Archived: Yew Tree Care Centre

Updated 18 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We inspected the service on 5 May 2016. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. The inspection team consisted of two adult social care inspectors, a pharmacist inspector and two experts by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed all the information we held about the service. We did not ask the registered provider to complete a provider information return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with 28 people who used the service and 14 relatives. During our inspection we observed how the staff interacted with people who used the service. We looked at how people on the dementia care units were supported by using our Short Observational

Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spent time in all of the communal areas and observed how staff interacted with people

During the visit we spoke with 14 staff, this included the registered manager, the operations manager, the deputy manager, two nurses, two senior care assistants, a maintenance worker, an activity co-ordinator and five care assistants.

During the inspection we reviewed a range of records. This included eight people’s care records, including care planning documentation and medication records. We also looked at staff files, including staff recruitment and training records, records relating to the management of the home and a variety of policies and procedures developed and implemented by the registered provider.

Updated 18 June 2016

We carried out a comprehensive inspection of this service on 15 September and 27 October 2015. At this inspection breaches of legal requirements were found. There were insufficient staff deployed to meet the needs of people who used the service, the management of medicines was unsafe, Staff were not suitably trained and effective governance arrangement were not in place. The registered provider wrote to us telling us what action they would be taking in relation to the breaches.

We inspected Yew Tree Care Centre again on 5 May 2016. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. This was another comprehensive inspection and also to check whether action had been taken in relation to the breaches identified at our inspection in September and October 2015. At our inspection on 5 May 2016 we found that the registered provider had followed their plan and improvements had been made in all areas.

Yew Tree Care Centre provides both personal and nursing care to a maximum number of 76 people. There are four separate units in the service. There are two units in which people living with a dementia are accommodated and cared for, one of which is for people who require nursing care. There is a residential unit in which people who require personal care are accommodated and cared for and there is also a general nursing unit. Units are divided across three floors. At the time of our inspection there were 71 people who used the service.

The home had a registered manager in place. 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.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The registered provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff.

We found that action had been taken to ensure staff completed all of the required training. Although not fully up to date the majority of staff (90 – 95%) had completed all of the mandatory training in health and safety, moving and handling, COSHH, fire and infection control and the nurses were undertaking sufficient training to meet the revalidation requirements. The registered manager was aware of the shortfalls in training and was arranging for this training to take place.

We saw that staff had received supervision on a regular basis and an annual appraisal.

Improvements had been made in the management of medicines to make sure people received their medicines safely, however further improvement was needed in the recording of medicines.

There were effective systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out by the registered manager. We saw where issues had been identified; action plans with agreed timescales were followed to address them promptly.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. However, fire drills including evacuation were out of date for many of the staff. The registered manager was aware of this and had been on training to carry out the fire drills with staff.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as moving and handling, choking, falls and behaviour that challenged. This enabled staff to have the guidance they needed to help people to remain safe.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. Where appropriate there was evidence of mental capacity assessments, however, for some people these were not decision specific.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed and nutritional screening had taken place.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

We saw people’s care plans were written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people and relatives were involved in all aspects of their care plans.

The service employed two activity co-ordinators to plan activities and outings for people who used the service. There was a plentiful supply of activities and outings, however more thought needed to be given to those people who were living with a dementia and were less able.

We saw a copy of the provider’s complaints policy and procedure and saw that complaints had been fully investigated with a written response to the complainant.