Archived: Yew Tree House Residential Care Home for the Elderly

Yew Tree House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Yew Tree House Residential Care Home for the Elderly is registered to provide accommodation for up to 13 older people with nine single room’s one shared room and two independent living flats. The service caters primarily for older people some of whom may have age related physical and mild dementia type conditions.

Yew Tree house is located in a residential area of the main high street of the village of Headcorn and is within walking distance of village shops and other community facilities. The property is currently owned by a sole provider. At the time of this inspection the service was full with 12 people in residence and the shared room used for single occupancy. This inspection took place on the 4 and 5 April 2018 and was unannounced.

The service 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.

People told us that they felt at home in the service were safe, well cared for and had their choices respected. At the last inspection in March 2017 we identified several breaches of regulations and requirement notices were issued, we asked the provider to tell us what actions they were taking to address these shortfalls which they did. At this inspection we checked that the improvements were in place and had been sustained.

At the last inspection on 15 and 16 March 2017 we had identified that recruitment files had not contained all the required information. We had also found that some people’s bedroom doors were propped open compromising fire safety across the building. At previous inspections there was a lack of audits and survey feedback from people and/or their relatives. Whilst enough improvement has been made to meet the breach of regulation this remains an area for ongoing development to ensure all aspects of care quality are monitored and sustained.

The registered manager undertook assessment of people referred to the service to ensure only those people whose needs could be met were admitted. Care plans were developed with the involvement of people and their families to guide and inform staff about how people preferred to be supported. Staff knew people well, they were able to describe the support people required on a daily basis and understood their characters and wishes, their feedback matched most of the information in care plans which would benefit from some improved detail. Staff helped people to retain their independence for as long as possible

People’s health needs were monitored and the registered manager and staff were proactive in seeking advice and guidance from health professionals to ensure people remained healthy. Staff spent time with people and got to know their characters and individual preferences; they delivered care and support in line with these.

Staff had a clear knowledge of how to protect people and understood their responsibilities for reporting any incidents, accidents or issues of concern. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of decision making processes for people who lacked capacity but how this was recorded was an area for improvement.

People and relatives who provided feedback during the inspection showed a positive appreciation for the quality of care and support people received in a homely environment.

Staff said they enjoyed working in the service and coming to work; they said they received the training they needed to fulfil their role competently. They said the registered manager was supportive and approachable and promotes an open culture but recording around staff supervision and appraisal was an area for improvement.

Medicines were managed safely and administering staff are trained to do so. People ate well and meals were nutritious and cooked from fresh.

People and relatives said they felt able to raise concerns if they had them. Due to the small intimate nature of the service people and staff were in each other’s company for much of the day, this made it easy for people to share their views at any time but occasional resident meetings were held and satisfaction surveys sent out to relatives.

Staffing levels were sufficient. The registered manager used a dependency tool to review staffing needs. There was flexibility to use additional staff when required should a person’s needs increase greatly.

There were systems in place to monitor service quality, some records viewed would benefit from additional detail but there was an emphasis and culture in the home that the needs of people were prioritised. The provider was a visible presence on an almost daily basis in the service and knew the people that lived there well. The provider had an overview of what happened in the service.

We have made one recommendation for specific guidance for staff in regard to pacemakers.

At the last inspection on 3 February 2016, we asked the provider to take action to ensure outstanding remedial building and electrical works were completed. We also asked the provider to take action to improve staff recruitment checks, record staff meetings and ensure an adequate monitoring system was in place for assessing service quality. We also made some recommendations for the provider to consider.

At this inspection we saw that the provider and registered manager had made efforts to address previous shortfalls but breaches in recruitment and quality assurance had not been fully addressed.

Improvements to the recruitment records had not ensured health statements were in place. People and relatives were surveyed but a mechanism for analysing and aggregating their feedback was still to be implemented. Improvement to the quality assurance system gave the registered manager better oversight of service quality but the completion of checks was not robust to ensure it was effective.

