Combe House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs were assessed at regular intervals to ensure their changing needs were met. The service encouraged people, their relatives and advocates to be part of this process. People’s mental capacity to make decisions had been appropriately assessed and restrictions put in place to keep people safe when absolutely necessary. In these situations, the least restrictive option had been used to ensure people still had maximum choice and freedom.

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.

Staff confirmed they reviewed people’s needs regularly and in response to any changes required in the care they receive.

Staff were aware of restrictions in place for people, such as keypad on the front door and that people could not leave the service alone due to risks to their safety. Staff were aware of the importance of ensuring restrictions in place were the least restrictive option to people. One staff member said “[Restrictions] are put in place to protect residents and keep them safe.”

Records demonstrated this, showing people’s needs were regularly reviewed through assessment to ensure their support plans continued to reflect their needs. The most recent full reviews of people’s care had taken place in August 2023. However, staff carried out in-house care plan reviews each month.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

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. Mental capacity assessments had been carried out to establish whether people had capacity to make informed decisions about their care and treatment. Relatives and an advocate we spoke to confirmed their views had been sought regarding decisions made in people’s best interests. Furthermore, we observed during our site visits that staff sought people’s consent before supporting them and explained what the support would involve.

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. The processes and systems in the service supported this practice. Deprivation of Liberty Safeguards had either been applied for or were already in place for people in the service. These included restrictions around of a lap belt when using a wheelchair and constant supervision by staff. We fed back to the registered manager that best interests processes in people’s care records could be clearer. The registered manager responded to feedback immediately and carried out a review of all mental capacity assessments and best interests procedures to ensure evidence of appropriate best interests processes were clearly recorded.

Staff were aware of restrictions in place for people, such as keypad on the front door and that people could not leave the service alone due to risks to their safety. Staff were aware of the importance of ensuring restrictions in place were the least restrictive option to people. One staff member said “[Restrictions] are put in place to protect residents and keep them safe.”