Yew Tree Holdings Limited

Yew Tree Holdings Ltd is a residential care home providing accommodation and personal care to up to 26 people in one adapted building. The service provides support to people with varying needs, including dementia, diabetes and mental health needs. At the time of our inspection there were 26 people using the service.

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

People told us they felt safe and were well cared for. One person told us, “I see the staff every day. Everybody is very caring. If we aren’t well, we get looked after here.”

The assessment of individual risks had improved, and plans were in place to manage risks and prevent harm to people. Accidents and incidents were better recorded and monitored to prevent further incidents. People’s medicines were now managed well, so people could be assured they received their medicines safely.

People were protected from potential abuse by a staff team who were clear about their responsibilities to protect people. There were sufficient staff who were suitably skilled and trained to meet people’s needs. Robust recruitment processes were now in place, so safe choices of new staff were made. People were protected from infection by appropriate infection prevention and control measures.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People told us they were supported to make choices and decisions if they needed it.

People’s needs were now assessed and reviewed regularly, and care plans provided detailed guidance for staff that was person centred. People were happy with the food provided and their nutritional and hydration needs were met. Healthcare professionals were contacted quickly if people needed advice or treatment for health concerns.

People, relatives and staff were complimentary about the registered manager, describing her as supportive and approachable. People told us all staff were kind and caring and treated them well. A more robust system was in place to monitor the quality and safety of the service. Action was taken to learn lessons and continue to improve.

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 17 July 2021) and there were breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the management and leadership, people’s care and the cleanliness of the service. 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 requires improvement to good. 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 Holdings Ltd on our website at www.cqc.org.uk

Follow up

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

Yew Tree Lodge is a residential care home providing personal care to 23 people aged 65 and over at the time of the inspection. The service can support up to 26 people.

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

Individual risks were not always effectively identified and managed to keep people safe. Lessons were not always learnt from accidents and incidents to prevent future occurrences. People's medicines were not always managed in a safe way. People could not be assured new staff were recruited safely.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider and registered manager did not always have sufficient oversight of the service. Records did not always reflect the changing needs of people. Audits were not always effective at identifying areas for improvement or taking action when needed.

Staff training and support had improved since the last inspection, staff received the training they required to provide safe support. Some staff had been slow to update their training within the timescales they were meant to. The registered manager had given those staff a deadline. This is an area to improve further.

People said they felt safe and described the service as their home. Staff knew what to do if they had concerns that needed to be addressed. We were assured infection control procedures were followed by staff, people and their relatives confirmed this. People were able to have visitors, following the latest government guidance.

People received the medical attention they needed if they had issues with their health and said the food was good and nutritious.

People, their relatives and staff described an open-door culture where they could raise issues when they needed to and were confident they would be listened to.

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 17 July 2019) and there were four breaches of regulation. This service has been rated requires improvement for the last two inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an unannounced comprehensive inspection of this service on 22 May 2019. Breaches of regulation were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and good governance.

We undertook this focused inspection to check they 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, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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.

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 monitor the service.

We have identified four breaches, in relation to safe care, safe recruitment, consent to care, accurate record keeping and governance systems 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 and meet with the provider to discuss how they will increase their rating to at least good. 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.

Yew Tree Lodge is a residential care home providing personal care to up to 34 people aged 65 and over. There were 22 people living at the service at the time of inspection. People had varying care needs, including, living with dementia, recovering from a stroke, mental health needs and diabetes. Some people could walk around independently and other people needed the assistance of staff or staff and equipment to help them to move around.

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

People’s experience of using this service:

Monitoring systems needed improvement to make sure people were provided with a safe and good quality service.

Some areas of people’s safety were not managed well. Lessons were not learnt following accidents and incidents to improve outcomes for people.

People were not always supported by staff who had the up to date training they needed to meet people’s needs.

People and their relatives were not asked for their feedback on a regular basis, so the provider and registered manager would know where to make improvements.

The registered manager had not notified CQC of some significant events that happened in the service as they are required to by law.

People could be assured their prescribed medicines were managed in a safe way.

People said they felt safe and the staff knew how to support them. There were enough staff to meet people’s needs, people did not have to wait long periods to be attended to.

The provider had systems in place to makes sure only suitable staff were employed to provide people’s care and support.

People were involved in decisions about their care and were appropriately supported to make decisions when they needed assistance.

Staff provided care and support that respected people’s privacy and dignity. People were living in a supportive and friendly environment.

