Yew Tree Holdings Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to Requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to people’s safe care and treatment.

This service scored 50 (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 always have a proactive and positive culture of safety based on openness and honesty. Staff did not always report safety events such as concerns around safe moving and handling practices within the service. Lessons were not always learnt to continually identify and embed good practice. For example, to reduce the number of falls within the service, management had instructed staff to be present in the quiet lounge in the afternoons, however, during our inspection we observed on 3 occasions staff were not present. The third time we raised this with the Senior who confirmed a member of staff should have been present, the Senior then asked a member of staff to stay in the quiet lounge.

However, when accidents and incidents occurred, such as falls or people became unwell, these were reacted to appropriately by staff. Staff told us they knew the action to take in an emergency and gave examples of when they had acted on concerns for people’s well-being. A relative told us, “The home lets me know of any issues quickly, for instance if [person’s name] falls and hurts [themselves], a doctor or paramedic is called. They've been very responsive and helpful in those situations."

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported to have safe and comfortable admissions into the service. Initial assessments were completed to ensure the service was able to meet their needs. People were able to look around before making a decision about moving. A new admission took place during our inspection, and we observed the person was made welcome and comfortable, staff introduced themselves and asked about the person’s preferences and choices which the staff supported and respected. Relatives also felt staff supported good transitions. A relative said, “Staff keep [person’s name] safe, and supported us through a difficult time.” Another said, “We were advised from the start about how [person’s name] would be looked after and are kept well informed.”

People were supported to access other services when required. People told us they saw the doctor when they needed to. A person said, “They want to know if I am feeling well. They get the doctor if I need it.” Another said, “They do my nails and toes which I like.”

Feedback from professionals confirmed the service operated safe systems and pathways which met people’s needs. A professional told us, “Staff there do pick up on any resident’s changes in health and respond in a timely manner…They appear to action any referrals I complete.” Another told us, “The care staff and management have identified changes in my clients’ health and sought the most [appropriate] support to meet their needs."

The provider did not always concentrate on improving people’s lives or protecting their right to live in safety, free from avoidable harm. We observed unsafe moving and handling practices at the service during our inspection which we referred to the local authority safeguarding team. These unsafe practices had not been identified as safeguarding concerns by the provider. We brought this to the provider’s attention who told us they would take action to update staff’s moving and handling practices to ensure it was safe.

However, the provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. People told us they felt safe at the service. A person said, “Yes, I am happy here.” Another said, “They say, ‘Are you comfortable?’” Relatives confirmed they felt people were safe at the service. A relative said, “The home makes [person’s name] feel safe… [person’s name] likes being there and is well looked after.”

There was an up-to-date safeguarding policy and procedure which was followed. Referrals were made to the local safeguarding team, and notifications were submitted to Care Quality Commission as required.

Staff were trained and knew the signs of potential abuse and felt confident to escalate any potential concerns within the service as well as to outside agencies. Staff comments included “You need to make sure people’s rights are protected and they are not abused in any way.”, “If you suspect anything, you must report it. Abuse can be physical, mental, emotional, financial – it takes lots of forms.” And “We talk about [safeguarding] in supervisions and meetings.”

The provider had applied for Deprivation of Liberty Safeguards (DoLS) with the local authority to deprive some people of their liberty where required. This is a necessary legal procedure for when a person who lacks capacity to consent to their care and treatment requires restrictions in order to keep them safe from harm.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe and supportive.

For example, staff did not support people safely to mobilise and did not follow people’s risk mitigation and planned care. We observed a person was drag-lifted into a better seating position which put the person and the staff at risk of injury. We received negative feedback from a relative about moving and handling practice. They told us, “[Person’s name] was put into a hoist, it wasn’t explained to [them] what was happening, and [they were] petrified, but this has got better.” We observed staff used the incorrect sized sling when they supported a person to transfer to a chair using a hoist. The person was distressed throughout the process and was placed at risk of discomfort and potential injury. The person’s care plan also stated they should have a pressure cushion to reduce risk of pressure damage to their skin, but this was removed from the seat before the person was transferred there. We raised this with the provider who told us staff would be re-trained in moving and handling practices.

Some risks for people were not assessed and there was not always detailed guidance in place for staff to follow to ensure risks were mitigated such as risk relating to constipation. We found instances where staff recorded people had not had a bowel movement for between 3 and 5 days. People had not received sufficient treatment to resolve this in a timelier manner.

