The inspection took place on 20 and 24 July 2017. This was an unannounced inspection. The service was last inspected in April 2016.

Yercombe (Gloucestershire) Trust provides accommodation for up to 10 older people . The service looks after people on a permanent or respite basis. At the time of our inspection there were seven people living at the service and three who were having a short respite stay.

There was a registered manager employed at Yercombe. 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 time of the inspection there was an interim manager in post as the registered manager had taken a planned period of leave. The service had notified CQC about this temporary change.

There were four breaches of legal requirements at the last inspection in April 2016. We identified shortfalls in relation to the safe management of medicines, gaining people’s consent, safeguarding people from abuse and the service’s quality assurance systems were not always effective . We found at our comprehensive inspection on 20 and 24 July 2017 the provider had followed their action plan and met the requirements of the regulations.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure people received safe care and treatment. Staff had a good awareness of safeguarding policies and procedures and felt confident to raise any issues of concerns with the management team. Where there had been safeguarding concerns these had been investigated appropriately and the local authority and CQC had been notified about these. The registered manager had carried out the relevant checks to ensure they employed suitable people at Yercombe Trust.

People received effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular individual meetings called supervisions and appraisals. Where required, the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS). People had sufficient levels of food and drink and were supported by the staff to maintain their nutritional intake. People were supported to access other health professionals when required. The environment had been adapted to meet the needs of people living at the home. People were supported to personalise their living spaces.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and provided care which maintained people’s dignity. People had end of life care plans which reflected their needs and preferences.

The service was responsive to people’s needs. Care plans were person centred and contained sufficient detail to provide consistent, high quality care and support. People were supported to engage in a range of activities based on their preferences and interests. There was a complaints procedure in place and where complaints had been made these had been dealt with appropriately?

The service was well-led. Systems had been implemented to assess and monitor the safety and quality of the service. The registered manager and interim manager were well liked and respected. Staff morale was good and reflected the positive support from management. There was a positive and open culture within the service. The vision and values of the service were well known to all of the staff and the management. The registered manager had informed CQC of the relevant notifications as required by the law.

This inspection took place on 7 April 2016 and was unannounced. The last inspection of the service had been carried out in July 2013 and at that time there were no concerns. Yercombe (Gloucestershire) Trust provides accommodation for up to 10 people. The service looks after people on a permanent or respite basis on a four to six ratio. At the time of our inspection there were five people living at the service and five who were having a short respite stay.

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.

People were satisfied with the way they were looked after and enjoyed being at Yercombe. We received positive comments about their views and experiences of the service. People got on well with the staff, were accommodated in clean and tidy surroundings and their care and support needs were fully met. Despite the positive views of people using the service and health and social care professionals, improvements were required in a number of areas as the service was in breach of four regulations.

Improvements were required with the management of medicines to ensure that people were not placed at risk. For those people who have short respite stays in the service, the staff were not double-checking that the handwritten entries they recorded in respect of people’s medicines were correct. Some handwritten entries did not provide sufficient instructions on what dose or how often the medicine should be administered. There was a lack of knowledge and understanding amongst the staff team regarding when and if an emergency medicine should be administered.

The registered manager did not demonstrate a clear understanding of the safeguarding reporting protocols and would benefit from additional training and greater awareness of the locally agreed reporting procedures. The registered manager was also unclear as to the difference between safeguarding and the Deprivation of Liberty Safeguards (DoLS).

The registered manager did not demonstrate a clear understanding of DoLS legislation and was uncertain whether an application for one person was being processed by the local authority. The registered manager had not notified the Care Quality Commission regarding one person who was subject to a DoLS authorisation. The registered manager had only completed a basic MCA and DoLS on line training programme and would benefit from more in-depth training.

The systems the registered manager and provider (the trustee’s) had in place to assess and monitor the quality and safety of the service were inadequate. There was no programme of audits and, where feedback had been obtained from people using the service, no actions plans were devised to drive the improvements needed. Following events such as accidents, incidents or complaints, there was no analysis of what had happened. This meant the opportunity to identify any triggers or themes and then make changes to prevent or reduce reoccurrences was missed.

Staff were aware of their responsibility to keep people safe and to safeguard them from coming to harm. They knew how to identify and report abuse. The recruitment procedures followed when taking on new staff ensured that only suitable were employed.

Any risks to people’s welfare were identified and well managed. There was a programme of regular checks in place to ensure that the premises and any equipment was well maintained. However the fire risk assessment needs to be reviewed as this had been completed many years ago.

The numbers of staff on duty each shift were calculated and based upon the collective care and support needs of the people in residence at any given time. Because the service offers short st

This was a positive visit and we could see that people were well cared for and supported appropriately by all staff. We spoke with four people who lived in the home and observed the care they and other people received. Staff were dedicated and caring. It was evident through observation and in discussions that they enjoyed working in the home and supporting people. People were happy to see us and understood why we were visiting them.

The home was bright and airy and was well maintained throughout. We saw that people had access to appropriate equipment such as wheelchairs and walking frames and staff ensured that these were close to hand for people. We looked at various records throughout the day and found that there were procedures and systems in place to ensure the smooth running of the home.

We carried out an inspection of Yercombe Lodge in June 2012 where we found some improvements were needed to care plans and the details of records. We also identified that the home had not sought the feedback of people who used their service or other interested stakeholders in order to support their quality assurance. We asked the provider to address our concerns.

We visited the home on 4 December 2012 to see what improvements had been made. We found that new person centred care plans had been put in place and the required improvements had been made to the daily records and risk assessments. The home had consulted with people about their end of life wishes. The manager explained they had set up a new system to illicit people's views on the quality of the service. There was now a three-monthly audit targeting different groups of people who either used the service, relatives and other stakeholders.

We talked with four people who lived in the home and with two people who were there on the day for personal support. People said they liked living in the home and thought the staff treated them very well.

The home had a warm and cosy atmosphere and was clean throughout. The main lounge area had comfortable easy chairs where people socialised in the day time. We chatted to people in the lounge, one person was knitting squares to be made up into blankets for a local charity. Another person was knitting a multi-coloured sweater and said, "It keeps me busy, I broke my wrist a while back so it's good exercise".

People visited their local GP when they needed to and in addition other health services such as visits to the hospital, chiropodist and the dentist and optician when required. The district nurse visited the home on a regular basis to give health care.

At lunch time we observed that staff gently escorted people to their table. Everyone greeted each other and there was general chatter between the tables. People were offered a choice of meal and asked how much they would like. Three members of staff ate their meal alongside residents. One care worker supported a person to eat, they described what they were putting on the spoon and waited until the person indicated they wanted more food. People continued to chatter throughout the meal reminiscing about people they knew.

Staff received appropriate professional development. We spoke with two members of

staff who said they were well informed of people's needs and the support people

required. Most staff had worked at the home for many years and said they knew

people well, their likes and dislikes and were familiar with their care plans.

We asked the manager how they engaged with people and their families to find out their views on how the service was run. We were told the home had carried out survey's but not in the last two years. They had not sought the views of their stakeholders.