Yewtree Care Limited t/a Yewtree Nursing Home

Yewtree Nursing Home is a residential care home providing personal and nursing care for up to 40 people with various support needs, including brain injury, learning disability, physical and/or sensory impairment. At the time of our inspection there were 31 people using the service. The home is set in easily accessible grounds and consists of one adapted building.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff enabled people to access specialist health and social care support in the community. Staff supported people to take part in activities. One person said, “I feel very pleased to have landed here and I wouldn’t want to be anywhere else.”

Right Care

People received kind and compassionate care. Staff understood and responded to people’s individual needs. Where appropriate, staff encouraged and enabled people to take positive risks. Staff knew the best way to communicate with people.

Right Culture:

People led inclusive lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. People received good quality care, support and treatment because trained management and staff could meet their needs and wishes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 July 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 18 and 19 May 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yewtree Care Limited t/a Yewtree Nursing Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Yewtree Nursing Home is a residential care home providing personal and nursing care to 31 people with various support needs, including brain injury, learning disability, physical and/or sensory impairment. The service can support up to 40 people. The home is set in easily accessible grounds and consists of one adapted building. There were a range of communal areas for people to enjoy.

People’s experience of using this service and what we found

The provider and registered manager had taken action in response to the findings at our last inspection, but further improvement was needed to ensure people’s safety. Whilst the quality of the care plans had improved, we found gaps and inconsistencies in some records which could mean people were placed at risk of harm.

The registered manager had shared the responsibility for auditing the service amongst the senior team. The quality and frequency of the audits had improved, and they had been effective in identifying and driving improvement in many areas. Further work was needed, however, to ensure people received consistently safe and effective care.

Staff shared mixed feedback about the culture of the service. Whilst some staff were very happy in the roles and with the support they received, others felt communication needed to improve and did not always feel confident to approach management with issues or concerns.

The home was clean, and staff had been trained in infection prevention and control. There were clear measures in place to manage the risk of the COVID-19 pandemic. We signposted the registered manager to guidance on the wearing personal protective equipment (PPE), specifically face masks.

The provider and registered manager had collaborated openly with a safeguarding enquiry into wound care practice at the home, but had not fulfilled all the requirements under duty of candour. We have made a recommendation about this in the report.

Most people spoke positively about their care and experiences of living at the home. People told us staff were caring and supportive. One person said, “Very good and caring staff here. I have no complaints at all”. A relative told us, “I can’t sing their praises enough, beautiful home, atmosphere is brilliant, all having a good time.”

Since our last inspection, more activity staff had been employed. People cared for in their rooms received regular one to one time and support which made a positive difference to their wellbeing. People spoke positively about the activities on offer and we observed people participating with enthusiasm.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The recording of best interest decision making had improved since our last inspection.

Staff were skilled in supporting people at the end of their lives. Relatives spoke highly of the care their loved ones had received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 11 March 2020). The service remains rated Requires Improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to wound care and infection prevention and control. As a result, we undertook a focused inspection to include the safe key question. We also reviewed the effective, responsive and well-led key questions which were rated as requires improvement at the last inspection.

We reviewed the information we held about the service. No areas of concern were identified in the caring key question. We therefore did not inspect it. The rating from previous comprehensive inspections for that key question was used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report. You can see what action we have asked the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

New people were not being admitted to the home during the coronavirus outbreak. The provider had a business contingency plan in place and was in regular contact with the GP surgery and community nurses.

People were being supported to isolate safely in their rooms. Social distancing was promoted in communal areas with posters on the walls and spacing markers on the floors.

Staff wore appropriate personal protective equipment (PPE) for all contact with people. Staff were trained to wear and dispose of PPE safely and there were plentiful supplies around the home.

There were activity coordinators providing one to one social support to people while they isolated. People were supported to have telephone and video calls with family and friends.

There was a visitor policy in place with a booking system to manage visits safely. A dedicated room was available for visits, this had a clear screen to act as a barrier for infection control when people met. There was an enhanced cleaning schedule through the day and in between visits.

Yewtree Nursing Home is a residential care home providing personal and nursing care for up to 36 people with various support needs, including brain injury, learning disability, physical and/or sensory impairment. At the time of our inspection, 36 people were in residence. The home is set in easily accessible grounds and consists of one adapted building. There were a range of communal areas for people to enjoy.

People’s experience of using this service and what we found

Feedback from people was largely positive. One person told us, “I'm very happy here”. Another said, “You couldn't better the staff”. We found, however, that people who were cared for in their rooms lacked social contact. Although they had contact and conversation with staff when care was being provided, there was little time for social contact or activity. Following our feedback, the provider took action to increase the staff time dedicated to providing one to one activity and we will assess the impact of this on our next visit.

