Archived: Yew Trees

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. Staff were adhering to personal protective equipment (PPE) guidance and practices, and there was a space for staff to change before and after their shift.

Communal areas were well spaced and residents, and with support from staff they were encouraged to maintain social distancing. Clear plans were in place for those who were required to self-isolate. For those residents who struggled with isolation additional support was provided.

The provider had created a safe and dedicated visiting area to allow residents to see and speak to their friends and relatives. The room had divider screen and external door. The room was well-ventilated and cleaned between visitors.

Staff continued to support people to access healthcare, and arrangements were in place should residents need to attend, for example outpatient appointments safely.

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

Staff were trained in the protection of vulnerable adults and used their safeguarding policies and procedures to protect people from harm. The administration of medicines was safe. Staff were robustly recruited, and the provider undertook all required environmental checks. Any risks to people were assessed to protect their health and welfare.

People were supported to live healthy lives because they had access to professionals, a well-trained staff team and a choice of a nutritious diet. The service worked with other organisations to provide effective and consistent care. 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 were trained in equality and diversity and they respected people’s choices. Where people wanted, they could follow their religion of choice or maintain their relationships. People were treated as individuals which helped protect their dignity. People and relatives said staff were kind and caring.

The service responded to the needs of people by providing meaningful activities, having regularly reviewed plans of care and any concerns acted upon. Staff training enabled them to care for people at the end of their lives.

The registered manager attended meetings to discuss best practice topics and liaise with other organisations to improve the service. People and staff said managers were available and approachable. People, staff and relatives were able to air their views about how the service was run.

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 requires improvement (published 28 March 2019). 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 was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Since our last inspection a manager and deputy manager had been appointed. The manager was in the process of making an application to register with the CQC. Feedback from staff and visitors was positive about the management of the home. We were told the manager listened and acted upon their views. Staff felt supported in their role and said morale within the team had improved.

People’s medicines were not managed safely. Monitoring records used to help manage areas of risk to people were not always kept up to date and completed in sufficient detail. These areas needed to be improved to help keep people safe and maintain their health and well-being.

People and their relatives felt they were safe and well cared for by competent staff. Staff were seen to be respectful and supported people in a dignified and compassionate way. Opportunities were provided for people to take part in a range of activities. These were to be reviewed as part of the improvement planned for the home. Formal ways of involving people and their relatives were in place enabling them to share their views.

Suitable arrangements were in place to ensure the premises, equipment and hygiene standards were adequately maintained so that potential risks were minimised. The manager and provider monitored all areas of the service to help identify if improvements were needed. Where shortfalls had been identified, action plans were put in place to address these. The new manager was being supported to improve the quality of information being recorded.

We have identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to maintaining accurate and complete records. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Good (21 February 2018)

Why we inspected: This was a comprehensive inspection which was brought forward due to information of risk or concern we had received.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor the service through the information we receive, and future inspections.

The service was last inspected by the Care Quality Commission (CQC) on 3 July 2017 following which the service was rated overall as Inadequate and was placed in special measures. Services placed in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will inspect the service again within six months. This inspection was conducted to check if the provider had made significant improvements within that timeframe.

The provider sent us an action plan giving details of how they intended to address the requirements and make the necessary improvements. During this inspection we found that the action taken had addressed the findings in those requirements made.

Yew Trees is one of a number of care homes in Tameside owned by Meridian Healthcare Limited, part of HC-One Limited. The service is situated in the Dukinfield area of Tameside and is registered to provide residential care for up to 43 older people.

At the time of our inspection there were 36 people living at Yew Trees.

There was a registered manager in post at the time of the 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.

Care workers understood their role in keeping people as safe as possible and received appropriate training in safeguarding adults.

At the time of inspection medicines were safely managed.

Staffing levels were sufficient at the time of the inspection to meet the needs of people who were cared for and supported by the service.

Risk assessments were in place to minimise the potential risk of harm to people during delivery of their care.

