About the service:

Coumes Brook Home Limited is a 24 bedded service providing nursing or personal care to older people and people living with dementia. At the time of our inspection there were 22 people using the service.

People’s experience of using this service:

• Staff were very caring. Everyone we spoke with was very complimentary about the staff. There was a strongly embedded culture within the service of treating people with dignity, respect, compassion and love.

• Activities were available to keep people occupied both on a group and individual basis. Trips out were also organised in line with people’s preferences.

• Medicines were being administered safely and people’s dietary and healthcare needs were met. However, minor improvements were required with medicines management to ensure it was delivered in line with best practice guidance.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polices and systems in the service supported this practice. Although this was not relevant at the time of inspection as everyone could consent to their care and treatment, improvements were required to the systems which support people who are not able to make these types of decisions themselves.

• Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. We found the system for calculating safe staffing levels was not robust, which was an issue raised at the previous inspection. Staff were receiving appropriate training which was good and relevant to their role. Staff said they felt supported by the manager.

• Care plans were up to date and detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to the safeguarding team when this had been necessary.

• There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

• Without exception people, staff and visiting professionals said the registered manager was very approachable and organised. We identified times where the service was not always well led and the registered manager had failed to adequately address all feedback from the last inspection. We were satisfied the registered manager had clear improvement plan in place to address this.

• As the key areas ‘safe’ and ‘well-led’ had deteriorated to requires improvement, the service achieved a rating of requires improvement overall.

For more details, please see the full report which is on the CQQ website at www.cqc.org.uk

Rating at last inspection:

At the last inspection the service was rated as good (report published 5 November 2016).

Why we inspected:

This was a planned inspection to check the service remained good.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection was unannounced, which meant the provider did not know we were coming. It took place on 17 October 2016. The home was previously inspected in August 2014 and was meeting the regulations we looked at.

Coumes Brook is a care home for older people, providing accommodation and personal care for up to 25 people all on one level.

The home had a registered manager. 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.

We saw there were systems and processes in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding vulnerable people and were able to explain the procedures to follow should an allegation of abuse be made.

People’s needs were assessed and care, and support was planned and delivered in line with their individual support plan. The individual plans we looked at included risk assessments which identified any risk associated with people’s care. The plans of care were being reviewed at the time of our visit to ensure they were more person centred.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified some improvements could be made.

We found the service to be meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good understanding of the requirements.

People were supported to eat and drink sufficient to maintain a balanced diet and snacks were available in-between meals. People we spoke with who used the service told us they liked the food and could choose what they wanted and when they wanted to eat.

We found there were enough staff with the right skills, knowledge and experience to meet people’s needs. However, the dependency tool used did not the detail hours required to meet people’s needs. The registered manager was looking at new tools to be able to determine this.

Staff were provided with appropriate training, support and supervision to help them meet people’s needs.

Systems were in place to assess and monitor the quality of the service, including obtaining feedback from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns, and incidents and accidents were managed well. Management took steps to learn from such events and put measures in place which meant lessons were learnt and they were less likely to happen again.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Coumes Brook is a residential care home which was providing care and support to 22 people at the time of our inspection.

As part of the inspection we spoke with five people who lived at the home, five members of staff and the registered provider/manager.

This was a follow up inspection to check that improvements had been made in the safeguarding of people who use the service and supporting workers.

On our previous inspection on 17 June 2014 senior staff spoken with during our inspection acknowledged they had failed to report incidents to safeguarding. This meant people were put at risk because procedures weren’t in place so that immediate action was taken to ensure any potential abuse was identified and stopped.

During our inspection on 17 June 2014 a person who used the service was found outside the home. Staff said this had happened on other occasions. This meant staff had not recognised their personal responsibility in safeguarding people who used the service and taken action to respond appropriately.

During our inspection on 17 June 2014 we looked at staff supervision forms and found no members of staff had received formal supervision throughout 2013 or 2014. Also staff had not been provided with a yearly appraisal. This meant staff were not properly supervised and appraised.