Improvements to fire arrangements included increased fire drills for staff and door guards had been installed on some bedroom doors. Other bedroom doors however still remained propped open and continued to compromise fire safety. Recording of weekly fire checks and tests had not been sustained and could place people at risk if equipment was not in working order.

Outstanding remedial building and electrical works had been completed although a tidy up of the garden area was ongoing. Meetings between the registered manager and the provider were now recorded and opportunities for staff meetings had increased.

There was a registered manager in post. A registered manager is a person who is 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 premises were clean, homely in style and maintained to a satisfactory standard. There were ongoing small works here and there with a recent upgrading of carpeting having taken place and some improved seating in the garden. All necessary checks, tests and routine servicing of equipment and installations had been carried out.

People were treated with kindness and respect by staff and we observed and heard many examples of kind, and patient interactions between staff and people. People told us they felt safe and liked the staff that supported them. Many people came from the local area and the presence of the service in their own area was important to them; as was being part of the community of the village. People enjoyed the relaxed and quiet atmosphere of the service.

Activities were not structured. From our discussions with people this reflected their personal preferences and choices Relatives told us they had no concerns about the service and were satisfied with the overall standard of support provided. They felt confident in the quality of care and said they were kept informed by the Registered manager or staff of important changes;

Staff continuity was very good. New staff received an induction into the service tailored to their specific level of experience. Sixty per cent of the staff team held nationally recognised care qualifications. Staff said that they felt listened to and supported.

People said they enjoyed the food they ate and their preferences and choices were taken account of. People’s health and wellbeing was monitored by staff who alerted health professionals and relatives appropriately. People were supported to maintain links with the important people in their lives; relatives told us they were always consulted and kept informed of important changes.

People were encouraged by staff to retain their independence and carried out tasks for themselves at a pace to suit them. People and their relatives were consulted about the care and support provided. Individualised plans of care guided staff in the support they delivered to people. Risks to people were appropriately assessed. Staff understood how to keep people safe from abuse and how to report their concerns. People told us they found staff approachable, they had no concerns but felt sufficiently comfortable with staff to be able to raise any issues with them if they had them.

Staff were observed to seek peoples consent and consult with them for everyday decisions; they worked to the guiding principles of the Mental Capacity Act 2005 (MCA). The MCA provides a framework for acting and making decisions on behalf of people who lack mental capacity to make particular decisions for their selves.

We have made one recommendation:

We further recommend that the provider seek assessment and guidance from occupational therapy professionals as to whether a second handrail on the opposite side of the staircase would provide better support for people using this means of escape in an emergency and for general safety in everyday use.

We found three 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 the report.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

People told us they were treated with dignity and respect. One person told us they had "No concerns with staff interactions...people are really happy and settled". We observed that people had personalised their rooms with their own belongings.

People told us they were involved in their care planning and that staff were approachable and happy to discuss people's care with them. One person said they were "Quite satisfied with all the care they received".

The service was clean, tidy and well maintained. People felt they lived in a "Home from home". People said staff were helpful and any concerns regarding the environment or any other issues were sorted out quickly by the service.

The service had effective record systems in place. The records were accurate and concise which protected people's welfare and safeguarded them from the risks of inappropriate care and treatment.

People told us they could make choices in their daily life and were asked their views about their care and the service they received. We saw that people's preferences about their care had been recorded in their care plan. People had their health and personal care needs met and were encouraged to be as independent as possible. One person told us 'They do enough for me, but not too much'. Risks to people's safety and welfare had been assessed and minimised.

People told us they enjoyed the meals and we found that people's nutritional needs had been assessed and planned for. However, the service did not keep a record to show that people were offered snacks and drinks in the evening and some people told us they were not routinely offered hot drinks and snacks.

People were kept safe from harm and abuse, but were not always protected from unsafe or inappropriate care because accurate records about their care were not always maintained.