Yew Tree Residential Care Home

Yew Tree Residential Care Home is registered to provide accommodation for up to 18 people requiring nursing or personal care, including older people and people living with dementia. There were 11 people living in the home on the day of our inspection.

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

When we last inspected the service we found multiple areas of serious concerns. At this inspection we found significant improvements. However, there were still further improvements required.

Although quality monitoring processes were in place these needed further work to ensure when issues were highlighted it was clear what action would be taken and by whom. The provider recognised they need to have better oversight and ongoing support for the manager.

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; however the policies and systems in the service did not always support this practice and further improvement was required to record how best interest decisions were made.

People were supported safely and risks to their safety had been assessed using nationally recognised assessment tools, with measures in place to support them. The manager had processes in place to ensure people were protected from the risk of abuse and staff showed good understanding of safeguarding issues. People’s medicines were managed safely, and the service had good infection prevention and control practices in place to protect people from the risks of infection.

People were supported by adequate numbers of staff who had received support and training for their roles. The manager had processes in place to ensure learning from events at the service.

People were supported with their nutritional needs. Specialist diets were in place when required and people were monitored to help them retain a healthy weight. Their health needs were monitored, and staff ensured when support from external health professionals was required this was sought in a timely manner.

Staff engagement with the people they support was good and people were treated in a caring and respectful way. People and their relatives had the opportunity to express their views on their care. Staff worked in a way which supported people’s dignity and privacy.

People’s care was provided in a person-centred way and staff showed good knowledge of the people they supported. There were social activities available on a regular basis to help prevent social isolation and people’s communication needs were supported.

People received appropriate care at the end of their lives and their wishes for their care at this time in their life were recorded and carried out.

The service had a complaints policy in place and staff were aware of how to support people should they wish to complain.

The manager of the service was approachable and open, staff and people in their care felt supported.

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 inadequate (published 4 May 2023). 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.

This service has been in Special Measures since 8 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from Inadequate to Good based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yew Tree Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Yew Tree Residential Care Home is registered to provide accommodation for up to 18 people requiring nursing or personal care, including older people and people living with dementia. There were 15 people living in the home on the day of our inspection.

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

People were not protected from potential abuse as there was a lack of processes in place to robustly monitor and investigate allegations of abuse.

Environmental safety hazards identified at our last inspection had not been addressed and the risks to people’s safety were not well managed. This included a lack of a clear evacuation strategy, open stairwells posing a risk to people who were living with dementia and mobility issues. Moving and handling equipment was not regularly serviced and there were incorrect slings for people who required hoisting support. Bed rails which could cause entrapment were in place and there was a lack of bed bumpers.

Medicines were not well-managed. Some prescribed medicines were not in stock for people and people were not receiving their medicines as prescribed. Risk assessments and care plans were not up to date and contained conflicting information on people’s care needs.

Infection prevention and control measures were not robust. A number of raised toilet seats had body fluids on them, plastic spout cups in use were not clean and good hygiene practices were not carried out in the kitchen.

There was a lack of staff, and safe recruitment processes had not been followed. Staff had not always received appropriate training and support for their roles.

People’s nutritional needs were not always well managed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Although staff were kind and caring people were not always well supported and this impacted on their emotional and physical well-being. People’s care records did not always contain enough information for staff to be able to provide personalised care. People’s social needs were not well met.

The service was not well led. Shortfalls in organisational governance found at our last inspection had not been addressed and systems designed to ensure safety and the quality of care people received remained ineffective.

There was a lack of provider oversight and learning from events.

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 inadequate (8 July 2022) and there were breaches in regulations. 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 the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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 Yew Tree Residential Home on our website at www.cqc.org.uk.

Enforcement

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 eight breaches of regulations relating to the assessment and management of risks; staff training; staff recruitment; protection of people’s rights under the Mental Capacity Act (MCA); safeguarding people from abuse; managing nutrition; providing person centred care and organisational governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will also request 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Yew Tree Residential Care Home is registered to provide accommodation for up to 18 people requiring nursing or personal care, including older people and people living with dementia. There were 17 people living in the home on the first day of our inspection.

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

We identified numerous safety hazards in relation to premises and equipment which placed people at risk of harm.

Quality assurance systems were inadequate and placed people at risk of harm. The provider had failed to assess and mitigate a range of potential risks to people's safety in areas including infection prevention and control; medicines management; care planning and individual risk assessment; staff recruitment and organisational learning.

The provider had failed to provide staff with sufficient training and supervision for their roles. Senior staff lacked knowledge of important legal requirements and current best practice in some areas. Systems and processes to safeguard people from the risk of abuse were not consistently effective.

People did not support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Aspects of organisational culture were ineffective and the provider had failed to ensure adequate oversight of, and professional support for, the registered manager. The registered manager had not notified CQC of some significant events which had occurred in the home.

More positively, there were sufficient staff to meet people's needs. Food and drink provision met people's individual needs and preferences.

Staff worked closely with local healthcare professionals and had developed other positive links between the home and the local community. Relatives and friends felt involved in the running of the home and in their loved one's care.

Throughout our inspection, the registered manager maintained an open, responsive approach and took prompt action to address many of the concerns we identified.

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 17 July 2018).

Why we inspected

We initially conducted a targeted inspection prompted by information we received about a specific incident in which a person using the service sustained significant harm. This incident is subject to a criminal investigation and, as a result, this inspection report does not cover the specific circumstances of the incident.

On our targeted inspection, we identified concerns about the assessment and management of potential risks to people’s safety; the protection of people’s rights under the Mental Capacity Act (2005) (the 'MCA') and organisational governance. As a result, we widened the scope of the inspection to become a focused inspection to review the key questions of Safe, Effective and Well-Led.

