Yewtree Care Limited t/a Yewtree Nursing Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of a legal regulation in relation to dignity and respect.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure people’s privacy and dignity were respected. Records showed no evidence that dignity, choice or compatibility were considered when people were moved into shared rooms, and we observed undignified care experiences as a result. For example, we observed interactions about people’s care could be overhead by the other person in the room. The privacy needs of a person receiving end-of-life care were not assessed or planned for. As a result, a person sharing the bedroom was temporarily moved overnight because the other person was dying. There was no evidence the appropriateness of sharing a room under these circumstances had been considered for either person. During the inspection a person cared for in bed was served their lunch whilst there was a strong malodour in the room resulting from the other person requiring their incontinence pad to be changed. Staff failed to acknowledge this, and the person was left with their lunch which they did not eat. These actions demonstrated people were not always supported in a way that upheld their dignity or promoted a respectful care environment.

However, we saw examples where staff treated people with kindness, empathy and compassion and observed positive and warm interactions. We saw a staff member supporting a person at lunchtime in a person-centred and dignified way. They provided support at a pace the person was comfortable with, they communicated well and maintained the persons dignity throughout. People spoke highly of staff, describing them as “lovely” and “caring.” One person told us, “They’re friendly. There’s very good staff here. If I ask them to do something, they do it.” Another said, “They’re brilliant. Most staff haven’t changed over the years. There’s a continuity of care that’s important. You build up a relationship with them.”

People were not consistently supported in ways that recognised their individuality, preferences or needs. Staff did not always consider the strengths, abilities or aspirations of people with a learning disability, and told us they lacked resources and equipment to support people in line with their assessed needs and preferences. This included insufficient staffing to support a person’s assessed need to have opportunities shop for nice dresses. And not being able to support a person to spend time out of their bed because the comfortable chair in their room was not suitable for their needs. There was no evidence the provider had considered how these needs and preferences could be met.

People told us they could receive visitors when they wished and were afforded privacy. A person said making daily choices, such as when to get up or what to wear and eat was important to them and staff respected this. Some bedrooms were personalised with items that reflected people’s identities and interests; for example, 1 person proudly displayed a collection of Elvis memorabilia and enjoyed sharing this with us.

The provider did not always promote people’s independence, particularly for those living with dementia or a learning disability. Care and the environment did not reflect best practice and offered limited sensory or meaningful activities. The institutional layout, with people seated around the edges of the lounge, did not support interaction or choice. People living with dementia had few visual prompts or personal references to support engagement or reminiscence. Several people told us every day felt the same, they never went out and spent most of their time sitting in the lounge. Comments included, “I do nothing every day” and “They sit me in this chair every day… until they wheel me back for bed.” Our observations over the 3 inspection days reflected this experience.

However, some care plans reflected people’s preferences and guided staff to respect individual decisions. For example, 1 person chose not to follow dietary advice, and staff appropriately respected this choice as the person had capacity and understood the associated risks. Another person told us their care and treatment choices were listened to, and this helped them feel involved and in control of aspects of their daily life.

The provider did not always understand people’s needs or wishes. Staff did not take a holistic approach to a person with a learning disability and associated complex needs. The person frequently screamed throughout the 3-day inspection, and people and their relatives said this happened daily and most nights. However, there were no planned wellbeing checks or clear guidance to help staff identify or alleviate the person’s distress, beyond considering pain relief or personal care. We raised these concerns with the provider and the local authority.

People told us they had a good response to call bells, and we saw this at inspection. The call bell system alerted staff to emergency situations, and we saw staff responding appropriately and quickly to these. A visitor said, ‘I explain how [relative] is feeling and they’re receptive to me. If you want something, they say they’ll be back with it in 10 minutes, and they generally are.’

The provider cared about and promoted the wellbeing of their staff. Staff consistently reported feeling valued. Staff told us they felt supported by both the manager and the provider, and many had worked at the service for several years. They described it as a positive place to work with strong support systems in place. One staff member described the team as “fantastic” and added, “Staff listen to one another.”

The provider’s grievance procedure enabled staff to raise concerns formally and appropriately. Staff were aware of this policy and felt confident to use it. The supervision policy promoted open dialogue between staff and their supervisors. Supervision provided opportunities for personal development and learning. Staff working under sponsorship arrangements told us they were treated well and felt valued for the contribution they made to the service.