The inspection of Combe Lea Community Resource Centre took place on 15 and 16 March 2018 and was unannounced. When the service was last inspected in October 2016 four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Combe Lea Community Resource Centre, on our website at www.cqc.org.uk.

Combe Lea Community Resource Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Combe Lea Community Resource Centre provides care and accommodation for up to 30 people. On the days of the inspection 30 people were living at the home. The home was over two floors, with access to all floors either via stairs or the lift. All bedrooms have en-suite facilities. Gardeners Row was on the first floor and was a unit for people living with dementia. Willow on the second floor was for older people who were physically frail.

At the last inspection the service was rated as Requires Improvement. At this inspection we found that improvements had been made within the service. All of the four previous breaches had now been met.

There was 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.

The provider had failed to take action required following a fire service inspection. The provider had not made improvements needed to the fire systems at the service. The registered manager had notified the provider who had placed it on the corporate risk register. We have notified the fire brigade of this.

People were protected from the risk of infection because staff followed the correct procedures in respect of laundry and avoiding cross infection. However, we noted the laundry baskets were broken and identified this as a potential risk. The provider sent evidence that new baskets had been ordered following the inspection.

The service had received an award after being nominated by a person’s relative. The provider had a video clip of the relative talking about the service on their website. People and their relatives were complimentary about staff. We observed staff interacting with people with warmth and kindness. It was evident staff knew people, their histories and preferences. People’s independence was promoted where possible and staff protected and respected peoples’ dignity.

Care plans were person centred and gave staff clear information about people’s likes and dislikes. We observed staff ensuring everybody received attention and were supported to do things they liked.

Staff were confident about identifying and reporting any suspected abuse and the provider’s procedures were followed if any concerns were identified.

People had clear risk assessments to guide staff how to keep them safe and staff followed this guidance. People had clear assessments in place to ensure their health needs, nutrition and skin condition was monitored. Staff liaised with health professionals to maintain peoples’ wellbeing and to address any new health concerns.

Staff were trained, experienced and supervised. There were enough staff to meet people’s care needs and they carried out their tasks with kindness and discretion. Staff supported people in line with the Mental Capacity Act 2005.

People received their medicines in the way they preferred to take them and medicines were stored and dispo

Combe Lea Community Resource Centre. is registered to provide accommodation and personal care for up to 30 people. On the day of the visit, there were 30 people at the home.

There was a registered manager for the service. 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.

At the last inspection in June 2015, we asked the provider to take action to improve some areas of the service. This was in relation to the system for managing people’s medicines that was not fully safe. People’s personal care needs were not always identified. Care plans did not always show how to support people in a way that met their needs. We had also found that the system of supervision to support staff effectively in their work was not up to date. There was also a lack of meaningful activities for people to take part in.

The provider had made some improvements in relation to providing social and therapeutic activities.

Some improvements had been made in relation to care records. Care plans had more detail and were more informative about people’s care and support needs. However, some assessments, that identified what level of support people needed had not been completed or regularly reviewed. This meant there was a risk that staff may not know what peoples current needs were or how to support them.

Improvements were needed in relation to the safe storage of some medicines. Some medicines had not been stored securely. Staff supervision was still not being provided regularly to all staff. Some staff had had recent one to one meetings with a supervisor but there were gaps of up to six months when staff were not being formally supervised. This meant staff were not consistently guided and supported to fulfil their job roles effectively.

The majority of staff told us that they felt distant from the management of the service .They said the registered manager was kind and helpful when they did see them. However, staff said they did not see the registered manager on a regular basis.

Although quality audits identified shortfalls in the service such as medicines storage being unsafe actions had not been taken to address these matters.

The staff knew people they looked after well and were aware of their likes, dislikes and personal circumstances. However, we found that the guidance and information provided about people's backgrounds, life histories, cultural and religious beliefs was not always detailed or fully completed. This information is useful in ensuring staff see each person as a unique individual.

Staff understood their responsibility to protect people from avoidable harm and potential abuse and knew how to report concerns. There were processes in place to ensure that staff were trained to care for people and suitable to work within a caring environment.

We found that people were given their medicines safely at the times that they needed them. Medicines were reviewed regularly by their doctor to make sure they were still suitable.

People had their needs met by enough staff. There was some use of agency staff and ‘bank’ staff who work for the provider. These are staff who work at the service on an occasional basis. The provider had a recruitment and retention strategy in place to employ and keep more staff.

People said that they liked the food and we saw they were offered choices at each mealtime to help them decide what option they wanted. People spoke highly of the staff team that supported them. They told us that they were kind and that they worked hard.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the

The inspection took place on 5 June 2015 and was unannounced. The service was last inspected in September 2014 and met with legal requirements.

