Yew Tree House is a residential care home for nine adults. People living at the home have a range of sometimes complex needs including learning and physical disabilities. There are two floors; people with physical disabilities live on the ground floor. At the time of our inspection there were nine people using the service. At the last inspection on 22 May 2015, the service was rated Good. At this inspection we found the service remained Good.

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.

This inspection took place on 22 May 2015 and was unannounced. Yew Tree House provides accommodation and personal care for up to nine people with a learning disability or autistic spectrum disorder. There were nine people living at the home at the time of our inspection. The home comprises of nine bedrooms and a communal lounge and dining room with a secured back garden.

A registered manager was in place as required by their conditions of registration. 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 and associated Regulations about how the service is run.

People were cared for by staff who had been trained and supported to work with people with complex physical and emotional needs. Staff were caring and compassionate towards people and were able to adapt their approach to communicate with people who had communication difficulties. The care and support provided by staff was focused around people’s individual needs. People’s care records provided staff with guidance about their independence levels, achievements and goals as well as the support they required with day to day activities. People’s privacy, dignity and decisions were respected and valued by staff.

Some people helped to plan and prepare the meals. They told us they enjoyed the meals and snacks provided. There were individual and group activities provided in the home and also in the community. The home had good links with the local community. People’s medicines were ordered, stored and administered in a timely and appropriate manner. When required, people were referred to specialist health care services. The home maintained good links with the local GP surgery.

Staff were appropriately recruited and trained to carry out their role. There were sufficient staff available to meet people’s needs. The staffing levels were flexible to allow some people to have individual support if they became unwell. Staff had received regular formal and informal support and were supported with their personal development.

The registered manager kept up to date with local and nationally recognised practices and legislation. The home had piloted new systems which helped to monitor people’s well-being. All complaints and concerns were acted on immediately. Any incidents or poor practices were reported, investigated and actions had been put in place to help eliminate it occurring again. Monitoring systems were in place to ensure the service was operating effectively and safely.

We were unable to ask people about their views of living in the home because of their complex communication needs. However, we spent time in the lounge observing people and seeing how staff interacted with them. We saw that staff understood people's communication needs and were able to support people to make choices about their daily living.

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.

We were unable to ask people about their views of living in the home because of their complex communication needs. However, we observed that staff understood peoples’ communication needs and were able to support people to make choices about their daily living. Care plans detailed what day-to-day decisions people had been assessed as able to make and what decisions staff would need to make in their best interest. Staff we spoke with showed that they had a clear understanding of involving people in day-to-day decisions about their care.

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.

We did not seek feedback from people living at the home at this responsive review.

We observed people in the home. They were calm and settled helping out in tasks or doing activities. People were supported by staff to go out in their local community or for a trip to a community farm. Staff were interacting positively and calmly with people.

A person told us that the care they received reflected their wishes and aspirations. They said staff helped them to stay well and healthy. We observed staff supporting people in a range of activities including access to the community. One person told us they liked to go for walks, swimming and shopping. Others enjoyed using local social facilities. A person told us they enjoyed the food and they helped to choose meals to go on the menu. They liked to help out with the cleaning and cooking. A person said they liked the staff and could talk to them about their worries or concerns. People were being involved in the interviews of new staff. A person said they had house meetings where they talked about what activities they would like to do.