Yew Tree House

Yew Tree House is a residential care home for up to nine adults with complex needs including learning and physical disabilities and mental health needs. The service is provided in adapted building in a residential area in a small rural village. At the time of our inspection there were nine people living at the service.

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

People were supported to live safely in their home within the community. People appeared to be relaxed and happy in their home environment and while interacting with staff.

We observed the lunchtime support at the service. The atmosphere was busy and friendly. During the morning people had been supported to access the community for activities and to attend appointments. People who remained at home were supported to engage in activities such as bingo and story reading. We met everyone living at the home, spoke with some people and observed the support offered by staff during lunch.

Staff understood people's needs and how to assist them to protect them from avoidable harm. Care plans and risk assessments were in place, which provided staff with guidance on how to meet people's needs and manage identified risks.

People were supported to receive their medicines safely and as prescribed.

The service had infection control processes and systems in place to reduce the risk of people contracting COVID-19. The home was clean and decorated in a homely style.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Based on our review of safe and well-led, this service was able to demonstrate how they were currently meeting the underpinning principles of ‘Right support, right care, right culture’.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had developed a model of care and an environment that maximised people's choice, control and independence. People's care was planned and delivered with their individualised needs in plans.

People were supported to access facilities in their local community such as carriage horse riding, trampolining and swinging.

The managers at the service and staff described their priority as delivering person centred care that met people's individual needs. Staff received autism and learning disabilities training.

We received very positive feedback from staff, relatives and professionals regarding the service and leadership in the home.

There was a robust quality assurance system in place to ensure people received the best possible service. The registered manager worked closely with the provider and partner agencies and services to promote best practice within the service and make a positive impact to people's lives.

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 good (published 12 October 2017).

Why we inspected

We received concerns in relation to people’s safety and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service remains the same based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

A variety of safe visiting options were offered and thorough checks were completed before visitors entered the service. An individual risk assessment had been used to support one person to visit their family home.

People were supported to maintain social distancing through effective use of communal, personal and community spaces. People had been supported to restart activities in the community safely, in-line with any lockdown restrictions, their individual risks and support needs.

There had been no vacancies at the service during the pandemic. Staff followed national guidance to ensure people returned from hospital and home visits safely.

Staff wore facemasks correctly and consistently during our visit. The registered manager told us about checks in place to ensure staff maintained high standards in use of PPE.

Testing was carried out in-line with national guidance. People's capacity to consent to testing had been assessed and best interests decisions made.

Portable PPE stations were set up throughout the service. A deep cleaning and surface cleaning programme was followed daily.

The service had responded effectively to manage and limit outbreaks. This included use of zoning and cohorting to reduce risk of transmission of infection and working closely with external professionals to keep people safe. Staff were supported to isolate on full-pay when a risk was identified.

Management plans, policies and procedures reflected best practice. The registered manager kept staff and relatives informed of changes to national requirements.

Why the service is rated Good.

People felt safe in the service and with the staff who supported them. Staff understood how to protect people from harm and abuse. Risks to people's safety were identified and clear, detailed support plans were followed by staff. Environmental risks were assessed and managed appropriately. There were sufficient staff on duty and recruitment procedures were thorough. People received their medicines as prescribed.

People were supported by knowledgeable staff who received ongoing training and support to maintain or improve their skills and competency. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to eat and drink sufficient amounts and the service worked closely with external healthcare professionals to meet people’s complex needs.

People received support from caring staff who valued and understood them. People’s privacy was respected and they were treated with dignity and kindness.

People were supported to maintain relationships with others who were important to them. They received personalised and responsive care which enabled them to live as full a life as possible and to experience stability and make progress when previously this had been lacking. A relative said, “He’s blossomed since he’s been here. It’s so good as parents to be able to say that”. People could raise concerns about the service and have their complaints listened to.

Everyone we spoke with commented positively on the leadership of the service. There were systems in place to seek the views of people, their relatives, staff and visiting care professionals. Additional systems ensured key messages were communicated and the quality of the service was closely monitored. The registered manager put people’s needs first and always strove to improve the service for people.

Further information is in the detailed findings below.

We looked at the care records for three people and spoke with staff about those people's needs. Care plans were personalised to each individual's needs and from the people we observed we saw that they accurately reflected their needs and wishes. Risk assessments had been completed where necessary and all care records were reviewed monthly. Activities were individualised and relevant to people's needs.

There were enough qualified, skilled and experienced staff to meet people's needs. Care was provided in an environment that was safe, well maintained and met people's needs. The provider had a complaints procedure in place and this was made available to people who used the service and their families and representatives.

Care plans were personalised to each individual's needs and detailed the wishes of the person and how they wanted to receive their support. Risk assessments had been completed where necessary and all care records were reviewed monthly.

The home had robust audit systems in place to monitor the quality of the care provided to people. The home regularly asked people who used the service, their representatives and other professionals for their views about the care and support the home provided. When feedback was given by people the home acted on it and used these comments to improve the service. We saw that all appropriate checks had been carried out when staff were recruited.