Coombe Hill Manor is a care home providing nursing, personal care and support for up to 104 older people. The service has a specialist dementia care unit known as ‘Auguste’ which can accommodate and care for up to 24 people. At the time of our inspection 89 people were living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

This inspection visit took place on 14 and 27 November 2018. Our first visit was unannounced. At our last inspection in 2016 we rated the service Good, with an Outstanding rating in the ‘responsive’ key question. At this inspection we found evidence to support an improved overall rating of Outstanding.

People using the service and their relatives were very positive about the care and support provided at Coombe Hill Manor.

People were kept safe. There were enough staff deployed to ensure people’s needs were being met. Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern.

People received their medicines as prescribed. Any risks associated with people’s care were managed well and people were supported to maintain their independence wherever possible.

People and their relatives told us that they received an effective service. People received the support they required to meet their health and nutritional needs.

Staff spoke positively about the support and training they received. Staff members were safely recruited and received an induction to the home. Staff we spoke with were confident that they provided a high quality service to people and said they would recommend the home to others.

We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service was exceptionally caring. The registered manager and her staff team were committed to providing high quality compassionate care. We observed excellent relationships between staff and people using the service. Respect and dignity for people was at the heart of the service with people and their relatives consistently saying that staff were very respectful, kind and caring. There was also a strong emphasis on ensuring compassion, dignity and respect at the end of a person’s life.

The service continued to be exceptionally responsive to people’s changing needs. People were supported to live their life to the full and had access to a wide range of activities, events and facilities. Staff worked creatively to enhance people’s enjoyment of life, including tailoring activities to people’s needs and creating opportunities for people to still be involved in their local community.

Care and nursing staff and the registered manager made sure people’s changing needs were met and strove to ensure people received exceptional person-centred care. People and their relatives concerns and views were listened to and acted upon. Relatives told us the management team was always responsive and approachable.

Individual care and support needs were fully assessed, documented and reviewed at regular intervals. An electronic system for care planning provided a very effective tool for staff to do this.

Good leadership, management and governance of the service supported the delivery of high-quality and person-centred care. The registered manager and provider organisation had effective systems to monitor and improve the quality of service people received at Coombe Hill Manor.

The registered manager kept up to date with good practice and had a clear vision of how they wanted the service to develop and improv

We undertook this unannounced inspection of Coombe Hill Manor on 21 June and 6 July 2016. This was the first Care Quality Commission (CQC) inspection of the service since they were registered with us in June 2014.

Coombe Hill Manor is a care home that can provide nursing, personal care and support for up to 104 older people. The service has a specialist dementia care unit known as ‘Augusta’ which can accommodate and care for up to 24 people. At the time of our inspection 94 people were living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Staff actively encouraged and used innovative ways to keep people active and to support them to pursue a wide range of meaningful activities within the home and in the wider community. The provider had introduced ‘OOMPH’ and ‘Namaste’ programmes to help older people and people living with dementia improve their quality of life through gentle exercise, stimulating the senses and social activity sessions.

In addition, Staff ensured people were not socially isolated. Leisure and educational facilities and services that people might be able to access only if they went out of the home had been recreated inside the home for people who may not be able to access the wider community. For example, we saw there was a fully operational cinema showing a rolling programme of films chosen by people living in the home, a salon-bar, a well-stocked library and a games/internet/computer area.

Care plans had been developed for each person using the service, which reflected their specific needs and preferences for how they were cared for and supported. Staff were each provided with a handheld care monitoring device which contained an electronic version of people’s care plans. This ensured that each care staff could easily access a person’s care records if they were not sure about how to care for the person, such as if the person’s needs have changed or they have been off for a few days or on annual leave.

People’s needs were reviewed at least every 60 days and any change that may be needed to the care and support they received was included in their care plans and automatically reflected on the electronic device. This helped to ensure that staff had easy access to the most up to date information about people’s needs.

Management and staff were very motivated and committed to ensuring that people had the best possible care. The staff provided people with positive care experiences and ensured their care preferences were met.

The management team demonstrated a strong commitment to providing people with a safe, caring and quality service. The management structure showed clear lines of responsibility and leadership and managers understood their roles. The provider had developed effective governance systems and there was a strong emphasis placed on continuous improvement of the service. Where the need for improvement was identified, the provider took appropriate action to make the necessary changes. Managers used learning from near misses, incidents and inspections to make improvements that positively enhanced people’s lives.

People told us they were happy living at Coombe Hill Manor. We saw staff looked after people in a way which was kind and caring. Feedback we received from people using the service, their relatives and community health care professionals supported this. Staff spoke with people in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand.

People felt safe living at the home. Staff knew what action to take to ensure people were protected if they suspected they were