Yewtree Care Limited t/a Yewtree Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of a legal regulation in relation to person centred care.

This service scored 58 (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’s assessment processes did not always ensure people received effective care and treatment. People’s needs were not always comprehensively assessed, and it was not always clear how they had been involved in the assessment process. Information obtained through assessments was not consistently used to inform accurate or effective care planning.

Pre-admission planning for a person receiving respite care failed to identify essential medical supplies and information, resulting in the service not having the equipment needed on the day of their admission. This placed the person at risk of avoidable harm. Assessments for people with a learning disability and for people living with dementia did not consistently reflect national best practice guidance. They were not sufficiently robust to ensure people were cared for in an appropriate environment or in a way that promoted choice, inclusion, control and independence.

Assessment tools were used to inform care planning. This included assessments to assess the risk of choking, malnutrition and developing pressure ulcers. The service followed the National Institute of Clinical Excellence (NICE) guidance on oral care and hygiene. People’s oral health care needs were reflected within their support plan

The provider did not always deliver care in line with evidence-based guidance or in partnership with people. Care plans did not always reflect what mattered to people. Records did not always show meaningful reviews or people’s involvement in decision-making. Care plans did not always include key information or individual support needs for health conditions such as diabetes, limiting the provider’s ability to ensure care was effective or person-centred.

Some care plans contained inaccuracies that had not been identified or addressed and had the potential to effect outcomes for people. For example, a person’s weight chart showed a loss of 3kg, however this was incorrectly recorded in their care plan as a loss of 3 stone. The 3 stone unplanned weight loss over the two-month period should trigger urgent medical investigation. Records confirmed the kilogram weight was accurate; however, the discrepancy went unnoticed until we identified it, demonstrating lack of oversight and accuracy in monitoring people’s care and outcomes.

The provider worked across teams and services to support people’s health, care, and wellbeing. When people’s needs or circumstances changed, referrals were made to multidisciplinary professionals for advice and treatment. People told us staff worked collaboratively with other healthcare professionals, to ensure they received continuity of care.

The provider used the Situation, Background, Assessment and Recommendation tool (SBAR) tool. The tool provided a standardised approach in communicating accurately and promptly with healthcare professionals, ensuring timely escalation, improved patient safety, and better clinical outcomes. During the inspection a SBAR referral was made to the local GP surgery resulting in a prompt treatment plan for the person.

The provider supported people to manage their health and wellbeing. People told us they received appropriate support with pain management, ongoing health conditions and their dietary needs. Staff had the clinical skills and knowledge required to meet people’s health needs safely. This included effective and safe support to manage a person’s Percutaneous Endoscopic Gastrostomy (PEG) tube. Staff followed specialist speech and language therapy (SaLT) recommendations for a person with an identified risk of choking. The person had a history of aspiration pneumonia and was provided with drinks and fluids prepared to the correct consistency to mitigate this risk.

People said they had good access to community healthcare services. A visiting healthcare professional from the local GP practice attended monthly, providing regular oversight of people’s health needs. One person told us, “It’s great and so reassuring to know that they are looking after my health.” People told us they received a varied diet with personal preferences and specialist dietary requirements catered for. Some people had fortified meals and drinks to maintain their health.

The provider routinely monitored people’s care and treatment to drive continuous improvement and ensure clinical expectations were met. One person described their positive experience of receiving complex wound care. They attributed their progress and the absence of infections and hospital admissions to the “exceptional care” provided by the nursing team. They also shared a letter from a vascular specialist confirming that their wounds “continue to improve with good nursing care.” Additional measures, such as a high-protein diet, were in place to support effective wound healing.

Multidisciplinary assessments were used effectively to monitor changes in people’s health, including risks related to malnutrition, skin integrity and pain. The service used the National Early Warning Score (NEWS) to identify and track deterioration in people’s health, enabling staff to respond promptly when people’s conditions changed.

The provider did not always ensure people’s rights under the Mental Capacity Act (MCA) 2005 were upheld. Where people lacked mental capacity to make informed decisions or give consent staff had not always acted within the requirements of the MCA and associated code of practice. Staff had received MCA training but did not always apply this to their practice.

For example, at inspection 7 people were accommodated in shared bedrooms. Care records recorded each of the 7 people lacked capacity to consent to their care and treatment. The provider was unable to evidence a person-centred approach to decision-making and obtaining consent to shared bedrooms. People sharing bedrooms were not related and did not have a known or documented friendship. There was no evidence of compatibility assessments or best interests’ decision-making processes required under the MCA. This demonstrated a lack of lawful and person-centred decision making by the provider

There was evidence of Deprivation of Liberty Safeguards (DoLS) applications made to the local authority. Records were kept demonstrating the provider regularly contacted the local authority for any outstanding applications where a decision was still required.