What life is like for people using this service:

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.

This inspection took place on 19 January 2016 and was unannounced. Yew Tree nursing home provides accommodation and nursing care for up to 41 older people. There were 41 people who were living at the home on the day of our visit.

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 inspected Yew Tree Nursing Home and spoke with five people who lived at the home and with two relatives. We observed the care and support people received. We looked at their care files and other supporting documents. We had discussions with the registered manager and six staff about how people were being supported.

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.

When we visited the home we met with people who lived there, we also spoke with the registered manager, a nurse and some care workers. We were unable to speak with some people who used the service. This was due to their health problems. We used a number of different methods to help us to understand the experiences of people.

The people we spoke with told us that staff made efforts to maintain their privacy, dignity and respect. During our visit we observed staff making positive interactions with people.

We asked people about staff who provided their care. They told us they got on well with staff and that the delivery of care was what they expected to receive and had requested. We saw that people were quite relaxed, at ease with staff and comfortable within their environment. They said that they felt safe living in the home.

The home had enough staff employed to meet people’s needs. People told us that any requests they made to staff for additional tasks, were responded to promptly.

The registered provider had an appropriate system for assessing and monitoring the quality of service provision. We saw that numerous audits were regularly being carried out to assist with this process. People told us they knew how to make a complaint but they had not needed to.