Coble House is a residential care home which provides accommodation and support for up to 52 older people who require nursing or personal care. Accommodation is split over two levels with lift access to the first floor. There were 46 people living at the home at the time of this inspection.

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 val

At a previous inspection we found concerns with the home’s arrangements for managing medicines and nursing care assessments and care delivery. We carried out this inspection to check whether action had been taken to address these concerns. We found that improvements had been made to make sure that people who lived at the home were cared for appropriately and they were given their medicines safely.

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 they were happy with the care and support they received. One person said, "They are looking after me very well." Another person said, "The staff are all very helpful." One person's relative said, "The care here is generally good. Some carers are better than others though."

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.

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.