Yewtree Care Limited t/a Yewtree Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

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

This service scored 57 (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 ensure people consistently received person-centred care or were fully involved in decisions about their support. People had mixed experiences of how well their needs and wishes were understood. Those who could not express their needs, or who lacked capacity, did not always experience care that met their individual requirements. For example, records showed people were sometimes moved between rooms without explanation, and where they lacked capacity, there was no evidence that a best interests process had been followed. For people living with dementia and people with a learning disability, it was often unclear how they were involved in decisions, and their wishes and personal histories were not consistently reflected in care plans.

Documentation, including daily notes, were not always written in person-centred language and did not promote independence or autonomy. For example, 1 person’s care plan repeatedly recorded the wrong name, and another person was incorrectly described as needing a liquidised diet despite receiving all nutrition and hydration through a PEG tube. People with a learning disability did not have a health action Plan (HAP). A HAP is a person-centred document for individuals with a learning disability that details their health needs and how to stay healthy.

Some people told us they experienced person-centred care, and their support was delivered in line with their wishes. We observed positive interactions where staff knew people well and spoke with them politely and respectfully. There were warm, light-hearted conversations that reflected trusting relationships. We saw several staff making repeated efforts to understand a person’s request. The person smiled and laughed when staff finally understood what they wanted, demonstrating staff attentiveness and a genuine commitment to meeting the person’s needs.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities. This meant care was not always joined-up, flexible or supportive of choice and continuity. For example, a young person with Down’s syndrome did not have a peer group within the nursing home, and opportunities to develop friendships, build community connections or taking part in age-appropriate activities had not been considered. This meant their social, emotional and developmental needs were not fully supported.

The provider did not engage with local support groups or organisations that could enhance people’s care, including those supporting people with dementia, learning disabilities or specific health conditions. Community resources such as dementia-friendly library materials, talking newspapers, dementia hubs, and communication libraries had not been explored or used. This limited opportunities for people to benefit from wider community support.

The provider did not always ensure people received information in formats that met their individual needs.Some accessible yellow signage was in place however this did not adequately support people living with dementia to orientate themselves or move confidently around the environment. People told us they did not have copies of their care plans and did not know they could request them. A person with a learning disability whose pre assessment recorded their use of an electronic tablet for communication did not have access to it, and staff were unaware of its importance or whereabouts, limiting their ability to express their needs.

People told us the unreliable Wi-Fi affected communication and independence. In addition, at the time of inspection, there had been no internet or telephone access for 5 days, impacting contact with families, professionals and access to electronic care records. We raised this with the provider who took action to resolve the issue. During this time contingency measures had been put in place for telephone communication.

People were able to share feedback and ideas, or raise complaints about their care, treatment, and support. People told us the manager and staff listened to them and that they felt comfortable raising any questions or concerns. A relative said, “The staff are approachable, and they let me know if there’s a problem.” A person said of the manager, ‘I’ve had dealings with him. He’s polite to me and accommodating.’

A relative told us, “I do a questionnaire from the home periodically. I don’t want anything changed. “A person said, “I went to a residents’ meeting. Nothing changed, but I don’t think I said anything should be changed.” Another person said, “I did a questionnaire on the food and different areas. The food is Ok, but it’s on a rota, you get tired of it. I suggested a pizza, and they did it for a change.” There was a complaints procedure. People and their relatives knew how to raise a complaint and felt confident to do this.

The provider ensured people could access the care, support and treatment they needed when required. People told us they had good access to healthcare services and were supported to attend routine and specialist medical appointments, which were clearly recorded. Staff were knowledgeable about signs of deterioration and care records showed they sought timely medical advice when needed.

During the inspection the nursing home’s communication systems were not working. We observed a staff member attend the local GP practice to raise concerns about a person’s health, resulting in antibiotics being prescribed and a follow-up home visit arranged. This helped ensure the person received prompt and appropriate treatment.

Staff and leaders did not always demonstrate awareness of the needs of people who may be at greater risk of inequality in their experience or outcomes. As a result, care was not consistently tailored to address people’s specific and unique needs. The environment did not always meet people’s needs, and staff lacked sufficient understanding of how to support people living with dementia well. As a result, people living with dementia experienced unequal outcomes, including reduced independence, limited engagement, and fewer opportunities for meaningful activity compared with others using the service.

Staff and managers did not demonstrate awareness of the significant health inequalities experienced by people with a learning disability, which can contribute to poorer health outcomes. During the inspection, we observed that staff had not followed recent medical guidance relating to a person with a learning disabilities condition and the required intervention. We raised this with the provider, and prompt medical intervention was sought.

People were supported to plan for important life changes, including decisions about their future and end-of-life care. Some people had personalised end-of-life care plans that reflected their wishes and what mattered to them. Anticipatory medicines were available within the nursing home to help ensure people remained pain free. A relative told us their loved one was being supported in a dignified and respectful way. We observed staff who were attentive, ensured the person was comfortable and hydrated, and maintained their appearance and presentation.

Some people had chosen not to discuss their end of life wishes at the present time, but processes were in place for this, should they change their mind. Information was in place for each person for what to do in an emergency medical situation should this be required.