Combe House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The ethos and values of the registered manager and staff members ensured the culture in the service was one of inclusivity, positivity, and equality. Feedback from relatives and staff was that the service had improved since the arrival of the Registered Manager. Staff had clear understanding of their roles and responsibilities, and felt confident in being able to speak up and raise concerns if needed. There were effective governance systems and processes in place to drive improvement within the service. Staff worked in partnership with external stakeholders to achieve good outcomes for people, including the community mental health team and GPs.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager told us they aimed to create a culture that promoted trust and understanding between staff and the people they supported. The registered manager used team meetings to talk to staff about the signs of closed cultures and how to avoid these and, instead, foster a positive culture in which people were respected, valued and listened to. The registered manager provided a good role model in her engagement with people who lived at the service, listening to and respecting people’s views and wishes. A member of staff told us, “There is good culture here. Our job is to support people, we have to respect it is people’s home and give the best life they can have.” Another said “It is a Very supportive team. Staff know that they can come to senior staff and the registered and deputy manager. It is people’s home and we are here to support them.

People who used the service, relatives and advocates, staff, and other stakeholders had opportunities to give feedback about the service through surveys. The provider had developed a purpose statement and a set of organisational values which were known and understood by the registered manager and staff. These included “To make sure that the people we support have a strong voice” and “To work together with families so that they choose us to support their loved ones.”

Relatives and staff spoke highly of the support provided by the registered manager. An advocate for a person using the service said “I can see things are improving under [registered manager’s] management. She is making great strides.” Staff told us the registered manager was approachable and supportive. They said the registered manager was always available for support and advice. One member of staff said, “[Registered manager] is brilliant; she is an amazing manager. We are grateful that she was able to come to our house.” Staff told us the registered manager used team meetings to talk to staff about the signs of closed cultures and how to avoid these and, instead, foster a positive culture in which people were respected, valued and listened to.

The registered manager operated an open-door policy to ensure that staff could have access to management at any time to discuss any issues or concerns they may have. In the provider’s information return sent to us in December 2023, the registered manager informed us “Everyone is treated as an important part of the team and this helps us to form a positive partnership in delivering our services for the benefit of the people we support.”

The provider had whistle-blowing procedures which were explained to staff in their induction and reinforced at team meetings and supervisions. People who used the service, relatives, advocates and other stakeholders were able to raise concerns in surveys and informally. None of the people we spoke with had concerns about any aspect of people’s care or treatment. The relatives and advocates we spoke with told us they would feel able to raise concerns if necessary and were confident action would be taken if they did so.

Staff told us they felt able to speak up if they had concerns about any aspect of the service. This was also confirmed in a survey staff were asked to complete in November 2023 in which all staff responded that they felt able to speak freely, offer feedback and raise concerns. Staff said they had been made aware of the provider’s whistle-blowing procedures. Staff were confident action would be taken if they spoke up but knew how to escalate concerns, including outside the organisation, if necessary. The registered manager confirmed she had spoken with staff about the importance of speaking up if they had concerns about any aspect of people’s care and treatment. They confirmed they used team meetings to talk to staff about the signs of closed cultures and reminded staff of their responsibilities to speak up if they had concerns about any aspect of the service. The registered manager understood their responsibilities under the Duty of Candour.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We reviewed the provider’s audit of the service dated December 2023. They had identified good practices and areas for improvement. For example, they identified that all people using the service required a review of their Deprivation of Liberty Safeguards. We observed that this had completed during our site visits.

Staff understood their roles and responsibilities within the team and how these contributed to ensuring the safety and quality of the service. The registered manager told us staff were given individual lead responsibility for aspects of the service including health and safety, fire safety, infection control and medicines. The registered manager said this increased accountability for individual aspects of the service. The registered manager was aware of her responsibility to maintain standards of governance and oversight of the service. The registered manager told us the provider’s regional manager carried out quality audits of the service and mock inspections based on CQC methodology. The registered manager said any areas identified as needing improvement were added to the service improvement plan.

There were a variety of health and social care professionals involved in people’s care to ensure the wider care they received was seamless. For example, staff had arranged a GP home visit to assess a person when they sustained an injury as the person did not like attending healthcare appointments. This ensured the person received the healthcare input they needed without causing the anxiety attending a healthcare appointment would have.

People’s care records demonstrated how staff worked with professionals including the GP, community learning disability team and psychiatrist. This was evident in records of healthcare appointments and their outcomes. The provider’s information return states “In accordance with GDPR (General Data Protection Regulation), Combe House only shares information about our people where appropriate to do so and will only share the information required for that individual outcome.” This was evident in the documents we received.

Feedback from the local authority confirmed the registered manager’s response to information requests had been slow. However, once these had been received they were able to close the safeguarding investigation.

The registered manager acknowledged areas where working with partners could be improved. They confirmed it had taken a long time to respond to the recent safeguarding investigation information requests from the local authority. This was due to them being based at two of the provider’s services and having to split their time. They confirmed now they were solely based at Combe House this was an area they were looking to personally improve.

The registered manager outlined the procedures in place to ensure learning was identified from complaints, incidents and adverse events. The registered manager told us that any accidents and incidents were recorded on the Radar system, which enabled her and senior managers to view accident and incident records and review these to ensure action was taken to reduce the risk of similar incidents happening again. Feedback was sought from people using the service to aid improvement. We viewed surveys created in accessible formats which staff supported people to complete. Here, people were able to feedback on areas such as which staff member they would prefer to have as their keyworker, if there was anything staff could do better and if they felt any home improvements were needed in the building.

Staff told us the registered manager used team meetings to share learning and to ensure the team understood the actions needed to improve practice and prevent a recurrence of accidents and incidents.