This inspection took place on 13, 14 and 15 December 2017 and was unannounced.

During a comprehensive inspection on 1, 2 and 3 June 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Regulation 9 Person centred care and Regulation 17 Good Governance. We asked the provider to complete an action plan to show us what they would do and by when to improve the key questions “safe, effective, responsive and well-led” to at least good. They told us these would be addressed by 31 December 2016 to, ensure people’s care and treatment was delivered in such a way which would meet their individual preferences and choices and to ensure accurate and relevant care records were maintained.

We undertook an unannounced focused inspection of Trevone House on 21 February 2017. This inspection was done to check that the above legal requirements, and improvements, planned by the provider, had been completed. During this focussed inspection the service was inspected against the key questions “safe, effective and well-led”. At this inspection we found the provider was compliant with the prior breaches of Regulation. However, a period of consistent and sustained improvement was required and the rating remained at Requires Improvement.

At this comprehensive inspection completed on 13, 14 and 15 December 2017 we found the service had sustained the improvements we found in February 2017 and this inspection therefore rated the service as Good overall.

Trevone House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Trevone House accommodates 47 older people in one adapted building. At the time of the inspection there were 31 people living there.

People are provided with a single occupancy bedroom. Each room has a sink, bedroom furniture and necessary equipment, a window and radiator. Additional communal toilets, bathrooms and rooms to sit and eat in are provided. The accommodation is across two floors; the second floor accessed by stairs or a passenger lift. There is a garden at the front of the home and off road car parking is available near to the building.

A registered manager was in place. 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.

Arrangements were in place to keep people safe from potential abuse, discrimination and risks which could have a negative impact on their well-being. Staffing requirements were monitored and had been adjusted to ensure people’s needs could be met safely. People’s medicines were managed in such a way which ensured they received as prescribed and needed. People lived in a clean environment where there were measures were taken to prevent and minimise the impact of infection. Staff worked with other health care professionals to ensure people’s health needs were both assessed and met. Risks to people’s health were identified and managed.

People’s consent to be cared for and treated was sought. 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. Where people could not provide consent and make independent decisions about their care and treatment, the principles of the Mental Capacity Act 2005 were adhered to in order to protect them. People were lawfully deprived of their liberty where this was needed to keep them safe and in receipt of the care they required.

People and those who mattered to them were cared for in a compassionate way.

We carried out an unannounced comprehensive inspection of the service on 1, 2 and 3 June 2016 when breaches of legal requirements were found. After this we asked the provider to take action to make improvements to: how and when people received their care, the accuracy and maintenance of people’s care records and ensure the systems in place to monitor the service’s performance led to improvements being made.

We undertook this focused inspection on 21 February 2017 to check that they had followed their improvement plan and to confirm that they now met legal requirements in relation to breaches of Regulation 9 and 17. This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lypiatt Lodge on our website at www.cqc.org.uk” We found these breaches to legal requirements had been met.

This service is registered with the Care Quality Commission to provide accommodation, nursing and personal care for up to 47 older people. At the time of our inspection there were 25 people living there of whom some also lived with dementia.

There was not a registered manager in post but the provider was addressing this. 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.

Since June 2016 outcomes for people had improved. People’s call bells had been responded to more quickly and effectively. This had helped people to receive care and treatment when they needed it and ensured their safety. Some improvements had been made to how people received their care. Staff were taking a more personalised approach towards people’s care. They were aiming to ensure they met people’s choices and preferences in relation to this.

People’s care records had been reviewed and they gave accurate and up to date information. The content of people’s care plans had also been improved and many had been more personalised. Additional records of the care and treatment provided were well maintained. This had helped senior staff and visiting health care professionals make decisions about how to maintain and improve people’s health.

There were interim management arrangements in place which were providing calm and supportive leadership to staff. Senior staff were visible and available for people and staff to approach if needed. The provider had closely monitored the care home’s progress and its compliance with the necessary regulations. These improvements needed to be sustained moving forward.

