Yew Tree Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 18 people, including older people and people living with dementia.

We inspected the service on 30 May and 5 June 2018. The first day of our inspection was unannounced. On the first day of our inspection there were 11 people living in the home.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

In October 2015 we conducted our first comprehensive inspection of the home and rated it as Good. On this inspection we were pleased to find overall service quality had been maintained and in some areas improved. The rating remains as Good.

Staff worked well together in a mutually supportive way and communicated effectively, internally and externally. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. There were sufficient staff to meet people’s care and support needs without rushing, although the registered manager agreed to keep staffing levels under careful review if occupancy increased in the future. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach. People were provided with food and drink of good quality that met their individual needs and preferences. The physical environment and facilities in the home reflected people’s requirements. People were provided with physical and mental stimulation appropriate to their needs.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

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 home supported this practice. At the time of our inspection the provider had been granted Deprivation of Liberty Safeguards (DoLS) authorisations for one person living in the care home and was waiting for a further three applications to be assessed by the local authority.

The registered manager was well known to, and respected by, everyone connected to the home. Throughout our inspection she demonstrated an admirably open and reflective approach. A range of audits was in place to monitor the quality and safety of service provision. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. There was evidence of some organisational learning from significant incidents and events. Formal complaints were rare and any informal concerns were handled effectively. She had taken action to address the area for improvement identified at our last inspection.

Yew Tree Residential Care Home is registered to provide residential care for up to 18 older people, including people living with dementia.

We inspected the home on 6 October 2015. The inspection was unannounced. There were 18 people living in the home at the time of our inspection.

The service had a registered manager (the ‘manager’) in post. The manager was also the registered provider (the ‘provider’) of the service. A registered manager is a person who has registered with CQC 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection the manager had submitted DoLs applications for two people living in the home and was waiting for these to be assessed by the local authority.

People felt safe living in the home and were cared for by staff in way that met their needs and maintained their dignity and respect. Staff understood how to identify, report and manage any concerns related to people’s safety and welfare.

Staff had developed strong relationships with local healthcare services which meant people received any specialist support required. Medicines were managed safely.

Food and drink were provided to a good standard and work was in hand to improve menu choices at lunchtime.

People and their relatives were involved in planning the care and support provided by the home. Staff listened to people and respected their needs and wishes in the way they delivered care. Staff understood the issues involved in supporting people who had lost capacity to make some decisions.

There was a lack of a structured approach in the provision of activities in the home which meant, at times, there was a lack of stimulation and occupation for some people.

People and their relatives could voice their views and opinions to the manager and staff. The manager listened to what people had to say and took action to resolve any issues. The provider reviewed untoward incidents and concerns to look for opportunities to improve policies and practices for the future. There were systems in place for handling and resolving complaints.

Sound recruitment practice ensured that the staff employed were suitable to work with the people living in the home. Staff received training and support to deliver a good quality of care to people and an active training programme was in place to address identified training needs.

There was a friendly, homely atmosphere and staff supported people in a kind and caring way that took account of their individual needs and preferences.

The manager demonstrated an open management style and provided strong and inspirational leadership to the staff team. The provider regularly assessed and monitored service quality.

Summary

Below is a summary of what we found when we inspected Yew Tree Residential Care Home on 16 April 2014.

The summary is based on our observations during the inspection, speaking with people who used the service, and the staff who supported them. We spoke with four staff members, the registered manager and three people who used the service during our inspection. We also looked at four care records and other documentation.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

During our inspection on 22 October 2013, we found care and treatment was not planned and delivered in a way that was intended to ensure people’s safety and welfare. The provider had sent us an action plan which addressed our concerns.

We observed staff did not always carry out manual handling practices in line with the provider’s policies and procedures which meant people and staff were at risk of injuring themselves. We also noted when we looked at people’s care records there were a number of incomplete risk assessments. This included incomplete risk assessments for nutrition, the use of bed rails, medication and management of pain. This meant that the person was at risk of receiving inappropriate care. We looked at consent forms for treatment and found that in some people’s records these had not been completed. This meant that people were at risk of receiving care that they had not agreed to.

