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Inspection carried out on 19 October 2017

During a routine inspection

This comprehensive inspection was carried out on 19 October 2017. The inspection visit was unannounced.

The Yews is a residential care home which provides accommodation and personal care for up to 13 older people. The care home is situated in Kettering Northamptonshire. On the day of our inspection there were 13 people using the service.

At the last Care Quality Commission (CQC) inspection on 19 August 2015, the service was rated Good in all domains.

At this inspection we found the service remained Good.

The service had a registered manager. The provider for the service was also the 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 and associated Regulations about how the service is run.

People continued to receive safe care. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. People had risk assessments in place to enable them to be as independent as they could be. Effective recruitment processes were followed by the service and there were enough staff to meet people’s needs. People received their prescribed medicines as prescribed.

The care that people received continued to be effective. There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff received an induction process and on-going training to ensure they were able to provide care based on current practice when supporting people. Staff were well supported with regular supervisions and appraisals.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. People were supported to maintain good health and nutrition.

Staff provided care and support in a caring and meaningful way and people had developed positive relationships with them. Staff were caring and treated people with respect, kindness and courtesy. They knew the people who used the service well and people and relatives, where appropriate, were involved in the planning of their care and support.

People continued to receive care that was responsive to their needs. Care plans had been developed with people and their families if appropriate to identify what support they required and how they would like this to be provided. People participated in a range of activities which kept them entertained and enabled them to follow their hobbies. People knew how to complain. There was a complaints procedure in place which was accessible to all.

The culture was open and honest and focused on each person as an individual. Staff put people first, and were committed to continually improving each person's quality of life. Quality assurance systems ensured people received a high quality service driven by improvement.

Inspection carried out on 19 August 2015

During a routine inspection

This unannounced inspection took place on the 19 August 2015.

The Yews accommodates and provides care for up to 13 older people, some of whom have dementia care needs. There were 12 people in residence when we inspected.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 cared for by sufficient numbers of care staff that were experienced and had received the training they needed to do their job safely. People were protected by robust recruitment procedures from receiving unsafe care from staff that were unsuited to the job. Care staff knew what was expected of them when caring for older people, including those with dementia care needs, and carried out their duties effectively. People were safeguarded from abuse and poor practice by care staff that knew what action they needed to take if they suspected this was happening.

People’s care needs had been assessed prior to admission and they each had an agreed care plan. Their care plans were regularly reviewed, reflected their individual needs and provided care staff with the information and guidance they needed to provide person centred care.

People were enabled to do things for themselves by friendly care staff that were attentive to each person’s individual needs and understood their capabilities. People’s individual preferences for the way they liked to receive their care and support were respected.

People’s healthcare needs were met and they received timely treatment from other community based healthcare professionals when this was necessary. People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People who needed support with eating and drinking received the help they required. People’s individual nutritional needs were assessed, monitored and met with appropriate guidance from healthcare professionals that was acted upon. People had enough to eat and drink.

People, and where appropriate, their representatives or significant others were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction.

People received care from care staff that were supported and encouraged by the provider and the registered manager to do a good job caring for older people. The quality of the service provided was regularly audited by the registered manager and the provider and improvements made when necessary.

Inspection carried out on 1 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

This is a summary of what we found-

Is the service safe?

People's needs were assessed and the staff were knowledgeable about the type of care and support they needed. Risks were assessed so that people's safety was maintained. There were sufficient staff on duty to respond to people's need and the registered manager was available to respond to any emergencies. One relative told us "I feel that Mum is safe here. The staff are marvellous." People received medication from staff who had been trained to administer it safely.

Is the service Effective?

From our observations, we could see that staff knew the needs of people very well. Staff were able to tell us about the needs of those they cared for and used care plans to support them in the delivery of people's care needs. Staff had received training, including in caring for people living with dementia, administration of medication and health and safety.

Is the service caring?

