilities in relation to protecting people from harm or abuse.
Staff were appropriately trained and the service had adequate systems in place to monitor the quality of the service that it provided.