Yercombe (Gloucestershire) Trust

Yercombe (Gloucestershire) Trust is a small residential care home providing personal care for up to 11 people. The service provides support to older people, younger adults, and people with a physical disability. At the time of our inspection there were 10 people using the service.

Yercombe (Gloucestershire) Trust accommodates permanent residents and 2 people for respite care. People are supported in one adapted building over 2 floors set in a rural location. There is a day centre attached to the property used by people living at the service and members of the community. The provider is registered and operates as a charity.

People’s experience of using this service and what we found

Improvements had been made to the service following our last inspection.

People’s health associated risks were assessed and reviewed to reflect their changing needs. Risk management plans were made in collaboration with people, ensuring staff had detailed and individualised guidance on how to respond and manage people’s risks.

People were supported in the management and administration of their medicines. People received their medicines as prescribed, when they wanted them and how they liked them to be administered. Record keeping of people’s medicines was quality monitored by a medicines champion.

Environmental risks were managed to keep people and staff safe. Staff followed safe infection control practices and had access to personal protective equipment (PPE).

Staff were mainly recruited into the service safely and systems had been developed by the provider. Staff received a thorough induction, ongoing training, and supervision to support them in their roles.

People were supported by a core staff team who knew them well. Agency staff were introduced to people and people were provided choice in the gender of staff providing them care. We received positive feedback about the care being provided, relatives told us, “[People] often say how good the carers are” and “We could not wish for a better place.”

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

Improvements had been made in the governance of the service. The registered manager and board of trustees had worked hard to develop and implement quality assurance processes and monitoring systems to ensure the safe running of the service. At the time of our inspection, some of these systems had not fully been embedded as more time was needed. Such as, quarterly analysis of trends from accidents and incidents.

The management team adopted an open culture of learning and growth. All staff were responsible for the ongoing improvement of the service, with the shared goal of the positive impact this would have on people. Feedback systems had been developed to gain the views of staff, people and relatives, which allowed them to contribute to the development of the service.

Staff worked in collaboration and communicated well with other agencies when supporting people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 January 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider review their recruitment processes to ensure that all pre-employment checks were completed and recorded. At this inspection we found the provider had introduced a checklist for recruitment and auditing system to support them in safe recruitment decisions.

Why we inspected

We carried out an unannounced focussed inspection of this service on 9 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Require improvement to Good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yercombe (Gloucestershire) Trust on our website at www.cqc.org.uk.

Yercombe (Gloucestershire) Trust is a small residential care home providing personal care and accommodation for up to 11 people. The service provides support to older people, people with a disability and younger adults in one adapted building over 2 floors. At the time of our inspection there were 11 people using the service.

The service provides support to permanent long-term residents and provides respite care. There is a day centre attached to the property that is used by people living at the service and members of the community. The provider is registered and operates as a charity.

People’s experience of using this service and what we found

People’s individual risks were not always assessed and staff were not given clear guidance or information on how to protect people from associated risks. People’s medicines were not always managed safely. All staff did not know what to do in an emergency. A robust system was not in place for staff to report and record safety incidents and to ensure the registered manager and provider had oversight of all incidents or accidents.

The service had recently had a Covid-19 outbreak where people and staff tested positive for the virus. At the time of our inspection good infection prevention control measures were not always followed.

The service had a mixture of permanent and agency staff members. People told us the permanent members of staff and the management team knew them well and they felt safe living at the service. Staff and the registered manager spoke passionately about the people and their roles.

The service’s management structure was newly developed over the past year and had the support of a board of trustees. The roles and responsibilities around the monitoring of the service were not fully defined and operational at the time of the inspection.

A comprehensive, effective quality assurance or audit system was not in place to ensure the quality of care and risks were monitored and improved where needed.

People and people’s relatives were positive about the caring nature of the service. People told us they liked the homely environment created by the service. Comments from people included; “It feels like home” and “It is a lovely house with lovely views.”

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection and update

The last rating for this service was good (published 16 January 2020).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

We also received concerns in relation to infection control, staffing issues and the quality of care people were receiving. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yercombe (Gloucestershire) Trust on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe care and treatment of people and governance of the service.

We have made a recommendation about staff recruitment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We have requested an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Yercombe (Gloucestershire) Trust is a residential care home which provides personal care to 10 older people. The service provides long term care and respite care. At the time of the inspection nine people were receiving care. Yercombe (Gloucestershire) Trust is based near Dursley, Gloucestershire. The service also provides day care services, which people living at the service can use, as well as people living in the local community.

People’s experience of using this service and what we found

People were comfortable, well cared for and benefitted from a whole home “family” approach to care. People enjoyed a varied and active life at Yercombe Trust. People were supported to follow their interests and their individuality and independence was respected.

People and their relatives told us all staff were kind, caring and compassionate. Staff were attentive to people’s needs and knew how to promote their wellbeing. People were treated with dignity and respect.

Staff were appropriately trained and had the skills to meet people’s needs. The registered manager ensured staff had access to the training, support and continued professional development they needed and requested. People received effective care and treatment. The service worked alongside a range of healthcare professionals to ensure people’s health and wellbeing were maintained.

People’s risks were known by care staff. Care staff were fully aware of their responsibilities to raise concerns and the provider ensured lessons were learnt from any complaints, incidents or accidents. There were enough staff deployed to ensure people received the support they required. People received their medicines as prescribed.

People received care which was personalised to their needs. Where people’s needs changed, care staff took appropriate and effective action to ensure their health and wellbeing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager and provider had clear and robust systems to assess, monitor and improve the quality of care people received. Systems were designed to continuously improve the service and drive positive changes.

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

Rating at last inspection

The last rating for this service was good (published 22 August 2017).

Why we inspected

This was a planned inspection based on the previous rating of “Good”. At this inspection we found that the service remained “Good”.

Follow up

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

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.

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 stay respite placement, the staffing numbers vary dependent on who the staff were looking after.

All staff had a programme of mandatory training to complete. This ensured they had the necessary knowledge and skills to carry out their roles effectively. The service rarely takes on new staff but must ensure that induction training for new staff is in line with the new Care Certificate, implemented in April 2015. The staff team were well supported by each other, the senior care staff and the management team.

People were provided with sufficient food and drink and were complimentary about the meals they were served. Their choices and preferences were met and meals were home cooked. People were supported to see health and social care professionals as and when necessary.

Staff were knowledgeable about the people they looked after and it was evident they had built up positive relationships based on trust and respect for each other. People were supported to dress smartly and looked well cared for. It was evident that people were treated with respect and dignity.

People’s care and support needs were fully assessed before being offered either a permanent or short stay placement at Yercombe. Their needs were continually assessed, monitored and evaluated and the way they were looked after was adjusted if their care needs changed. On the whole the information and care records were kept up to date and reflected the support people wanted and required.

People were listened to and were encouraged to have a say if they were unhappy or wanted things done differently.

The registered manager had been at the home for many years as had many of the staff team. The staff team worked well together and said the registered manager was open and approachable and actively enabled and encouraged open communication.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

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 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.