Combe Lea Residential Care Home is registered to provide personal care for up to 30 people.  There were 30 people at the home on the day of our visit.

There was a registered manager for the service. A registered manager is 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.

The system for managing people’s medicines was not safe. The recording of medicines was not always accurate. This meant medicine records did not always show whether people were given the medicines they needed.

People’s personal care needs had not always been identified and care plans did not always show how to support people in a way that met their needs. This meant people there was a risk people did not always receive care in the way they required.

The system of supervision to support staff effectively in their work was not up to date. This meant staff did not receive the right level of support in their work. This could impact on the quality of service people received.

There was a lack of suitable social and therapeutic activities for people to take part in. People told us there was not enough to do at the home.

A recent staffing restructure had taken place in the home. Staff were now working in all areas of the home. Previously staff had mostly worked on one of the two floors. There was mixed feedback from people about how effectively this new system was working. People were concerned they no longer saw staff they knew. People had not yet got to know the staff who were now providing them with some of their care.

People spoke positively about the staff and the way they were supported with their care needs. The staff were kind and caring in their approach with the people they supported. People and staff communicated positively and in a good humoured way. People told us they felt comfortable to approach staff whenever they needed.

People were supported to eat and drink enough to be healthy and their food preferences were taken into account when menus were planned.

Systems were in place so that the requirements of the Mental Capacity Act 2005 were implemented. This legislation protects the rights of people who lack capacity to make informed decisions.

People felt able to express their views about the service. They knew how to make a formal complaint if they were unhappy about any aspect of their care

Regular checks on the quality of care and service were undertaken. When needed, actions were implemented to improve the service. Quality checks had identified that medicine records and care records needed to be updated. They had also identified that staff supervision had not been kept fully up to date for all staff.

The registered manager and a senior manager had kept people, their families and staff well informed about the new staffing structure at the home. This was put in place in April 2015 and the registered manager told us the main purpose of the restructure was to provide people with a more flexible service.

We found two breaches of the regulations during our inspection. You can see what action we told the provider to take at the back of the full version of the report.

There were 25 people who use the service on the day of our visit; we spoke with two people who use the service on Willow View and three relatives on Gardner’s Row, where the people who use the service have a dementia. We spoke with three members of staff. People we spoke with said “they’re wonderful staff” and “they provide what I want”. People said that staff knew their needs “very well” and “we’re really looked after”. Staff we spoke with said “key workers sit with residents and go through care plans to explain anything”.

We saw four support plans and there was evidence that people's right to consent was recognised. People we spoke with said “I try to be as independent as possible, staff help with what I can’t do”, “if I want something done I ask and it gets done” and “I can change my mind”.

One person told us “my key worker does anything I want her to”. Another person said “we’re really looked after”. People said they felt staff treated them respectfully; everyone said they felt safe in the home and one person said “I’ve been very happy here”.

People we spoke with said that their opinions were listened to and that “there’s a form comes round every so often”.

One person we met said: “I would not change anything. I am happy here and would not want to move as I wouldn't find anything better”. Another person said: “I am looked after very well. The food is good and the staff are kind”.

One visitor we met told us: “the place is perfect and I have no concerns”. Another said: “I don’t think we could have picked a better home”.

All the people we talked with said they enjoyed the food. They said they were given a variety of meals and could choose them each day. They said they were able to ask for something different if they did not like what was on the menu that day.

We observed care delivered by the care staff. People were treated with patience and kindness. People were treated with dignity and respect. We observed that the care plans detailed the care needs of the people at the home. We saw that an assessment about people’s mental capacity had not been completed.

Staff told us that they had received all necessary training. The home has a system in place to monitor the quality of care and support provided at the home.

In October 2011 we carried out a review of Midsomer Norton Community Resource Centre and identified some areas where the service needed to make improvements. Following the review, the registered providers Sirona Care & Health CIC told us about the changes they intended to make. The purpose of this review was to visit the service to check on the improvements. The areas we were concerned about were: Care and welfare of people who use services.

We spoke to people living in the home when we carried out our previous review in October 2011, but we did not involve people during this review. We spoke to the home manager and looked at care records to ensure that the changes that were needed had been implemented. We saw that the care staff had reviewed peoples care plans to ensure they contained up to date information and that any changes were include in these plans. We saw that the care staff had ensured people's life histories were on their care files.

We saw that information in the care files was inconsistent and would not always equip staff with enough knowledge to care for people safely. Some people’s care files contained limited information about manual handling assessments, falls screening tool and risk assessments.