Risks in relation to people’s emotional well-being and who may express themselves in a way that might pose a risk to themselves, or others were not always assessed. There was not always detailed guidance in place to support staff to manage and mitigate these risks. A relative told us, “There is a way of approaching [person’s name] and not everyone has the knack, but on the whole, they are good.” Staff gave examples of different ways they supported people’s emotional well-being, however without guidance in place there was a risk that people would not receive consistent, effective support from newer staff or agency staff.

People and relatives had been involved in developing people’s care plans. A relative told us, “I am involved in everything. I was invited into the office to go through [person’s name’s] care plan and was happy with it. If anything needs changing, [deputy manager] emails me."

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

For example, we found there had been some issues with washing facilities. There were 4 bathrooms but only 1 was fit for purpose and in safe or effective working order. We fed this back to the provider who took action to resolve the issues with 2 of the bathrooms and told us further enquiries were being made into the third bathroom for renovation.

Information displayed for people was not always kept up-to-date to help them orientate to time and place. The wall planner contained incorrect information about the week and activities available for people. People’s bedroom doors were coloured and some had pictures outside to help people orientate to their bedrooms. The deputy manager told us they planned to put more in place to further support other people to identify their rooms. Other communal areas such as toilets had pictures to help people identify their use.

Staff were knowledgeable about how to keep the environment safe for people and were aware of the importance of functional equipment which was routinely checked by the maintenance staff. However, equipment staff used within the home was not always utilised safely to mitigate risks to people. For example, we observed staff had supported a person to mobilise with a wheelchair with a missing footplate. However, people who mobilised themselves through the use of walking aids had these close at hand throughout the inspection. A person said, “It’s in good working order, no problem.”

The home environment was kept safe. Fire risks had been assessed, equipment to mitigate the risk and to support safe management of evacuation were maintained within the service. A fire inspection had taken place in the service, all but 1 remedial works had been completed for which the provider had been granted an extension during our inspection.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

People told us they thought there was enough staff day and night, and that they were kind. However, feedback from relatives, staff and professionals was mixed about the staffing levels. A relative said, “There are shortfalls in staffing, especially in management, activities, and even care staff have dropped off.” Another said, “Not always but some days they appear to be short staffed.” Staff told us they felt there were enough staff during the day but not at night. A professional shared, “I have heard [staff] mention lack of staff on numerous occasions.” There had been no recent calculations to review people’s dependency levels to ensure the allocated staffing were sufficient. However, we observed staff were responding to people’s needs in a timely manner during the inspection and people appeared to have their needs met. We shared the mixed feedback about staffing with the provider who told us they would look into the staffing levels following our inspection.

Staff had been recruited safely with appropriate checks and references in place. Not all staff training was up to date, but the provider had begun to address this prior to our inspection. Several staff came in for different courses during the inspection. The provider was also in the process of ensuring staff supervision was up to date.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. For example, we observed slings hanging in bathrooms and toilets and staff were using the same slings between different people. We raised this as an infection control risk with the provider; the deputy manager told us this was on their list of concerns to address.

Domestic staff told us they sometimes ran low or ran out of some stock. On the day of our assessment there were no white refuse bags. We discussed this with the provider and the deputy manager; they agreed a new system during our inspection to ensure stock was maintained.

However, the home appeared clean. People told us they liked the environment and thought it was clean. A person said, “It smells nice here.” A relative commented, “[Persons name’s] clothes are always clean and ironed and their room is spotless.” Staff were knowledgeable about how to prevent the spread of infections. We observed staff followed appropriate infection control procedures such as wearing personal protective equipment and professionals also confirmed this in their feedback.

The provider did not always make sure that medicines and treatments were safe and met people’s needs. Stock and storage of medicines had not always been managed safely. We found a person’s anticipatory medicines, prescribed in the event of their health deterioration, were out-of-date during our inspection. There was a potential risk that the person’s condition would not be managed if they required these medicines. A senior carer took immediate action to return the out-of-date medicine and ensure in-date medicine was in stock for the person. Medicine bottles did not have the open dates recorded on them. An open date is to assures staff that medicines being used maintain maximum effect within particular timeframes. Protocols for ‘as required’ medicines were not being kept consistently, some were recorded on paper and some were on the online system. This meant staff may not always be able to access guidance they required. Medicines were not always recorded in line with best practice. For example, reasons for giving ‘as required’ medicines and its effect were not always recorded, and records were not consistently completed for the administration of people’s prescribed creams.

However, people told us they got their medicines on time. A person said, “I get them when I need them.” A relative told us, “The seniors know what medications [person’s name] is on, and how [person’s name] is getting on."