People told us they felt comfortable raising concerns with the registered manager or the staff team.

Rating at last inspection:

Good (Report published 16 November 2016)

Why we inspected:

This was a planned inspection based on the previous rating of Good.

Follow up:

We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Requires Improvement.

Yew Tree Holdings (Yew Tree Lodge) is a residential care home which accommodates up to 34 older people. On the day of our visit there were 26 people using the service.

There was a registered manager. 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 felt safe living at the service. It was evident from talking with staff that they were aware of what they considered to be abuse and how to report this. Staff knew how to use risk assessments to keep people safe, alongside supporting them to be as independent as possible. There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Recruitment processes were robust. New staff had undertaken the providers induction programme and training to allow them to support people confidently. Medicines were stored, administered and handled safely.

Staff were knowledgeable about the needs of individual people they supported. People were supported to make choices around their care and daily lives. Staff had attended a variety of training to ensure they were able to provide care based on current practice when assisting people. Staff always gained consent before supporting people. There were policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff knew how to use them to protect people who were unable to make decisions for themselves.

People were able to make choices about the food and drink they had, and staff gave support when required. Catering staff knew who required a special diet and this was taken into account. People had access to a variety of health care professionals if required to make sure they received on-going treatment and care.

People were treated with kindness and compassion by the staff, and spending time with them on activities of their choice. People and their relatives were involved in making decisions and planning their care, and their views were listened to and acted upon. Staff treated people with dignity and respect.

Care records were reflective of people's current needs and were reviewed and evaluated on a regular basis. People were supported to engage in a variety of activities, based upon their preferences. The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

People were complimentary about the registered manager and staff. It was obvious from our observations that staff, people who used the service and the registered manager had good relationships. We saw that effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvements.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with four people using the service, three of their relatives, four the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There was an auditing system in place to make sure that manager and staff learnt from events such as accidents and incidents, complaints, and concerns, thereby reducing the risk of harm to the people who lived at the home.

The service was clean and hygienic. We found examples of good practice regarding infection control and waste disposal. Maintenance issues identified at the last inspection had been attended to. For example, a new carpet had been laid in the main lounge.

Is the service effective?

People's health and care needs were assessed with them and their relative/representative (where this was appropriate), areas of risk identified within the assessment had been documented and staff were given information in people's care plans of how to minimise those risks Some of the care plans had still not been reviewed regularly, however we could see this had been addressed within the last two months.

Appropriate signage and adaptations had been made which enabled people to mobilise freely and safely around the home?

Visitors we spoke with confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Two people were able to tell us that they liked the home, and the staff who cared for them. We also had the opportunity to speak with three relatives during the day. They made comments such as, "The staff are kind and look after my Mum well', the staff always have time for me, and I am kept informed when X is unwell' and 'All the staff without exception are lovely to everyone, I watch them sometimes, they have so much patience with people, they really care'.

There had been relative/resident meeting since our last visit and suggestions were seen as a way that the staff could improve the service they provided.

Is the service responsive?

We looked at people's assessments of need, care and support. Care and support needs had been considered when formulating each person's care plan. We found that new people admitted to the service had an assessment undertaken by a member of staff prior to admission. Risk assessments had been undertaken and systems had been put in place to minimise future risk. This meant that staff were fully informed about the person's needs.

Is the service well-led?

The service had a quality assurance system, we saw records that showed that audits had been undertaken monthly to check that different aspects of the service provision had been undertaken in a timely manner. For example, there had been regular audits of the medication systems, cleaning schedules and incidents and accident forms. The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There was no auditing system in place to make sure that manager and staff learnt from events such as accidents and incidents, complaints, and concerns. This increased the risk of harm to people and failed to ensure that lessons are learned from mistakes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affected people's safety.

The service was not wholly safe, clean and hygienic. We found examples of poor practice regarding infection control and waste disposal, and areas that needed further maintenance. This was putting people at risk of harm. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control and the environment.

Is the service effective?

People's health and care needs were assessed with them and their relative/representative, but not all areas identified within the assessment had been highlighted in people's care plans. Specialist dietary needs were not always followed nor outcomes recorded appropriately. Some of the care plans had not been reviewed regularly. Care plans were therefore not able to support staff consistently to meet people's needs.

People's mobility and other needs were taken into account in relation to signage and building adaptation, enabling people to move around freely and safely.

