Yew Tree Lodge

Yew Tree Lodge is a residential care home that can provide the regulated activity of personal care to a maximum of 16 people. Three of the beds are crisis beds, with the remaining 13 residential (long term stay). The service provides care to people who have been diagnosed with mental health issues. There were 10 people using the service on the day of the inspection. Many of the individuals have experienced periods of stay in hospital and require a level of support prior to transitioning to community-based living.

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

Care plans and risk assessments did not contain adequate information for staff to know how to support people and manage their behaviours safely. People, their relatives and staff told us that staff were not always trained well enough to meet people’s specific needs of. Staff told us they did not always feel supported by the registered manager and they were not always listened to while raising concerns with the management team. Staff told us they were unable to spend sufficient time with people. The provider failed to make the improvements we had required at our January 2019 inspection and therefore people remained at risk of harm. The provider failed to ensure there was effective management of the service. There was a lack of effective systems to ensure risk management and oversight of the quality of care people received.

There were procedures in place to prevent visitors to the home from spreading Covid-19 at the entrance and on entering the premises. Medicines were managed safely, and people received their medicines as prescribed. Staff understood what action to take if they suspected somebody was being harmed or abused. Recruitment procedures ensured appropriate staff were employed to work with people and keep them safe as much as possible. The registration regulations were met by the registered manager. The Commission were sent notifications where required.

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 requires improvement (published 11 April 2019).

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 29 January and 19 February 2019. Two breaches of legal requirements were found. The service needed improvement because of low quality of risk assessments, gaps in staff training and staff not being trained in specialist areas in which they were delivering support.

We undertook the latest focused inspection to check whether the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yew Tree Lodge 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 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 have identified two breaches in relation to safe care and treatment and good governance at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service:

Yew Tree Lodge is a residential care home that can provide the regulated activity of personal care to a maximum of 16 people. Three of the beds are crisis beds, with the remaining 13 residential (long term stay). The service provides care to people who have a diagnosis of mental health issues. Many of the individuals having experienced periods of stay in hospital and require a level of support prior to transitioning to community based living.

People’s experience of using this service:

¿ Risks were identified for people on long term stay and actions put in place to prevent these. However, no guidance was provided to staff on what action to take, if the risk occurred.

¿ People on crisis beds did not have sufficient risk assessments in place to detail how staff were to support them and keep them safe, on admission.

¿ By day two of the inspection the registered manager had mitigated all risks, and ensured all paperwork was up to date and relevant to people.

¿ People reported feeling safe and well supported by the staff team.

¿ Medicines were managed safely, by competent staff.

¿ Recruitment procedures ensured appropriate staff were employed to work with people and keep them safe, as much as possible.

¿ The service ensured that measures were in place to prevent the spread of infection. The home was clean and tidy. People reported no concerns in relation to cleanliness.

¿ People reported that staff and the management team were approachable. We were told they listened to concerns.

¿ Quality assurance surveys illustrated the service had sought feedback from people, relatives and health professionals, and had made changes, where possible.

Rating at last inspection:

The service was last inspected in February 2018 and was rated Good in all domains. The service did not have anyone using the crisis beds at the last inspection. At this inspection we found that the service required improvements specifically in supporting people in crisis beds. As a result, the overall rating has been amended to reflect this.

Why we inspected:

This was a focused inspection that was prompted by a serious incident that resulted in a person’s death. As the death is currently being investigated, we did not look at this specifically during the inspection. We focused on the domains of safe and well-led for this inspection.

Follow up:

We will continue to monitor all information we receive about this service. This will inform our ongoing assessment of their risk profile and ensures we are able to schedule the next inspection in accordance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A newly registered manager was in post when we inspected. 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 2008 and associated Regulations about how the service is run.

The service remained safe. Sufficient staff were employed to manage people’s needs. Staff knew how to safeguard people from abuse and were able to describe the protocols to follow should they have concerns. They further advised of the confidential hotline details the provider had given the staff should they wish to raise concerns confidentially. Staff were involved in medicine management. Systems had been employed by the service to ensure safe medicine management. This had recently identified a couple of concerns that were promptly managed. On day two of the inspection, the inspector highlighted two issues with people’s medicines. These were reported to the registered manager. Staff were competency checked annually and upon returning to medicine management, with monthly audits of medicines completed to ensure people were kept safe.