The manager of Coumes Brook submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Without exception all people spoken with said they felt safe in the home and that they had no concerns about ill treatment of themselves or others.

Senior staff spoken with during our inspection confirmed there was a process in place to ensure any concerns raised were reported as incidents to safeguarding. This meant immediate action was taken to ensure any potential abuse was identified and stopped.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, relevant policies and procedures were in place. Appropriate staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as required.

We found all staff had completed Disclosure and Barring Service (DBS) checks before they were allowed to start working, which helped to safeguard people who lived in the home.

People were being cared for in an environment that was safe.

Is the service effective?

People we spoke with said they were happy with the care they received and felt their needs were met.

Staff were provided with training to ensure they had the skills to meet people’s needs. Managers’ were accessible to staff for advice and support. Staff were provided with formal individual supervision and appraisals at an appropriate frequency to ensure they were adequately supported and their performance was appraised.

Coumes Brook is a care home which was providing residential care for 22 people at the time of our inspection. We spoke with groups of people who were sitting in communal areas and with nine people individually. We also spoke with five members of staff, two relatives and a healthcare professional.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Without exception all people spoken with said they felt safe in the home and that they had no concerns about ill treatment of themselves or others.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, relevant policies and procedures were in place. Appropriate staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as required.

We found all staff had completed Disclosure and Barring Service (DBS) checks before they were allowed to start working, which helped to safeguard people who lived in the home.

In February 2014 the service had been visited by the Sheffield Clinical Commissioning Group who had carried out an audit of the service. Their report gave details about some incidents recorded in the accident book that should have been reported via the safeguarding process. Senior staff spoken with during our inspection acknowledged they had failed to report incidents to safeguarding. This meant people were put at risk because procedures weren’t in place so that immediate action was taken to ensure any potential abuse was identified and stopped.

During our inspection a person who used the service was found outside the home. Staff said another person who used the service had opened a fire door and the person had gone outside. Staff said this had happened on other occasions. This meant staff had not recognised their personal responsibility in safeguarding people who used the service and taken action to respond appropriately.

We found no evidence that a company representative or external person went into the service to carry out checks of finances. We were unable to check if people’s money tallied with what was recorded on their finance sheet because the registered manager/provider was on annual leave and they were the only person that could access the money.

We have asked the provider to tell us what they are going to do to ensure people who use the service are protected from the risk of abuse.

Is the service effective?

Care files we checked confirmed that initial assessments had been carried out by the staff before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people who were to live there. People’s health and care needs were assessed with them, and their family and friends were involved in the formulation of their plans of care. Specialist mobility and equipment needs had been identified in care plans where required.

We found when records showed people had lost weight no action was taken by staff in order to ensure people's health and welfare was maintained.

We found people were provided with nutritious food. Some people required specialised diets for health or personal reasons and these were provided. During our observation at lunch time we found desserts provided were not suitable for diabetics as they were not made with artificial sweetener. When we asked if desserts could be made with artificial sweetener so they would be suitable for diabetics the cook said they could be but they had never been asked to do this.

We looked at staff supervision forms and found no members of staff had received formal supervision throughout 2013 or 2014. The last recorded supervisions were in September 2012. Also staff had not been provided with a yearly appraisal. This meant staff were not properly supervised and appraised.

We have asked the provider to tell us what they are going to do to ensure persons employed are receiving appropriate supervision and appraisal.

Is the service caring?

We spoke with nine people to ask about their views of living at the home. Comments were all positive and included, "The staff are lovely," "I find the staff really easy to get on with and I am very comfortable here," "I'm happy and don’t have any worries," “I think we do very well here, there’s always someone to help you if you need it” and “The staff know me very well and do things as I like them done.”

During our inspection we observed staff speaking with people who used the service in a friendly and caring way. We observed care and support was provided to people when requested.

Care workers we spoke with demonstrated a good understanding of people’s needs and were able to give examples of how they promoted people’s independence. Staff were skilled and confident in recognising the diversity, values and human rights of people who used the service.

Is the service responsive?