We also 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.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yew Tree Residential Care Home on our website at www.cqc.org.uk.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified six breaches of regulations relating to the assessment and management of risks; safety of premises and equipment; staff training; protection of people’s rights under the MCA; safeguarding people from abuse and organisational governance.

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of Inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we re-inspect it and is no longer rated as Inadequate for any of the five key questions, it will no longer be in special measures.

We inspected the service on 30 May and 5 June 2018. The first day of our inspection was unannounced. On the first day of our inspection there were 11 people living in the home.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

In October 2015 we conducted our first comprehensive inspection of the home and rated it as Good. On this inspection we were pleased to find overall service quality had been maintained and in some areas improved. The rating remains as Good.

Staff worked well together in a mutually supportive way and communicated effectively, internally and externally. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. There were sufficient staff to meet people’s care and support needs without rushing, although the registered manager agreed to keep staffing levels under careful review if occupancy increased in the future. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach. People were provided with food and drink of good quality that met their individual needs and preferences. The physical environment and facilities in the home reflected people’s requirements. People were provided with physical and mental stimulation appropriate to their needs.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

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 home supported this practice. At the time of our inspection the provider had been granted Deprivation of Liberty Safeguards (DoLS) authorisations for one person living in the care home and was waiting for a further three applications to be assessed by the local authority.

The registered manager was well known to, and respected by, everyone connected to the home. Throughout our inspection she demonstrated an admirably open and reflective approach. A range of audits was in place to monitor the quality and safety of service provision. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. There was evidence of some organisational learning from significant incidents and events. Formal complaints were rare and any informal concerns were handled effectively. She had taken action to address the area for improvement identified at our last inspection.

Below is a summary of what we found when we inspected Yew Tree Residential Care Home on 16 April 2014.

The summary is based on our observations during the inspection, speaking with people who used the service, and the staff who supported them. We spoke with four staff members, the registered manager and three people who used the service during our inspection. We also looked at four care records and other documentation.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

During our inspection on 22 October 2013, we found care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. The provider had sent us an action plan which addressed our concerns.

We observed staff did not always carry out manual handling practices in line with the provider's policies and procedures which meant people and staff were at risk of injuring themselves. We also noted when we looked at people's care records there were a number of incomplete risk assessments. This included incomplete risk assessments for nutrition, the use of bed rails, medication and management of pain. This meant that the person was at risk of receiving inappropriate care. We looked at consent forms for treatment and found that in some people's records these had not been completed. This meant that people were at risk of receiving care that they had not agreed to.

During our inspection on 16 April 2014, we reviewed people's care records and found appropriate risk assessments were now in place and that consent to treatment forms had been completed. We also found that moving and handling techniques had been reviewed and that all staff had undertaken formal training on 22 January 2014. This was confirmed by records we looked at and staff we spoke with.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law protecting people who are unable to make decisions for themselves.

We found people were cared for in safe and accessible surroundings that supported their health and welfare. The premises had been maintained and appropriate safety checks had been undertaken by qualified professionals. This ensured that people, staff and visitors had been protected against the risks of unsafe or unsuitable premises.

Is the service effective?

There were details available for people who lived in the home and their relatives should they need to access an advocacy service so they could have additional support.

People's health and care needs were assessed and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. People we spoke with told us: 'The staff are stars and have been very caring and have taken their time to support me."

People who used the service, their relatives, friends and other healthcare professionals involved with the home completed an annual satisfaction survey. Where concerns or comments were raised these were addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. One person told us: 'I had a query and the manager sat and listened and did what I asked. I feel staff listen to what I say and try their best to accommodate my wishes."

The provider had a complaints policy in place and information was displayed around the home should people who lived there or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction to their role and were able to tell us how they would escalate any concerns raised. We spoke with the manager who informed us that there had been no formal complaints since our last inspection.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

Staff told us that they were clear about their roles and responsibilities. They told us they felt well supported and trained to safely do their job. One member of staff told us: 'We have done so much recently, it has been great. It was really worthwhile going over manual handling techniques and doing the practical session, it was a good refresher.' We found that training plans were in place which ensured that staff had the appropriate skills to meet people's needs.

To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI). SOFI allows us to spend time observing and helps us to record how people spend their time. We observed four people for an hour. We observed there was good interaction with people and staff supported people to take part in activities.

We observed the care people received and looked at three people's care records in detail. Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people.

We saw people were cared for in a clean environment and staff were aware of issues regarding infection control.

However we saw from the care plans and observations that on occasions people did not receive care which was appropriate to their needs. For example during our visit we observed moving and handling practices which presented a risk to people.

When we spoke with people they told us, 'Marvellous place' and 'Love it here.'

We knew the provider notified us of serious incidents appropriately.

Staff told us about providing a safe environment for people and were able to tell us how they would report any concerns about people's safety.

One person we spoke with who lived at the home told us, 'The staff have really looked after me well. Everyone is so kind and lovely.' They also said, 'No one could have done anything better, I'm quite satisfied.'

We spoke with a person who was on a respite break, they told us, 'I'm being very well looked after, actually, I'm being overly looked after.' They also told us, 'I feel safe, they are doing a very good job.'

We spoke with two relatives who were visiting the home. One relative told us, 'My wife has been very well looked after here. I have no concerns.' Another visitor told us, 'The staff are always polite and courteous, they phone me if there are any problems and I can visit whenever I like.'

We asked one of the people who lived in the home if they liked the staff, they told us, 'The girls are absolutely wonderful.'

On the day of the inspection, the provider/manager was on annual leave. Senior staff were left in charge of the home however the provider/manager contacted the home every day to make sure the home was running smoothly.