The service remained effective. Support was delivered by a knowledgeable and trained staff team, who were able to respond appropriately to people’s changing needs. Whilst refresher training courses had not been booked for all staff, this was rectified with competency checks completed until training was made available. Staff were supervised and supported by an effective management team, who made certain they were available to staff at all times. People were supported to have maximum control of their lives through recovery plans that were written by the people for themselves.

The service remained caring. Staff were polite, respectful and ensured they maintained people’s dignity when supporting them. They encouraged open communication and worked on motivating people to increase their independence within the home and in the community. Evidence of using systems of communication that reflected the person’s choice was evident in the service.

The service remained responsive. Recovery plans were individualised, focusing on people’s specific needs. It was recognised by the management that the current IT systems could possibly mean that not all information was made available to staff working with people. The provider had sought to remedy this by introducing a new IT system that would be developed in conjunction with the registered manager. This meant that the information that the staff working with people felt was necessary in supporting people was always made available.

The service took necessary action to prevent and minimise the potential of social isolation. Activities were arranged by the service, with individual programs developed working on reducing people’s isolation individually. People and staff were protected from discrimination. Measures were in place to allow people to be treated equally. Systems to monitor and investigate complaints were in place.

The service was well-led. The service had good methods of governance. A thorough quality assurance audit was completed annually with an action plan being generated, and followed upon. Feedback was encouraged from people, visitors and stakeholders and used to improve and make changes to the service. We found evidence of compliments and complaints that illustrated transparency in management. .

Yew Tree Lodge is a care home that offers accommodation for people who require personal care. Although registered to provide a facility for up to 16 people, the location currently has 12 people using the service. The location provides support to people who have a primary diagnosis of a mental health issue. The support is broken down into three main categories: crisis beds – for up to 5 days, respite care and long term support.

The home is required to have a registered manager. The last registered manager was in post until December 2015. In the absence of a registered manager, the home has been supported regionally by senior management. Interviews have been conducted and a successful candidate has been appointed to commence employment from February 2016. 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 2008 and associated Regulations about how the service is run.

As part of this inspection process, the action plans submitted following breaches from the December 2014 inspection were to be looked at to determine whether these had been appropriately met. It was found that the provider had taken sufficient action to rectify these breaches in the area of quality assurance and staff support.

Staff knew how to keep people safe by reporting concerns promptly. Systems and processes were in place to recruit staff who were suitable to work in the service and to protect people against the risk of abuse. There were sufficient numbers of suitably trained and experienced staff to ensure people’s needs were met.

We observed good caring practice by the staff. People using the service said they were very happy with the support and care provided. Care plans and risk assessments were found to be updated and reviewed in conjunction with external professionals and with each person. People were provided a copy of their risk management, for them to retain should they wish to have a copy.

People told us communication with the service was good and they felt listened to. All people spoken with said they thought they were treated with respect, preserving their dignity at all times.

People were supported with their medicines by suitably trained, qualified and experienced staff. Medicines were managed safely and securely. People were given the opportunity to independently self-administer medicines in agreement with health care professionals.

People received care and support from staff who had the appropriate skills and knowledge to care for them. All staff received comprehensive induction training and support from experienced members of staff. They felt supported by management and said they were listened to if they raised concerns.

Quality assurance audits and governance of documents were found to be completed by the service. This therefore ensured the opportunity to continually assess and make changes where necessary for improvement of the service.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People confirmed they were involved in their care planning. One person said "I am happy with everything".

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We looked at the training records of five members of staff. They contained evidence of appropriate training, supervision and appraisal. Staff told us they felt well supported by managers and they had enough training to enable them to meet the needs of the people they support.

People who use the service, their representatives and staff were asked for their views about the care and treatment provided and these were acted on. The provider had processes in place to regularly identify, assess and manage the risks relating to the health, welfare and safety of people who use the service and others.

We spoke with the person managing the service on the day of our inspection. Throughout this report, we have referred to this person as the acting manager. The location did not have a registered manager at the time of our inspection.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with nine people who use the service. All of them told us they were involved in their care planning. One person said 'suggestions about my care are respected and acted upon'. Another said 'staff are very supportive of my choices'.

There were effective systems in place to reduce the risk and spread of infection. We observed the home to be clean and tidy. Staff we spoke with had recent infection control training and were able to explain the relevant infection control and prevention procedures.

There were effective recruitment and selection processes in place and the appropriate checks were undertaken before staff began work.

The home had systems in place to deal with comments and complaints and people were made aware of the complaints system. Information about complaints was provided in a format that met people's needs. People told us they were aware of the complaints process and would be happy to use it if they needed to.