We observed that the staff spent time with people and care was not rushed. Staff were attentive to people and gave reassurance and support so that people were comfortable and relaxed. One relative told us "I can't fault them (the staff). They really deserve a medal they are so kind, caring and patient." They also said, “Mum was in another home but she didn't settle and was always agitated. When we came here she was happy and settled quickly."

Is the service responsive to people’s needs?

We observed that staff were able to respond quickly to people's needs and where necessary, two staff were available to respond to people's individual needs. We noted that care plans evidenced that people were referred to other healthcare professionals such as district nurses and their GP. We spoke with a visiting healthcare professional who told us, "The home is very responsive to people's changing conditions. I have always been called out for a visit in a timely way and for the right reasons. The staff here, do a really good job. The care plans are up to date and I can always follow them."

Is the service well-led?

There was a registered manager in post who had responsibility for the day to day management of the service. We saw evidence of audits and quality assurance processes used to ensure that the quality of the service was maintained. There were systems in place to seek the views of people using the service and to invite people to share their views. Some work was needed to remove some older policies and procedure to ensure that staff always had access to the latest information. The service was one of only eight in the county selected to pilot a new quality assurance process introduced by the NHS Institute for Innovation and Warwick University.

Inspection carried out on 28 June 2013

During an inspection to make sure that the improvements required had been made

During this inspection we spoke to the senior care worker and the registered manager. They told us that they had taken steps to ensure people's care plans including risk assessments had been reviewed formally with the people who used the service and or their representatives, their care staff, and other care professionals so people's changing care needs were kept up to date.

We looked at four care plan and found that these had been reviewed and updated since our last visit on 12 April 2013.

When we last visited on 12 April 2013 the provider told us that they did not carry out diagnostic and screening procedures or treatment of disease, disorder or injury. We have advised the provider to have these regulated activities removed if there is no intention to provide these.

Inspection carried out on 12 April 2013

During a routine inspection

We found that people were encouraged to express their views and make choices. A relative of a person using the service told us that staff treated them respectfully, maintained their dignity and enabled them to be as independent as possible.

People's care plans were detailed and took account of people's individual needs and how this would be supported. However we found that the provider needed to make improvements to ensure that people’s care plans were reviewed formally with the people who used the service or their representatives, their carers, and other care professionals at least every 12 months so people’s changing care needs were kept up to date.

We found that the provider took adequate steps to protect the people they cared for and their carers from harm. The provider had adequate quality assurance systems which made sure the safety and comfort of the people they cared for were maintained and any problems quickly resolved.

When we visited the provider told us that they did not carry out diagnostic and screening procedures or treatment of disease, disorder or injury. We have advised the provider to have these regulated activities removed if there is no intention to provide these.

Inspection carried out on 10 July 2012

During a routine inspection

We carried out this compliance review as part of our planned inspection programme. We also wanted to check that improvements had been made since our last inspection visit on 22 February 2012.

At the time of our inspection most of the 12 older people living at The Yews were living with dementia which meant they were not all able to tell us their experiences. We spoke with two people who told us that they were happy with the care that they received at The Yews. We saw that staff treated and spoke with people who used the service in a respectful manner.

Inspection carried out on 21 February 2012

During a routine inspection

We spoke with seven residents and two relatives during our inspection visit. As many of the residents at The Yews had dementia they were not all able to tell us in detail about their experiences of living there. All confirmed that they were happy with the care provided and one resident said “it is not like home but it is comfortable and staff are kind”.

Relatives spoke highly of The Yews and the staff there; they told us that they particularly liked the home because it was small and friendly. We also spoke with a health professional who described the home as a “warm and friendly place”.

We spent time listening and watching how staff spoke to residents and responded to their needs. We heard staff talk to residents in a calm and respectful manner and saw that they responded quickly to residents when they needed help. We saw that staff respected residents dignity and encouraged them to be as independent as possible.

Although the views of residents and their relatives were positive, our overall findings were poor. We had concerns about risk assessment, staff training, arrangements for safeguarding people and the lack of effective quality assurance systems.

Reports under our old system of regulation (including those from before CQC was created)