Action was needed to improve the systems and processes in place to monitor and improve the service. We found audits had not always been effective at identifying issues, ensuring problems were resolved or sustaining improvements.

While staff knew people well and understood how they wished to be supported, care records did not always contain complete or up to date information to reflect the person’s current needs.

The registered manager had only recently started to carry out best interest decisions when a person lacked capacity to make their own choice. We identified a missing capacity assessment and best interest decision for one person where bed rails were in use. Further time is needed to embed changes in the approach to, and recording of, decisions under the Mental Capacity Act (MCA) to ensure people’s rights are respected.

People had given their consent to the use of CCTV in communal areas. We have made a recommendation about making signage more apparent to alert visitors to its use.

People were looked after by kind and caring staff who knew them well. People with capacity were encouraged to be involved in decisions relating to their care and were treated with dignity and respect.

People's communication needs were identified and planned for, but the registered manager was not aware of the Accessible Information Standard (AIS). We have made a recommendation about this in the report.

People expressed confidence they could raise any issues or concerns with any member of staff or the management team and these would be addressed.

People could spend the rest of their lives at the home, if their needs could be met and this was their wish. Staff worked proactively with healthcare professionals to facilitate this.

People spoke positively about the staff who supported them and had confidence in their skills and experience. Staff had regular supervisions and an annual appraisal. People enjoyed the food and were able to make suggestions for changes to the menu. Snacks and drinks were readily available throughout the day.

Care staff were well informed about risks to people's health or wellbeing and knew how to deliver their care safely. Staffing levels were enough to meet people's needs. Medicines were managed safely. The home was clean, and staff had been trained in infection prevention and control. Lessons were learned if things went wrong.

People had access to a range of healthcare professionals and support. Premises were suitable and comfortable and met people's needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Yewtree Nursing Home is registered to provide accommodation and personal and nursing care for up to 40 people. At the time of the inspection there were 33 people living at the home ranging in age from 56 to 100 years.

There was a mix of double and single bedrooms. Twenty one bedrooms had an en suite bathroom which consisted of a shower, toilet and wash basin. There was a large living room which was also used as a dining room plus other communal areas which people used for activities or to have meals. There was also a separate activities room. A passenger lift was provided in two areas so people could access the first floor.

The service did not have a registered manager. 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. The provider had recruited a new manager who was in the process of applying for registration with the Commission. The provider had notified us of these changes.

At the previous inspection of 3 and 4 May 2016 we found the provider had not ensured people received safe care and treatment. This included the maintenance of safe premises and procedures for supporting people who had problems swallowing food. We made a requirement for this regulation to be met. The provider sent us an action plan of how this was to be addressed and at this inspection we found the regulation was met.

At the previous inspection of 3 and 4 May 2016 we found the provider had not ensured staff received adequate support and supervision to enable them to carry out their duties. We made a requirement for this regulation to be met. The provider sent us an action plan of how this was to be addressed and at this inspection we found the regulation was met.

At the previous inspection of 3 and 4 May 2016 we found the provider had not ensured care and treatment was only provided with the consent of people and where people lacked capacity had not acted in accordance with the Mental Capacity Act 2005. We made a requirement for this regulation to be met. The provider sent us an action plan of how this was to be addressed and at this inspection we found the regulation was met.

People and their relatives said they were satisfied with the standard of care provided at the home. For example, one person commented, “I would recommend this place if you need care.” Health and social care professionals also said the service provided a good standard of care.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed risks to people were assessed and the action to be taken to mitigate those risks. These assessments and care plans were reviewed and updated at regular intervals to ensure people’s changing needs were met.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

Medicines procedures were safe.

The home was found to be clean and free from any odours.

Newly appointed staff received an induction to prepare them for their work. Staff had access to a range of training courses and said they were supported to attend training courses.

There was a varied and nutritious menu where people could make choices. Steps were taken to ensure people had adequate food and drink.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

The environment and décor had greatly improved since the last inspection. Bedrooms had been refurbished and en suite bathrooms added. The home had ramped access for those with mobility needs. The décor and furnishing were of a good standard. The home was light and airy.

People were treated by staff in a kind and compassionate manner. People and their relatives described the staff as kind, respectful and as treating people with warmth and love. People were able to exercise choice and their privacy was promoted.