Visitors we spoke with confirmed that they were able to see people in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and ensuring care and support needs are met consistently.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff are very kind to me, they help me although I do most things myself'. A relative said, 'I visit my relative regularly and the staff have been very good to my mum, she has put on weight and is very happy'.

People using the service, their relatives, friends and other professionals involved with the service have not yet been asked to complete an annual satisfaction survey. There had been one relative/resident meeting since our last visit and suggestions were being looked into. Some people were starting to have their views and needs looked into, however not all peoples views were being sort.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning and reviewing their care.

Is the service responsive?

We looked at people's assessments of need, care and support. We found that not all of the identified care support needs had been considered when formulating a plan of care. We found that new people admitted to the service had not had an assessment undertaken by a member of staff at the home, and that the assessment undertaken by social services had been used. Assessments of risk to individuals were not always the subject of a full risk assessment with a management strategy for staff to minimise future risk. This meant that staff were not fully informed about the person's needs.

We have asked the provider to tell us what improvements that will make in relation to co-operating with other services. There relationship with the district nurses who visit has improved, with staff assisting the nurses when appropriate.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that not all audits had been undertaken monthly and therefore quality of the service was compromised. The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision. However internal reviews and checks were not always happening on a regular basis. The manager was fairly new to the service and evidence was seen that they had identified some shortfalls and were taking action to improve the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make in relation to improving the service provided.

During this inspection on the 30th October 2013 we found staff at Yew Tree Lodge had worked hard to protect the people living in the home and make sure they provided the assistance needed to meet people's agreed care needs.

We observed staff were protecting people's dignity and showed respect in the way that they interacted with them. Staff asked people for their consent before providing care and support.

People living in home and their families had been involved in formulating the care plans. We found staff understood the people's care needs and people were receiving their agreed care. A family member who we spoke with told us that they were pleased with the changes the home had made. They said, 'Mum is much happier now and we see staff around and doing things with the residents, the atmosphere is much calmer.'

We found that people were receiving the medicines they were prescribed.

There were sufficient staff on duty who had received training and gained the skills they needed to care for the people at the home.

Monitoring systems were found to be in place to make sure people were receiving good quality care and that records remained up to date.

The pharmacy inspector visited and found were still not receiving their medication safely or as prescribed.

Two inspectors visited the home they were joined by a specialist dementia advisor on the 29th July 2013. We found that the home remained non-compliant with all previous regulations, plus a further two regulations.

We had concerns for people's safety as we witnessed four incidents during our visit which we passed on the local authority safeguarding team.

We found that people were not always being treated with respect and their privacy and dignity was not protected. People were not always given the opportunity to choose or consent to care.

People were not always receiving the care and support they needed or had been planned to ensure their health and welfare. Risk assessments seen had not been supported by robust instructions to staff to minimise the risks.

People could be a risk of dehydration and malnutrition as there was a failure to follow up identified low in take.

Many staff did not have the skills, knowledge and understanding to provide good quality care due to the lack of training and support.

The home lacked robust monitoring systems to ensure people received consistent good quality care.

People living in the service suffered from different forms of dementia, therefore communication was not possible with some people. Those who were able to respond told us that they liked the staff and found them to be friendly.

We found that care records did not fully detail the care and support that individual people required. None were signed to show consent to the care being given. The risk assessments did not fully explore all the risks of the individual.

The medication audit undertaken by one inspector highlighted serious problems.

The home has an ongoing plan for refurbishments and improvements. They had installed different baths to meet peoples' changing needs.

There was no auditing being undertaken by the manager to ensure the safety and quality of the care provision. Records needed for the provision of care and support and health monitoring were not consistently accurate.

People told us or expressed that they felt safe and well looked after. A visitor told us 'I wanted (my relative) to be here. I came unannounced to have a look around and I was pleased with what I saw. I come and visit anytime I want and I telephone every day. The staff have been brilliant and very supportive'. Another visitor said 'I have no concerns. I have never had a problem here'.

People said that the home was clean and that their bedrooms were kept clean. A visitor said 'It's not the bees knees, it is not a hotel but it is homely and that's why (my relative) fits in'.

People told us the food was good and that snacks were available in between meals. However people had to wait until breakfast, served after 8am, for a drink even though they may have risen at 6am. People told us that they would like to be offered a drink before breakfast.

People told us that there was not much to do as activities were limited and no one was employed to arrange activities. This meant that care staff arranged ad hoc activities when they could spare the time but nothing was planned or structured.

A visiting social care professional said they had no concerns about the service.