This inspection took place on 1, 2 and 3 June 2016 and was unannounced. One inspector carried out this inspection. At the last inspection on 3 and 4 February 2015 the provider was found not to be adequately managing people’s nutritional risks. They wrote to us and told us what action they would take to address this. We followed this up during this inspection and found they had completed this action and people’s nutritional risks were managed.

The service offers personal and nursing care and can accommodate to up to 47 older people. At the time of this inspection there were 27 people living at Trevone House.

The registered manager in post has managed Trevone House since 2013. 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.

During this inspection we found the provider had not ensured people’s care records were accurately maintained and that they provided the information needed to ensure safe and appropriate care. We also found examples of people’s health needs not being sufficiently monitored to ensure they received appropriate care when they needed it. You can see what action we told the provider to take at the back of the full version of this report.

We also found the arrangements in place for staff to receive the information they needed before they started work not to be effective and we recommended that the provider review these.

People’s risks were on the whole managed in a way which kept them safe. There were some examples where these needed improvement but where it had not had a negative impact on people. We discussed these at the time with the registered manager who told us she would address these. The service had robust safeguarding procedures which staff understood and any concerns relating to any form of abuse were reported and managed correctly. There were enough staff to meet people’s care/nursing needs, albeit not necessarily when people wanted these met. Robust recruitment practices helped to protect people from staff who may be unsuitable. People lived in a clean environment and were protected from avoidable infection.

People’s health needs were predominantly met, although one example of not following one person’s condition put this person at risk of potential and unnecessary health complications. People who were not able to make decisions independently were supported to do so. People who lacked mental capacity were protected as staff followed the principles of the relevant legislation. However, the necessary and required records of this process were not always present. Arrangements had been made to improve the delivery of people’s medicines to the home and how and when people received these.

People received care from staff who were kind and genuinely interested in their well-being. We observed kind and caring interactions from staff although when they were busy these sometimes lacked compassion. People’s privacy and dignity were maintained. Where people had needed to wait for support their dignity had not been compromised. People who mattered to those receiving care were appropriately involved and welcomed at all times. People’s complaints and dissatisfactions had been investigated and the management team had aimed to resolve these to the person’s satisfaction.

The management of the service had improved since our last inspection but it had not been effective enough to maintain full compliance with the relevant health and social care regulations. Overall the service felt more organised and people told us the management team were more approachable. The provider had provided supported and had guided the management team through a period of improvement and they continued to monitor the service’s progress closely.

In this report it appears there is not currently a registered manager in post. The provider has appointed a manager who was applying for registered manager status with the Care Quality Commission at the time of our inspection.

Our inspection of 19 November 2013 found six monthly reviews of people's care had not taken place and assessments and monitoring charts had not been kept up to date. The provider wrote to us and told us what action they intended to do to resolve the concerns we found. This action included making staff responsible for updating the care files with monitoring from the senior staff. The provider told us the date they expected to have completed this work. We did not speak to people who used the service during this inspection because we were reviewing the actions taken by the provider. We looked at the care files for eight people who used the service (four files that we had looked at during our visit in November and four new files).

During this inspection we found that the six monthly reviews of people's care and risk assessments were up to date. We checked care charts, in particular charts used to record the re-positioning of people and their fluid in-take. We found that overall these had been completed appropriately.

We spoke to three people who used the service and one of their relatives. We spoke to staff and looked at the care files for four people who used the service and other documents held by the provider. We saw that one person had up to date care plans and risk assessments that reflected their individual needs. However we also saw examples where these were not in place. We saw examples where staff had not followed people’s care plans. This put them at increased risk of receiving poor or inappropriate care.

We observed the home to be clean and effective measures were in place for prevention and control of infections. The provider had systems in place for obtaining, storing and administering medicines. The majority of staff had received supervision and had completed training deemed necessary by the provider.

We spoke to three people who used the service and one of their relatives. The comments they gave us included “it’s very good here, the staff help you in any way they can”. “The staff are all very kind”. “I really like it here; they look after me very well”. “I have no concerns; I know they look after my mother very well”. We also observed excellent interactions between staff and people who used the service. This was friendly but respectful and showed that the staff knew each person very well.

