The Yews Residential Care Home

The Yews Residential Care Home is a residential care home providing personal care and accommodation to up to 40 older people, some of whom may be living with dementia. At the time of inspection there were 30 people living at the service. The service is over two floors and has communal spaces for dining and relaxation.

We found the following examples of good practice.

COVID-19 screening was done before people entered the home and personal protective equipment (PPE) was provided.

The home had recently had an outbreak of COVID – 19 and was closed to non-essential visitors. People were supported to contact their relatives and friends through video calls and telephone calls and window visits during this time. During the outbreak essential care givers and the families of people receiving end of life care continued to visit, in line with Government guidelines.

At the time of the inspection the home had reopened to visitors. We saw that visiting was done in a safe way, to enable people to spend time with their loved ones and following government guidelines.

Enhanced cleaning schedules included regular cleaning of touch areas such as handrails and door handles. This reduced the risk of cross infection.

Staff received training in infection prevent and control and the use of PPE and handwashing. Staff’s competency and compliance in these areas was checked and staff were observed wearing PPE appropriately on the day of our visit.

Staff and people living in the service accessed regular testing for COVID-19, so that action could be taken swiftly if anyone developed symptoms or had a positive test result.

The infection prevention and control policy was up to date.

Proactive measures were in place to keep people and staff safe. People and staff had risk assessments in place to identify their individual risks associated with COVID-19.

We found the following examples of good practice.

• The service had a COVID-19 outbreak at the time of the inspection and was therefore closed to non-essential visitors. Upon arrival essential visitors were required to complete a COVID-19 questionnaire, have their temperature checked, asked to sanitise their hands and wear personal protective equipment (PPE). COVID-19 related guidance was also available to visitors.

• During the COVID-19 pandemic people were supported to maintain contact with their friends and family by pre-planned visits. An outdoor pod had been created to safely facilitate contact or people saw their loved ones through the window.

• The registered manager had regular contact with people’s relatives, friends and representatives to share information about people’s health, care and welfare needs.

• The provider had ensured staff had an ongoing supply of PPE and we saw all staff wore PPE in accordance with COVID-19 best practice guidance.

• Staff had received training in the prevention and control of infections. The registered manager completed regular observations and checks to ensure staff remained compliant with infection control standards. An infection control audit and daily walk around by the registered manager were completed to continually review infection control practice.

• The provider had a COVID-19 and business continuity plan, and associated risk assessments to mitigate risks. Both staff and people who used the service received regular COVID-19 testing and plans were in place for all to receive the COVID-19 vaccination.

• The registered manager was supportive to the staff team ensuring staff received ongoing opportunities to discuss their role and raise any concerns. All updated COVID-19 related guidance was shared continually with staff.

• Changes to communication systems such the staff handover, staff meetings and when and how staff took their breaks had been planned to reduce the risk of infection transmission.

• Additional cleaning of frequent touch points such as door handles and hand rails were completed. At the time of the inspection a deep clean of bedrooms and communal areas had started.

• People were isolating in their bedrooms and outside each bedroom there was a supply of PPE and waste management followed best practice guidance.

• The registered manager spoke highly of the staff’s professionalism, dedication and care during a very challenging and difficult time.

The Yews Residential Care Home is a residential care home providing personal care to up to 40 older people. At the time of inspection, 22 people were using the service.

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

People received safe care and were protected against avoidable harm, abuse, neglect and discrimination. Staff understood safeguarding and whistleblowing procedures and were confident to use them.

Risks to people’s safety were assessed and strategies were put in place to reduce the risks. The environment was safe for people to use and regularly maintained. A large extension to the building had recently been completed, and a programme of refurbishment was in place for the older part of the building.

The recruitment practices ensured only suitable staff worked at the service and staff were employed in sufficient numbers to meet people’s needs.

People’s medicines were safely stored and administered. Staff received training that enabled them to have the skills and knowledge to provide effective care.

Healthcare needs were met, and people had access to health professionals as required. People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

Staff treated people with kindness, dignity and respect and spent time getting to know them. People were supported in the least restrictive way possible. Care plans reflected people likes, dislikes and preferences.

An activities programme was in place and people were engaged with throughout the service.

People and their family were involved in their own care planning as much as was possible. A complaints system was in place and was used effectively.

The management team were open and honest, and worked in partnership with outside agencies to improve people’s support when required.

More information is in the detailed findings below.

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

Rating at last inspection: Good (report published 01/02/2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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

We last inspected this service in October 2015 and found the service to be compliant with the regulations.

The Yews Residential Care Home is a residential care service providing personal care for up to 27 older people, many of whom are living with dementia. The property is set in its own grounds in a quiet part of Alvaston, Derby. At the time of our visit, there were 21 people using the service.

