Combe House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People received person centred care and were treated as individuals. People were encouraged and supported to take part in outings and activities that were meaningful to them. Staff supported people to ensure they were free from barriers that could be caused by discrimination and inequality. The registered manager had ensured communication needs had been accounted for by producing documents in easy read and pictorial formats for people. They had also ensured there was a culture of people and their relatives being able to raise concerns in confidence they would be resolved. Any learning points from these were raised with staff during staff meetings and individual supervision meetings. Where possible, people’s relatives and representatives had been involved in documenting people’s end of life care wishes.

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.

People’s care was centred around them and their needs. People were offered choices of activities that were meaningful for them. For example, one service user was particularly interested in animals. Staff had supported him to recently visit a local zoo and wildlife park. Staff had also supported another service user with an interest in transport to visit a local vintage transport museum. A relative told us “They know it is good for him to be out in the community now. [The Registered manager] understands that he needs that stimulation and encourages this.

Staff understood people were individuals with their own support needs, and they worked together as a team to provide person-centred care to people. One staff member told us “We support them according to their needs and treat them as individuals. Even though they have learning disabilities, they are not the same people, they have likes and dislikes, and we treat them as individuals.” Another staff member said “I’m there to support people and create some kind of memory with them, even like have a cup of tea. My motto is we have all day to support people.”

We observed during our site visits that the quality of staff engagement with people when they are in the service had improved, including when staff were providing one to one support. For example, one member of staff was sat doing art and craft with a service user, whilst another member of staff was supporting another service to play with his sensory objects.   On the second day of our site visit, staff had supported one person to visit their family and two staff had supported a service user to go out into the community. Our observations were confirmed by the relatives we spoke with, who told us people were much more engaged in activities that met their needs now and had more opportunities to go on outings, to college, adult education classes and to be part of their local community. This included visiting pubs, cafes and restaurants.

Where professionals had provided guidance about how care should be provided, this was recorded in people’s care records and understood by staff. For example, one person’s personal behaviour plan recorded their baseline behaviours, triggers for distressed behaviours, how staff should respond, what escalation of behaviours looked like, and recovery/post incident strategies.

People received joined-up care with good continuity. This ensured that despite having diverse health and care needs, people received care from professionals who were aware of their needs meaning their individual requirements when attending appointments or receiving emergency care could be delivered. Relatives confirmed this, with one telling us “[My family member] has epilepsy which is reviewed by a consultant annually.”

Care plans and risk management plans were in place where people had long-term healthcare conditions. Care plans outlined the support people needed in relation to healthcare conditions and risk management plans identified control measures to minimise any risks identified. Each person also had a health file in which contact with healthcare professionals and outcomes of appointments were recorded. This demonstrated that people were supported to access care and treatment when they needed it. Furthermore, people also had a healthcare passport which recorded their needs in the event of an admission to hospital or engagement with external healthcare professionals. This evidence demonstrated there was continuity in people’s care and treatment, and that people’s care and treatment was delivered in a way that met their assessed needs.

The registered manager told us the service had a good relationship with the GP and that the GP made home visits when necessary to meet people’s needs. For example, one person did not like attending healthcare appointments and found it challenging having to wait in a surgery reception. The GP made home visits to this person to minimise the anxiety attending the GP surgery would cause the person.

Staff members competed daily handover meetings to ensure important information was shared between staff on different shifts. One staff member told us “We do hand overs. We tell them what happened in the shift, and if there are any concerns we tell the next shift. It is recorded. We complete daily notes on what has happened, what activity [people using the service] had, meals they had, if eaten or not.”

People’s care records contained a communication profile and a communication passport. Important information was made available to people in ways they could understand. For example, the complaints procedure and information about safeguarding had been produced in picture format and was displayed prominently in the service. Picture formats had also been used to provide information to people about healthcare appointments and treatment.

Relatives told us communication from the service had improved since the registered manager took up their post. One relative said, “There have been improvements in communication since [registered manager] has taken over. I have spoken to her a lot more than I ever spoke to [previous registered manager].” The relative also told us, “[Deputy manager] also rings me; they give me updates on how [family member] is doing.” The relative said they had been kept informed when their family member had become unwell and was admitted to hospital for assessment and treatment. Another relative said they received communication from their family member’s keyworker to update her on how their family member had been and what they had been doing.

People, relatives and staff were encouraged to complete and return questionnaires to give their feedback about the service. Questionnaires for people asked for their preferences about which member of staff they wanted to support them, who they would like their keyworker to be, and when they wanted their support to be provided. Questionnaires also asked people for their ideas about improvements at the service. Each person had a keyworker with whom they met each month. Keyworker meetings provided opportunities for people to raise any issues they had about their support. Relatives told us they would feel able to complain or raise concerns if necessary. Some relatives told us the response from the previous registered manager when they had raised concerns was unsatisfactory but that the current registered manager had responded positively if they had raised concerns. One relative told us, “It has improved a lot since [registered manager] has taken over. I know I will get a response if I raise something. They are a lot more responsive.” Another relative said “They respond well now if I raise anything.”

The staff we spoke with during our site visits confirmed they felt able to speak up if they had concerns and were confident the registered manager would listen to and act on their feedback. Staff told us they used keyworker meetings with their key clients to encourage people to raise any concerns they had about their support. The registered manager told us they had aimed to develop a learning culture where incidents and complaints were reviewed and actions taken to improve. Staff we spoke to during our site visit confirmed this. The registered manager said any learning from incidents and complaints would be shared with staff at team meetings and at one-to-one supervisions.

Learning from incidents was shared with staff at team meetings, which took place each month. The provider also carried out internal audits which reviewed and monitored people’s quality of life, the environment, people’s outcomes and experiences, staff culture, and safety through learning. The registered manager confirmed there had been one complaint in the last 12 months. The complaint had been from a relative about a person’s appearance when staff had encouraged the person to complete their own personal care. The registered manager said staff continued to encourage the person to manage aspects of their own personal care as this was important in promoting independence, but staff now offered more support to the person during personal care, including providing verbal prompts.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People were supported to overcome barriers they may face in areas such as healthcare to ensure they were not discriminated. In the providers information return sent to us in December 2023, the registered manager had said “At Combe House we want to give everyone the best possible chance to exercise their rights and staff listen to what our people say and respond appropriately. Relatives and advocates views are listened to and acted on where possible.” One person was supported to attend a local college. This demonstrated that possible barriers to accessing higher education had been resolved and had led to a positive outcome for the person.

Processes were in place to ensure people did not experience disadvantage due to discrimination and inequality. The registered manager was aware of the barriers people may face in accessing care and treatment due to their healthcare conditions, disabilities and communication needs. The registered manager had taken action to ensure people were not disadvantaged by seeking out ways to address barriers to improve people’s experience. The registered manager was aware of human rights principles and had taken action to ensure these were adhered to.

Staff were positive about working as one team and they were confident they could challenge situations where people could be discriminated or disadvantaged. One staff member said “We encourage them to do things and say things about what they want to do. Then support them to do things.” Another staff member said, “I would challenge the staff if they discriminated people.”

People’s end of life wishes had been taken into consideration to provide them with personalised care at this stage of their lives.

Where relatives and representatives had been happy to engage, end of life care plans clearly stating people’s preferences had been created.

Staff told us they were proactive in contacting people’s next of kin or representatives to develop people’s end of life care plans. Equally, they respected if relatives did not wish to engage in this area of care planning at the current time and reviewed at a later date.