We did not speak to people who used the service. This was a follow up inspection to check compliance following a previous inspection.

People we spoke to told us that staff treated them with respect and called them by their preferred name. One person told us that the staff treated them “very well”. Another told us that when they received care from staff they were "kindness itself".

We were also told that they received enough input from staff for their needs. One person told us they were "quite happy" with the care they received.

People we spoke to told us that they felt safe in the care home with one person saying “I feel quite safe”.

We spoke to four people who were using the service. We heard differing views with one person saying “it’s great, I have no complaints, I like it here” although another person told us they were “not happy here”.

People also expressed mixed views about the staff and the attention they received when using the call bell.

People were aware that the home had a new manager and knew about plans for improving the service.

Although most people said they felt safe, one person told us they had concerns about one member of staff which we reported to the registered manager.

People who use the service and their relatives gave positive views about Trevone House during our visit.

One person told us that they were "happy" at Trevone House and stated “We must be grateful there are places like this.” and “I couldn’t be better looked after.”

Another person using the service described Trevone House as “First Class” and made positive comments about the staff.

A relative of a person using the service stated, “Apart from odd little things, no complaints at all.” Another relative stated, “I couldn’t fault it."

During the visit we also spoke to relatives of a person using the service who were not happy with aspects of the service provided. They were considering making a complaint to the provider organisation.

This inspection took place on 3 and 4 February 2015 and was unannounced.

The service cared for older people and accommodated 47 people. At the time of the inspection 39 people were being cared for. It provided additional nursing care to some people. People living with dementia were also supported.

There was 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 person’s have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the last inspection in July 2014 people’s dignity had been compromised and care records were not well maintained. During this inspection we found arrangements to ensure people’s dignity had generally improved. Although, there were some situations where staff needed to be more aware of when people’s dignity was at risk of being compromised. Care records had also improved and they recorded the necessary information.

This planned inspection was brought forward after we had received information of concern. There were general concerns about how the service was being managed and how people were being spoken to. People however, told us they had not been spoken to in an unkind manner and we found improvements had taken place in the way the service had been managed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The evidence was gathered prior to 1 April 2015 when the Health and Social Care 2008 (Regulated Activities) Regulations 2010 were in force. This related to people not getting the support they required in relation to their nutrition. This care had not been delivered according to people’s care plans. You can see what action we told the provider to take at the back of the full version of the report.

People had not always received the care and support they required when they needed it or when it best suited them. Although people we spoke with said they felt looked after, some had become resigned to the home’s routine taking precedent over their preferences. Care was not person centred. In some cases people’s well-being had not been considered and it had caused a degree of distress that could have been otherwise avoided.

Complaints had been raised and investigated but not always initially received in a positive and helpful way by staff. Ways to ensure this improved had been implemented.

A collective approach by the staff, the service’s management team and the registered provider had seen the service improve its performance in December 2014. The registered provider had carried out a review of the service’s performance and had found a more open and transparent working culture in place.

The service kept people safe because risks were effectively identified and managed. Levels of risk to people were continuously monitored. People were protected against abuse because the staff knew how to recognise this, what action to take and how to report it. The provider’s policies and procedures for safeguarding people linked in to the local County Council’s procedures on reporting and managing abuse. The service was therefore transparent and open about any reports or allegations of abuse. There were arrangements in place for people to receive their medicines safely and to be protected from potential medicine errors. People had access to various health care professionals as needed. There were social activities organised for people and adjustments made to these to suit people’s differing needs. Differences in people’s cultural heritages needed to be better considered in order to ensure people were supported as well as they could be.

There were enough staff to meet people’s care and nursing needs. Staff received training, although some relevant subjects had not been covered by all staff. Arrangements were in place for staff to receive training they still needed. Where some staff lacked knowledge or experience, other staff were available to provide suitable guidance. Support for staff in relation to their practice and performance had improved. Robust staff recruitment practices meant people were protected from staff that may not be suitable to care for them. Staff communicated well with people giving them reassurance and a sense of being looked after.