Yew Tree Cottage Residential Home is registered to provide care and accommodation for up to five people. The service specialises in the care of older people. At the time of this inspection, there were five people living at the service.

At the last inspection the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good:

People remained safe at the service. People told us there were sufficient staff on duty to meet their needs and to spend time socialising with them. Recruitment procedures were safe. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely and as prescribed.

People continued to receive effective care. Staff received training to ensure they had the skills and knowledge required to effectively support people. People’s healthcare needs were monitored by staff. People said they had access to healthcare professionals when needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People received support to eat and drink sufficient amounts.

The service continued to provide a caring service to people. People told us, and we made observations, that staff were kind and patient. People and staff referred to the service as being like an “Extended family” and spoke positively about all aspects of the service. People said they were involved in decisions about the care and support they received.

The service remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Staff understood the needs and personal histories of the people they supported to aid in delivering person centred care.

The service continued to be well led. People and staff told us the management within the service were open and approachable. The registered manager was actively involved in giving care and support to people. There were systems that monitored the health, safety and welfare of people at the service.

Further information is in the detailed findings below.

This inspection was unannounced and took place on 29 January 2016.

Yew Tree Cottage Residential Home is registered to provide care and accommodation for up to 5 people. The home specialises in the care of older people.

The last inspection of the home was carried out in May 2014. No concerns were identified with the care being provided to people at that inspection.

There is a registered manager in post. 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.

Before the inspection we had received concerns about some areas of the care provided. These covered people being spoken to in an undignified manner and the management of medication. Following this inspection we did not find evidence that people were spoken to in an undignified way and the current management of medication was safe.

We found the registered manager had not notified the Care Quality Commission of an accident in the home resulting in an injury which meant the person required medical intervention. They agreed to review the Care Quality Commission Guidance on statutory notifications and ensure all notifications were forwarded in future.

People living at Yew Tree Cottage told us they were happy with the care and support provided. They said the manager and staff were open and approachable and cared about their personal preferences and kept them involved in decision making around their care. One person said, “I am very happy living here, it is not your own home but I am treated with respect and the staff are all really good.” Another person said, “I have been here a while and can make up my mind whether I am happy. I would leave if I wasn’t”

Everybody told us they felt safe living in the home, one person said, “Yes I feel safe if I didn’t I would say something. I have never heard a cross word or rebuke from anyone.” Another person said, “I have stayed in another home and I certainly feel safe here.”

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed staff took time to talk with people during the day. One person said, “You can do as you wish and nobody says otherwise, you are never expected to do anything you do not want to do.” A staff member said, “I look forward to coming to work, it is a pleasure working here it is like a family. You look after the residents the same way you would look after your own family.”

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people, for example they were receiving training in end of life care to help support the way they wished at the end of their life. The registered manager explained the home was working towards the Gold Standard Framework for end of life care. The Gold Standards Framework (GSF) is a nationally recognised framework to improve palliative care for people nearing the end of their life. All the staff understood people’s needs and were able to explain to us how they would care for each person on a daily basis.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care or a relevant representative. All care plans included the person’s written consent to care. Staff had comprehensive information and guidance in care plans to deliver consistent care the way people preferred. Staff wrote people’s daily diaries whilst sat with them and their opinions or comments would be included.

The registered manager had a clear philosophy for the home. The statement of purpose said their aim was, “To provide care through the use of

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service caring?

People who lived in the home were very complimentary about the staff. One person said “I can’t speak too highly about the manager and the staff. They are all very caring”. Another person said “The staff are excellent. They are lovely people and very good at caring for us”.

We saw staff treated each individual with dignity and respect. They spoke to people in a caring, polite and friendly manner. One person said “They always treat you as a human being and how they would expect to be treated themselves”.

We observed staff knocked on people’s doors and asked for permission before entering their rooms. All of the rooms had en-suite bath and/or shower facilities. This meant the environment supported people’s privacy and dignity.

People told us they received visits from friends and family on a regular basis. One person said “The staff put themselves out to welcome visitors and encourage them to come again”.

Is the service responsive?

People who lived in the home told us the manager and staff were always responsive to their needs and preferences. We spoke with all five of the people who lived in the home. They told us they were able to make their own daily living choices such as meal choices and activities.

One person said “The food is absolutely wonderful. It’s so varied and changes every day. We always get a choice of two meals and can ask for an alternative if we like”. Another person said “You can have company or privacy as you like. You can watch TV with others in one lounge, or sit quietly in the other lounge or in the conservatory, or watch TV in your own room”.

We observed people were allowed their own space but staff were on hand when they were needed. One person said “We can come and go as we wish. It’s like home from home”.

We saw care plans detailed people’s preferences regarding personal care routines, food, interests and social activities. One person said “I don’t need to look at my care plan, it’s so personal you just tell the manager and they always fit in with your preferences”.

Is the service safe?

People who lived in the home told us they felt safe and were well treated by staff. When asked if they had ever been treated badly or witnessed anyone else being treated badly, one person said “Gosh no, that would be absolutely foreign and nothing further from the truth”. Another person said “All the staff are lovely. There isn’t one problem at all. If there was I can approach the manager or any of the other care staff”.

We spoke with the manager and a member of staff on duty. They knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns. The manager told us they carried out relevant employment and criminal record checks when new staff were recruited. This helped protect people from the risk of abuse.

Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. We saw care plans included a range of individual risk assessments and actions for managing these risks. These included assessment of risk of falls, people’s skin integrity and nutritional risks.

People had call bells in their rooms and could wear them as pendants around their necks. This gave people added confidence when they went for walks and enabled them to call for staff assistance whenever needed.