The service has 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.

People using the service told us they felt safe and relatives felt their family members were safe. Staff understood their role in protecting people from potential harm and knew what to do if they had any concerns about the well-being of people. Potential risks to people had been assessed and were reviewed and updated to reflect people's current needs.

There were enough staff on duty to keep people safe and meet their needs. Staff had time to interact and socialise with people as well as providing personal care. Staff were safely recruited to ensure they were suitable to work in the service.

There were processes in place to ensure people received the medicines prescribed for them in a safe manner.

Staff received training and support that provided them with the knowledge and skills they required in their roles. We observed staff were confident and skilful in their interactions with people and talked with people as they supported them and put them at their ease.

People were supported to have sufficient to eat and drink and maintain a balanced diet. People had a choice as to what they ate and where. Where people had specific nutritional needs, these were assessed, monitored and reviewed on a regular basis in order to maintain their health.

We found the requirements to protect people under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had been followed. Records showed that the service monitored and reviewed authorisation to ensure people were not unlawfully deprived of their freedom. Staff understood the needs for people to consent to their care and respected people right to decline care and treatment.

Staff were kind and compassionate to people using the service and supported them to maintain their dignity and privacy. People and, where appropriate, relatives were involved in developing their care.

Staff were knowledgeable about the people they supported and provided care that was personalised. Care plans had been developed to focus on individuals and described their choices, decisions and preferences as to how they wanted their care to be provided. Care plans were reviewed regularly and in response to changes in people's needs and wishes.

Activities were available on a one-to-one and group basis. People and their relatives told us they could choose to participate in activities if they wished to.

There was a complaints procedure in place and people we spoke with felt confident their concerns would be listened to and acted upon.

People, their relatives and staff were afforded opportunities to be consulted and involved in the running of the service. The registered manager oversaw all aspects of the service. People and staff had confidence in both the registered manager and the provider.

The provider had systems in place to assess, monitor and improve the quality and safety of the service. This included audits, checks and regular surveys which gave people and their relatives the opportunity to comment on the quality of the service. The provider, registered manager and staff were committed to ensuring people were provided with quality care and we saw on-going improvements had been made as a result of this.

This is a summary of what we found-

Is the service safe?

Staff were trained and knew the needs of people using the service and how to meet those needs safely and as the person wanted. People's care needs were not always assessed and risks were not always identified. However staff spoken with told us how they asked people what support to provide to ensure they received the care they needed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People's nutritional needs were assessed and professional advice and support was obtained to ensure that people's needs were met in the most suitable way.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Only some staff had received training in understanding the relevance of this legislation. The manager and deputy manager had not been trained to understand when an application should be made and how to submit one. The provider should note that all relevant staff should receive training to ensure people receive the support they need.

People received their medication when they needed it and records were well maintained. Staff received the training they needed to administer medication safely.

Records indicated that audits to monitor the quality and safety of the service did not always take place regularly. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us they were happy with the care that they received and that their needs were met by staff. It was clear from our observations and from speaking with staff that they understood the needs of people using the service. One person told us. 'I haven't been here long but they (the staff) are lovely. When I need help they don't rush me they give me the time I need.'

Is the service caring?

People using the service were supported by kind and attentive staff. We observed staff showing patience and taking time to talk with people when they provided support. People told us they could choose how they spent their day. We observed people being able to eat their meals when they wanted to and we were told by people using the service they could eat in their room if they wanted to.

Is the service responsive?

Support plans did not always show how people wanted to receive their support and they were not always kept up to date and relevant. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People spoken with confirmed they received their care as they preferred it but not always as written in the support plan.

Is the service well-led?

Staff spoken with understood the standard of care expected of them by the provider, they spoke highly of the manager. The manager spent time speaking with people who used the service on a daily basis to ensure any concerns were dealt with promptly. Staff told us they were clear about their role and responsibility. However the new manager is not registered with the Care Quality Commission and the provider must ensure that the manager is registered as soon as possible to ensure compliance with the regulations.

No one we spoke with could recall being involved in planning or reviewing their care and we saw that care plans and risk assessments were not always updated to reflect people's needs. Staff we spoke with felt that care plans did not reflect the person they cared for and they did not find them helpful.

People told us they received medication when required and had never experienced any problems with medicines. One person told us 'I have quite a few tablets in the morning at teatime and at night; I've never had any problems'. However during our inspection we identified concerns with the administration and management of medicines.

People we spoke with told us they felt The Yews was well maintained and they would be happy to raise a complaint with the provider or senior staff and were confident it would be resolved. However we noted people did not routinely have the opportunity to give their feedback about the home and that regular audits of medication, care plans and risk assessments were not carried out.