The previous report recommended the provision of activities should be extended. At this inspection we found there were a range of activities for people who were satisfied with this level of provision.

Each person’s needs were assessed and this included obtaining a background history of people. Care plans and assessments were comprehensive and showed how people’s needs were to be met and how staff should support people. Care was individualised to reflect people’s preferences.

The previous report recommended the complaints procedure was updated to include the correct details of the government ombudsman. At this inspection we found this had been completed. People and their relatives said they knew what to do if they wished to raise a concern.

A number of audits and checks were used to check on the effectiveness, safety and quality of the service which the provider used to make any improvements. These included audits by external consultants, medicines audits and health and safety checks. The provider sought the views of people, professionals and relatives as part of the quality assurance process.

Yewtree Nursing Home is registered to provide accommodation, personal care and nursing care for up to 40 people. At the time of the inspection there were 30 people living at the home ranging in age from 56 to 100 years. These people had needs such as a learning disability, Parkinson’s disease and dementia.

There was a mix of shared and single bedrooms, 16 of which had an en suite facility. There was a large living room which was also used as a dining room plus other communal areas which people used for activities or to have meals. A passenger lift was provided in two areas so people could access the first floor.

The service had a registered manager. 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.

At the time of the inspection there was a programme of refurbishment taking place. Steps had been taken to reduce any disruption caused by the building works by the use of screening. Upon entering the building at the main entrance people and visitors needed to duck to avoid hitting their head on a low ceiling in a corridor leading from the entrance hall. This was also the case in the hallway immediately above the hall on the first floor. The provider told us this was being addressed as part of the ongoing building works. Measures were taken to ensure the equipment and premises were safe but it was unclear how the provider was maintaining safe hot water temperatures to prevent scalding to people and for reducing the risk of legionella.

The garden at the front and rear of the home was not well maintained and there was a risk of people tripping on the long grass.

Medicines procedures were generally safe with the exception there was no guidance for staff to follow of when a person needed an ‘as required’ medicine. The main office was used to store medicines on a temporary basis as the treatment room was undergoing refurbishment. Staff were trained in medicines but this did not involve a formal assessment which involved observation of their competency to do so.

The home was found to be clean and was free from any odours.

Staff received formal supervision of their work but this was infrequent.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Whilst the provider made DoLS applications to the local authority for people who were unable to consent to their care and treatment and whose liberty was restricted, assessments of capacity were not carried out. This meant there was a risk people may have had an application to deprive them of their liberty when it was not appropriate.

There was a varied and nutritious menu where people could make choices. Steps were taken to ensure people had adequate food and drink but the monitoring of those who had difficulties in swallowing was not always effective.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm. Further information needed to be included in some care plans to highlight to staff how people were safely bathed.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

Newly appointed staff received an induction to prepare them for their work. Staff had access to a range of training courses and the registered manager and provider were aware of those areas where additional training was needed.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

Staff were observed to treat people with kindness and dignity. People were able to exercise choice in how they spent their time. Staff took time to consult people before supporting them and showed they cared about the people in the home.

Each person’s needs were assessed and this included obtaining a background history of people. Care plans showed how people’s needs were to be met and how staff should support people. Care was individualised to reflect people’s preferences.

An activities coordinator was employed for five days a week from 8am to 2pm each day but only provided activities for one to two hours each day. Staff and people commented there were insufficient activities for people and we have recommended this is improved.

The complaints procedure was available to people but needed to be amended as it had the incorrect address and contact details for the ombudsman.

A number of audits and checks were used to check on the effectiveness, safety and quality of the service which the provider used to make any improvements. These included audits by external consultants. We identified that where these audits identified improvements were needed that action was not always taken.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Some people living in the home had complex needs and were not able to tell us about their experiences. We observed people to be treated with kindness and respect and being given choices throughout the day and people who we were able to speak with said they were happy in Yewtree Nursing Home. One said "I am happy here, the staff are very helpful and treat me with respect and I'm not stressed in any way". The visiting GP told us "It is a super home with amazingly good care. It is clean and the atmosphere is nice, staff are friendly and our care calls are always appropriate".

Relatives told us they were satisfied with the quality of care and confirmed that people's needs had been assessed before they agreed to move and that they had been involved in the admission process. The plans of care we saw were person centred, regularly reviewed and included up to date risk assessments.

Medicines were administered safely and as prescribed by competent nurses.

The recruitment and selection processes in place ensured that all staff had appropriate checks before starting work and undertook relevant training.

Systems were in place to monitor the quality of the service. We found that the provider was responsive when issues were raised and lessons were learnt from incidents.