Combe House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safeguarding processes and systems were in place to protect people from the risk or abuse and neglect. Staff were aware of their responsibility to safeguard people and how to raise concerns. Risk assessments detailed individual risks known to people and how staff should support people to mitigate these. We observed staff following the risk assessments during our site visits. There were sufficient numbers of suitably trained and experienced staff to meet people’s needs. People received their commissioned one to one hours to support them engage in activities that were important to them and staff were engaged with them throughout this. There was a consistent staffing team who knew people and their needs well, with minimal use of agency workers.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The registered manager had notified CQC and the local authority of safeguarding concerns and contributed to safeguarding investigations to ensure people were protected from abuse. One relative told us “You can tell [staff] really care for him.” Feedback from a recent safeguarding investigation noted that a relative confirmed that they had no concerns regarding her loved one’s care and feel they are happy at the service.

Staff were aware of their responsibility to protect people from abuse. One staff member told us “If there is anything I’m concerned about, I would tell the senior staff, manager, deputy. I would also record what I’ve seen and noticed.” Staff members were able to confirm they would contact CQC if they needed to whistleblow due to concerns.

The provider had a safeguarding policy in place, and we observed that safeguarding referrals had been made appropriately and steps taking to safeguard people from abuse. The registered manager informed us due to managing two of the provider’s services at the same time it had taken longer than she anticipated to send the local authority the information they required to be able to complete their safeguarding investigation. However, since October 2023 she had been working solely and Combe House and provided assurances that any future information requests would be responded to in a timely way.

Staff were aware of risks to people and were able to tell us what action they took to mitigate these. One staff member told us “As you read the support plan, you know who can do what and cannot do what, so you know the risks. You know who needs two to one or one to one care.”

People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. Staff involved people in managing risks to themselves and in taking decisions about how to keep safe but still carry out activities they chose to do. Relatives told us risks to people were managed safely by a staffing team that knew people’s needs well. A relative told us “The care is good. They do their best to accommodate his needs.” An advocate for a person using the service told us “They know the residents really well and they have built a good rapport with them.”

People’s care plans included clear risk assessments. These included areas such as a personal emergency evacuation plan (PEEP), finances, medicines, nutrition and hydration, and health risk assessments for specific conditions such as epilepsy. Risk assessments stated what the risk to the person was and what action was necessary to mitigate it. For example, one person required their food to be prepared in a particular way due to dental issues. This was clearly recorded in their care plan along with information from the Speech and Language Team who had provided guidance.

We observed staff following people’s risk assessments in order to keep them safe. For example, one person was at risk of falling. The person had a falls risk assessment in place which stated staff should support the person when they moved around the service to ensure their safety. We observed staff supporting this person to move around the service safely during our onsite assessment. The person had been assessed as needing two staff to access the community safely. During our second site visit, the person was supported by two staff when they went out in the community as per their risk assessment.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

At the last inspection in November 2021, we observed staff supporting people on a one to one basis were not proactive in engaging with them. As a result, although one to one staffing kept people safe, people were not getting the maximum benefit of one to one support. During this assessment, we observed that staff supporting people on a one to one basis were proactive in engaging with them.

Staff told us they had no issues with staffing, and they worked together as a team to support and care for people without rushing them. A staff member told us “We have plenty of time to do our jobs, no issues with staffing; we are here to support people and support them according to their needs. If they are slower, we take their time. We don’t rush them at all. If we need staff cover, we ask first permanent staff then seek agency staff.”

People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. The service had enough staff, including for one-to-one support for people to take part in activities and visits how and when they wanted. This had a positive impact on people's experiences and was an improvement form the last inspection in November 2021. Staff engaged people in activities of their choice and engaged them in conversation. Relatives we spoke with confirmed that their family members received their commissioned one to one hours and that their family members were able to choose how they used this support. There was minimal use of agency staff which ensured people received continuity in care from staff who knew them well. One relative told us “It is a lot more stable [staff team]. [Family member] is autistic and changes upset him. It is much better for him now.”

People were supported by staff who had the induction, training and support they needed to do their jobs effectively. The service’s training record demonstrated that staff received training appropriate to their roles. The registered manager found on their arrival in post that staff supervision had not been happening as often as it should and had addressed this. All the staff we spoke with confirmed they had regular one to one supervision. This provided staff with the opportunity to discuss their performance in their role, their training needs, and to seek support if they needed it.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.