During our inspection on 16 April 2014, we reviewed people’s care records and found appropriate risk assessments were now in place and that consent to treatment forms had been completed. We also found that moving and handling techniques had been reviewed and that all staff had undertaken formal training on 22 January 2014. This was confirmed by records we looked at and staff we spoke with.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law protecting people who are unable to make decisions for themselves.

We found people were cared for in safe and accessible surroundings that supported their health and welfare. The premises had been maintained and appropriate safety checks had been undertaken by qualified professionals. This ensured that people, staff and visitors had been protected against the risks of unsafe or unsuitable premises.

Is the service effective?

There were details available for people who lived in the home and their relatives should they need to access an advocacy service so they could have additional support.

People’s health and care needs were assessed and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. People we spoke with told us: “The staff are stars and have been very caring and have taken their time to support me."

People who used the service, their relatives, friends and other healthcare professionals involved with the home completed an annual satisfaction survey. Where concerns or comments were raised these were addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. One person told us: “I had a query and the manager sat and listened and did what I asked. I feel staff listen to what I say and try their best to accommodate my wishes."

The provider had a complaints policy in place and information was displayed around the home should people who lived there or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction to their role and were able to tell us how they would escalate any concerns raised. We spoke with the manager who informed us that there had been no formal complaints since our last inspection.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

Staff told us that they were clear about their roles and responsibilities. They told us they felt well supported and trained to safely do their job. One member of staff told us: “We have done so much recently, it has been great. It was really worthwhile going over manual handling techniques and doing the practical session, it was a good refresher.” We found that training plans were in place which ensured that staff had the appropriate skills to meet people's needs.

During our visit we spoke with two people, two staff members and the registered manager.

To help us to understand people's experiences we used our Short Observational Framework for Inspection (SOFI). SOFI allows us to spend time observing and helps us to record how people spend their time. We observed four people for an hour. We observed there was good interaction with people and staff supported people to take part in activities.

We observed the care people received and looked at three people's care records in detail. Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people.

We saw people were cared for in a clean environment and staff were aware of issues regarding infection control.

However we saw from the care plans and observations that on occasions people did not receive care which was appropriate to their needs. For example during our visit we observed moving and handling practices which presented a risk to people.

When we spoke with people they told us, “Marvellous place” and “Love it here.”

We knew the provider notified us of serious incidents appropriately.

Staff told us about providing a safe environment for people and were able to tell us how they would report any concerns about people's safety.

We spoke with four people who lived in the home. Some of the people were unable to tell us their experiences as they had dementia so we observed the care they received and spoke with their relatives. We saw people received support in a caring and kind manner and staff were aware of people’s individual needs.

One person we spoke with who lived at the home told us, “The staff have really looked after me well. Everyone is so kind and lovely.” They also said, “No one could have done anything better, I’m quite satisfied.”

We spoke with a person who was on a respite break, they told us, “I’m being very well looked after, actually, I’m being overly looked after.” They also told us, “I feel safe, they are doing a very good job.”

We spoke with two relatives who were visiting the home. One relative told us, “My wife has been very well looked after here. I have no concerns.” Another visitor told us, “The staff are always polite and courteous, they phone me if there are any problems and I can visit whenever I like.”

We asked one of the people who lived in the home if they liked the staff, they told us, “The girls are absolutely wonderful.”

On the day of the inspection, the provider/manager was on annual leave. Senior staff were left in charge of the home however the provider/manager contacted the home every day to make sure the home was running smoothly.

We spoke with several people who live in the home who told us, “I’m being very well looked after” and “I’m very happy here.”

Another person told us, ”The staff are very pleasant, we have a laugh. We have some really nice times here.”

A relative we spoke with said, “I rate this home very highly.”

Another relative told us, “I wouldn’t want Mum to live anywhere else. It’s spot on!”

We saw a ‘thank you’ card on the notice board sent by a relative which said, “It’s the best place that Mum could possibly be.”