There was a robust recruitment and selection system in place to minimise the risk of unsuitable people being employed to work in the service.

People were supported to participate in activities that encouraged physical interaction, such as light exercise, and sensory stimulation, such as participating in sing-a-longs, doing jigsaws and reminiscence for people living with dementia, such as use of ‘flash’ cards, photographs and pictures.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant that people who may lack capacity were being appropriately supported to make their own decisions whenever possible.

Staff were provided with relevant training and had access to online information and support. Staff confirmed that the training they received was appropriate and supported them to carry out their job roles effectively. Training also included Person Centred Approaches to Dementia Care giving staff a deeper and clearer understanding of how to support people living with dementia.

At the last inspection in July 2017 we rated the well-led domain as 'inadequate' as we found the management of the service was not, at that time, well-led and staff lacked clear management leadership. At this inspection we found the provider had taken action and was now meeting the legal requirements. Although we saw improvement had been made, we have not rated this key question as 'good', to improve the rating to 'good' would require a longer term track record of sustainable good practice.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Yew Trees is registered to provide accommodation and personal care for up to 43 people. At the time of the inspection 41 people were using the service. People who used the service were mostly living with dementia.

There was a new manager who had been in post since March 2017. There were in the process of registering with us. 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 were not receiving care that was safe as there were insufficient suitably trained staff to meet their needs in a safe way. Staff had not received adequate training and support to meet the complex needs of people who used the service.

People were not always safeguarded from abuse as some staff did not recognise that people were at risk of abuse through acts of omission and unplanned restraint. Risks of harm to people were not always assessed, monitored and managed to maintain people's safety.

The principles of the Mental Capacity Act 2005, were not being consistently followed to ensure that people who lacked mental capacity were supported to make decisions which were in their best interests. People were at risk of being deprived of their liberty as some restrictions in place for people had not been agreed through the Deprivation of Liberty Safeguard procedures.

The meal time experience did not support people to eat and drink sufficient amounts to maintain a healthy diet. People who required extra support with eating and drinking did not always get it due to a lack of staff and suitable choices of food that met their individual assessed needs.

People did not always receive the health care advice they needed in a timely manner. Some people would have benefitted from health care support to ensure their emotional and psychological needs were met.

People were not always treated with dignity and respect as staff did not have the time to spend with them. People's personal care needs were not always met and they were not receiving care that met their individual assessed needs and personal preferences.

People were not offered hobbies and activities that met their individual needs. There was a lack of physical and sensory stimulation to meet people's needs in relation to their dementia.

The systems the provider had in place to monitor and improve the quality of the service for people were ineffective. People's concerns and complaints had not been acted upon to ensure an improvement in people's experience at the service.

People's right to privacy was upheld and staff spoke to people in a kind and caring manner.

People's medicines were stored and administered safely.

The provider employed new staff using safe recruitment procedures that ensured staff were of good character and fit to work with people.

We found the provider obtained consent from people who used the service before they provided care and support. When a person had limited capacity to make an informed choice or decision, relatives and other relevant healthcare professionals were involved so that decisions were made in the person's best interests.

Care plans and risk assessments were in place for each person and these were reviewed regularly to ensure that staff provided appropriate care.

The manager and staff confirmed that they had good working relationships with visiting health care professionals.

The provider had effective recruitment and selection processes in place.

We found from our observations during our visit and from the records looked at, that the registered manager was able to demonstrate to us that there were sufficient numbers of suitably qualified staff on duty.

The provider undertook audits to identify any risks or areas that required improvement. Where actions were identified, the provider took appropriate action.

From speaking with the manager and staff it was demonstrated that they had a good knowledge and understanding of people's needs and how best to meet those needs. During our visit we heard staff speaking with people respectfully and politely. We saw staff supporting and assisting people at a pace that was unhurried and met their needs.

Each person using the service had a care plan in place and this was being reviewed on a monthly basis or sooner should the need arise.

We found everywhere to be clean, tidy and comfortably furnished with no unpleasant smells detectable.