Yew Tree Nursing Home

Yew Tree House Nursing Home is registered to provide accommodation, nursing and personal care for up to 41 older people, including people living with dementia. At the time of our inspection visit, 30 people lived at the home.

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

People did not always have risks to their health and welfare effectively managed. Steps to reduce the risk to people from falls were not always in place.

Medicines were not always managed safely. Medicines were not always given in line with the prescribed instruction.

Oversight of accidents and incidents needed improving. There was no analysis of causes or triggers of incidents. This did not allow for learning lessons to reduce the frequency of accidents or incidents.

Care plans and risk assessments did not always contain the information staff needed to keep people safe.

Audits were not effective in identifying area of concern or where actions where needed to improve the experiences of people that used the service.

There were systems to identify when people needed safeguarding and staff understood their responsibilities to keep people safe.

Staff had access to comprehensive training and support to carry out their roles.

People and relatives told us they felt safe and were happy with the care they received.

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

Rating at last inspection

The last rating for this service was good (published 24 January 2021).

Why we inspected

We received concerns in relation to the management of falls risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective 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 has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yew Tree Nursing Home on our website at www.cqc.org.uk.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe management of falls and in the governance and management oversight of the service 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

floor. People had their own bedrooms.

We found the following examples of good practice.

¿ On their arrival at the home, visitors were screened for symptoms of COVID-19 and were required to complete a lateral flow test to ensure their visit could take place safely in line with current guidance.

¿ Government guidelines during an outbreak were followed with the home closed to visitors during an outbreak. However, for people who were receiving end of life care, important visits were arranged and supported safely.

¿ A bedroom had been decommissioned and converted to a visitors room to allow more people to see friends and family members. A new 'visiting entrance' was created and this additional entrance allowed for visitors to visit from the garden area, minimising cross infection risks to others in the home. A booking system helped ensure visiting was maximised, whilst keeping people safe. Clear partitioning helped keep people safe from potential risk of cross infection.

¿ Some furniture in communal areas had been spaced to allow people to get together whilst respecting social and safe distancing.

¿ Staff completed regular testing and those staff almost without exception, were double vaccinated. The manager was confident the planned government legislative changes with vaccinated staff, would not affect their current staffing levels.

¿ Management plans during a COVID-19 outbreak included the creation of an isolation unit. This unit was staffed by the same staff cohort to limit the risk of cross contamination. People who had tested positive, were encouraged to stay within their room and unit to help reduce the spread of infection.

Yew Tree House Nursing Home is registered to provide accommodation, nursing and personal care for up to 41 older people, including people living with dementia. At the time of our inspection visit, 38 people lived at the home. The home has two floors, with communal areas throughout and a dining area on the ground floor. People had their own bedrooms.

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

We found improvements since our last inspection and some improvements in staff practice were still required. Medicines were administered safely to people by trained staff. However, we found prescribed thickeners were not stored safely and during our visit, we saw thickeners prescribed to named individuals, given to other people. We also found some paraffin-based creams were not stored safely. We raised our concerns to the registered manager. Following our visit, the registered manager sent us an immediate action plan to show lockable storage in communal areas and people’s rooms was now in place. This would help mitigate the risk of people choking and unopened creams from being used by others.

People told us they felt safe living at the home. Staff knew how to protect people from poor and abusive practice. Safe staffing levels ensured people received support when needed. Agency staff use continued to be used to support permanent staff whilst plans for recruitment continued. Since the last inspection, staff followed safe principles for infection control and their training and practice meant the potential for cross infections was kept to a minimum.

Staff were confident in their abilities because their training and development needs were met by the provider. Staff training included refresher training alongside an induction for new staff, plus training support from external health professionals. One to one supervision meetings; observed practice and regular staff meetings gave staff the opportunity to discuss any development opportunities.

People said staff were respectful, polite and caring in how they supported them with any choices they made. People had individual care plans and assessments that met their health and social needs. People were supported by nursing and care staff and on occasions, other health care professionals were involved to maintain their overall health and wellbeing.

People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; most of the policies and systems in the service supported this practice. However, CCTV recorded images internally and externally to help identify any potential issues within the home. Although signs were displayed, there was no evidence to show people’s feedback and consent had been sought and that the on-going use of CCTV had been considered and reviewed. We recommended the provider sought guidance from our website and other agencies responsible for such imagery as well seeking people’s feedback. Following our visit, the registered manager said they would notify people and relatives in the January 2020 newsletter about this matter and raise at people and relatives meetings.

Staff protected people’s privacy and dignity, however, when people used one downstairs shower room, the door was not always closed if equipment (hoist or wheelchair) was required. A privacy curtain was used to minimise privacy, however not everyone was happy with this. We recommended the registered manager explored other opportunities to make sure people’s personal care routines were respected.

There were opportunities for people and relatives to give their feedback on the service. The provider’s complaints policy was displayed so people had the information they needed.

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 5 January 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

People were not always safe as the provider had not followed effective infection prevention and control procedures. The provider did not have effective systems in place to monitor the quality of the service they provided and to drive improvements where needed.

People received care and support from a staff team who had been trained to recognise signs of abuse or risk and knew what to do to safely support people. People received safe support with their medicines by competent staff members.

The provider supported staff in delivering effective care for people through person-centred care planning, training and individual support. They ensured the provision of best practice guidance and support met people's individual needs. People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet. People were supported to express and meet their wishes as they approached the end of life.

People received help and support from a kind and compassionate staff team with whom they had positive relationships with. People were supported by staff members who were aware of their individual protected characteristics. People were supported to maintain their independence.

People participated in a range of activities that met their individual choices and preferences and that they found interesting and stimulating. People were provided with information in a way that they could understand. Policies and guidelines important to people were provided in a way people couple access. The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

The provider and management team had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection: Good (date last report published 21 April 2016)

About the service: Yew Tree Nursing Home is registered to provide accommodation, nursing and personal care for up to 43 people. At this inspection 38 people were living there including some who were living with dementia.

Why we inspected: This was a planned inspection based on the rating at the last inspection, ‘Good.’ At this inspection we found improvements were needed and therefore the overall rating was ‘requires improvement.’

Follow up: We will monitor the progress the provider makes following the publication of this report.

There was a registered manager in place at the time of our inspection. 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.

People lived in a safe environment as staff knew how to protect people from harm. We found that staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions.

There were sufficient staff on duty to meet people’s needs. People told us that staff helped them when they needed assistance. Regular reviews of people’s care and deployment of staff meant staffing levels were reviewed and reflected the needs of people who lived there. People’s medicines were administered and managed in a safe way.

People received care and support that was in-line with their needs and preferences. Staff provided people’s care in-line with their consent and agreement. Staff understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. We found that people had access to healthcare professionals, such as the dentist and their doctor when they required them and where supported to hospital appointments.

We saw that people were involved in the planning around their care. People’s views and decisions they had made about their care were listened and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected.

We found that people knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last 12 months and found that no complaints had been received.

The registered manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, which meant that people’s received care and support in-line with their needs and wishes.

We found that the checks the provider completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to ensure that lessons were learnt and used to improve staff practice.

We saw that people gave their consent to staff which met their day to day care needs and where able had signed their care plans. One person who lived at the home told us: “They do tell me what they are doing even though they know me and my routine”.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person’s needs and how to give care and support to meet those needs. People who lived at the home told us: “It’s my home now” and: “I get my appointments and I have a hospital appointment next week”.

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

Records we saw had been reviewed, updated and kept securely to protect the information held about the people who lived at the home.