There were arrangements in place to deal with foreseeable emergencies. The manager said staff received first aid training and were instructed to call out the paramedics if they had any concerns. Records showed quarterly fire drills took place.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people’s human rights. The manager said they had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the manager was aware when an application should be made and knew where to go if an application was required.

There were a range of health and safety policies and procedures in place. We saw evidence of current risk assessments for fire safety, portable appliance testing, premises and grounds. We observed the environment throughout the home looked in excellent condition.

Is the service effective?

People told us the manager and staff were effective in meeting their care and support needs. They were encouraged to be as independent as possible and were supported to achieve the best quality of life possible.

One person said “They look after you when you aren’t very well. They are very concerned for your welfare. The manager has terrific experience of what people need. They pick up on symptoms and are on the phone to the doctor with no hesitation”. Another person said “I’ve been looked after extremely well. This is a very friendly and supportive home”.

People’s care plans contained information about their support needs and personal preferences. People’s needs were assessed before they moved to the home to ascertain whether the service could meet their requirements. This included any health needs and equipment required to maintain their independence, such as mobility aids.

People were supported in promoting their independence and community involvement. They told us they regularly went out into the community either with their family members or with support from the staff. People went out for walks, shopping, coffee, the garden centre and trips to places of interest. One person said “We have little trips out. The girls (meaning staff) drive us. Sometimes all the residents go out together for a meal but it’s your choice you can stay home if you want. There’s no pressure, it’s geared to easy living here”.

Is the service well led?

The home was run as a family business by the manager and their spouse. The manager was registered with the Care Quality Commission as the registered manager for the service. The spouse dealt with all the administration and financial aspects of the service. Both lived on the premises and participated in the staff rotas.

The manager said as a small care home they monitored the quality of service mainly through their daily contact with people and their families. People told us “I would give the home 10 out of 10”; “The manager is absolutely first class” and “The owners are extremely nice and caring. They are here all the time”.

The manager told us they used to be a clinical nurse specialist and tutor in elderly care and dementia. They were an active member of the care staff and supervised the other staff on a daily basis. The manager told us most of the staff had worked at the home for several years. This meant people were supported by a small experienced team providing a consist level of care.

A member of staff said they received practical in-house training from the manager including first aid and food hygiene. They also completed a rolling programme of distance learning modules. This included protection of vulnerable adults, equality and diversity, fire safety, administration of medicines and dignity and respect. We looked at the staff training matrix and this showed other members of staff had received similar in-house training.

There was a clear staffing structure in place with clear lines of reporting and accountability. The member of staff said they always received excellent support and appropriate advice from the manager.

At the time of our visit, there were four people living at the service. We met with each person. Everyone told us they were very happy with the care and support they received from the staff. One person told us "they're all so lovely". Another person said "nothing is too much trouble for the carers".

Staff were polite and considerate. People told us they were treated respectfully and with good humour. One person told us "some of them make me smile so much". Another person said "they're all so caring".

No one we spoke with had any complaints, but each person told us they would mention any concerns they may have with any of the staff if they needed to".

Each person told us they felt safe and happy at this service. One person said "I'm so glad I came here".

The manager had systems in place to check the quality of care being delivered and to make improvements where necessary.

At the time of the inspection there were four people living at the home. We were able to meet with everyone who lived at the home and one visitor. Everyone was very happy with the care and support they received. Comments included; “I’m very well looked after, it’s a home from home really” and “I couldn’t be happier with the care that is provided.”

People told us they were always treated with respect by the staff who supported them. Throughout the day we observed that staff interacted with people in a friendly and polite manner. One person told us “Staff are always kind and respectful.”

There was a medication policy and procedure which was available to all staff. Staff spoken with said they were aware of the procedure which made sure that all medicines were safely managed.

We looked at the personnel files of three members of staff. These gave evidence of a robust recruitment procedure which minimised the risks of abuse to people who lived at the home.

We observed that staff were competent and cheerful. All staff spoken with said that they enjoyed their job and felt they had the skills and experience to safely care for the people who used the service.

No one we spoke with had any complaints but all said they would be able to speak with a member of staff if they were unhappy with any aspect of their care. One person said us “I would complain if I needed to. There is no question that any issue would be sorted out.”

People we spoke with were very happy with the care that they received. Comments included; “You get everything you need and I’m well looked after,” “We are looked after wonderfully and nothing is too much trouble” and “I’m very content with everything.” Everyone felt that their care was tailored to their personal needs and wishes. All felt that they continued to be in control of the care that they received.

People who lived at the home told us that they continued to make decisions about all aspects of their day to day lives. People said that they were able to make choices about what time they got up, when they went to bed and how they spent their day. One person said “It’s a home from home, the staff just fit in with you.”

People said that they were able to discuss issues and make suggestions at anytime. One person said “They are always willing to listen to make sure you get the things you want.”

Everyone asked said that staff respected their privacy and were always sensitive when assisting with personal care. During our visit we observed that staff always knocked on bedroom doors and post was delivered to people unopened.

People told us that if they were unwell the manager was quick to access medical support on their behalf. One person told us “They are good at spotting any problems and get the doctor straight away.”

Everyone we asked said that they would not hesitate to speak with the manager or a member of staff if they were unhappy about any aspect of their care, or the staff who supported them. One person commented “The manager would sort out anything you weren’t happy with.” Another person said “I feel completely safe here and would always tell someone if something was worrying me.”

People were extremely complimentary about the staff who supported them. We were told that staff were “kind” “patient” and “always willing to help.”

People said that they never felt rushed and that staff responded quickly if they requested assistance. Throughout our visit we saw that staff were very attentive to people which ensured that they were always comfortable and had everything they needed.