Staff told us the care and support provided was flexible to the person’s needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed.

We spoke with two relatives who told us they thought the home, "Is quite brilliant and the staff are welcoming and friendly. Another relative told us, "I live out of town so can't visit often but the staff keep me well informed about how my family member is. When my relative isn't well, I'm the first to know."

People were able to join in with a limited range of activities. We saw a copy of the weekly activities programme was on display, so people were aware of what was planned each week. Examples of activities on offer were crafts and games, exercise and quiz. People living in the home told us that entertainers also performed at the home, which they enjoyed very much.

People knew how to make a complaint if they were unhappy. Relatives spoken with said they had no worries or concerns about the home but if they did they could talk to any of the staff and they would listen and sort it out."

Is the service well-led?

The service worked in partnership with key organisations, including the local authority and NHS to support care provision. We saw evidence the service had taken advice provided by other healthcare professionals so that the quality of the service would be improved.

Information collated by CQC evidenced that the service had not reported the death of any person who used the service since November 2013. It is a legal requirement for services to inform CQC about the death of a person who uses the service. If services do not inform CQC they are at risk of receiving a fine or being prosecuted.

We found the last ‘quality assurance audit’ was completed in 2012. Since 2012 no surveys had been sent to people who used the service, relatives, staff and healthcare professionals. This meant people had not been given the opportunity to give their opinions on such things as care, cleanliness, food and social activity.

We visited the service on 21 October 2013 as part of our scheduled inspection programme. We spoke with 12 people who used the service, three relatives of people who used the service, five staff and the registered manager/provider.

We found people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us they had the choice to do things they wanted and when they wanted to.

People experienced care, treatment and support that met their needs and protected their rights. One person said, "I feel very lucky to be here, things couldn't be better." Another person said, "Everyone is kind and I feel at peace here."

Relatives of people living at the home told us that they were kept informed about their family member's care. One relative told us, "My family member's health has improved since coming here."

We found that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people. People also had positive interactions and communication with each other.

During our inspection we conducted a tour of the premises and found it was clean, tidy and free of any unpleasant odours. There were systems in place to reduce the risk and spread of infection.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found that records were held securely and retained for an appropriate period of time.

People told us that they were happy living at the home and that they were satisfied with the care they received. They said, "I have no complaints what so ever" and "I'm well looked after, all the staff are attentive and kind."

People told us that their health and personal care needs were met. People that we were unable to fully communicate with looked content and we observed positive interactions with staff and people living at the home.

Records checked showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes. Where people lacked capacity we saw that families and advocates had been involved in decision making.

We spoke with a visiting healthcare professional. They said, "when we are here treating people, we are thoroughly supported and appreciated by the staff. We can see that this is one of the best homes in the area. We have never had any concerns about the care provided at this home."

We found that, where necessary, people were supported with the administration of their medicines, by staff that were trained in medication administration.

We found that a complaints policy and procedure was in place. People spoken with said they had no complaints or concerns about the home.

Information that we received from Sheffield Local Authority, Contracting and Commissioning confirmed to us that they did not have any current concerns about the home.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said, "They look after us very well", "The staff are pleasant" and "It's very nice here, we're well looked after." One person said "There are enough activities to keep us occupied." Another person said "We have games to play and entertainers that come in." We spoke to two relatives who told us "I can't speak too highly of this place, it is absolutely wonderful" and "I have no worries or concerns about the care at this home".

We spoke with Sheffield Local Authority, Contracting, Commissioning and Safeguarding

and they told us that they had not identified any concerns at the home.

The majority of people who we were able to communicate with told us that they were

happy living at the home and that they were satisfied with the care they received. People

said, "They look after you alright," "The staff are pleasant" and "It's very nice here, we're well looked after." One person said "The home is lovely but I get very bored, there's not enough to do." Two other people agreed with this and said "It makes it feel like really long days, we would enjoy more activities."

We spoke with Sheffield Local Authority, Contracting, Commissioning and Safeguarding

and they told us that they had not identified any concerns at the home.