Inspection on 05/05/10 for Yew Trees

This is the latest available inspection report for this service, carried out on 5th May 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Yew Trees 05/04/07

Yew Trees 10/01/06

Yew Trees 15/08/05

Yew Trees 22/03/05

Yew Trees 03/07/04

Yew Trees 02/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Yew Trees Off Long Lane Sycamore Avenue Chadderton Oldham Lancs OL9 8BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 0 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Yew Trees Off Long Lane Sycamore Avenue Chadderton Oldham Lancs OL9 8BQ 01616816204 01616816204 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Karen McCarley Name of registered manager (if applicable) Mr Michael Hall Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Old Age, not falling within any other category - Code OP, maximum number of places 16 Date of last inspection Brief description of the care home Yew Trees Rest Home is a residential home registered to provide for 16 older people over two floors. The home is situated within walking distance of convenience stores, take-away restaurants and a video rental shop. The garden area is easily accessible and pleasantly landscaped with raised beds and planted pots. The accommodation consists of 12 single rooms, eight of which have en-suite facilities and two double Care Homes for Older People Page 4 of 31 Over 65 16 0 0 4 0 6 2 0 0 9 Brief description of the care home rooms. Bathing and toilet facilities are adapted to meet the needs of the service users. There is a choice of two large lounges and a dining room. The home displays the previous inspection report at the main entrance. The home charges approximately 375.00 pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced, which means that the owner,manager, staff and residents were not told that we would be visiting, and took place on 5th May 2010 commencing at 8:15am. The manager and senior management were available on the visit and provided us with information and records,in addition to the support from staff on duty during our visit and residents. The inspection of Yew Trees included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection which was held in June 2009. Every year the owner,person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some weeks before our visit the manager filled in a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the home see the service they provide the same way that we do. We considered the Care Homes for Older People Page 6 of 31 responses and information the senior manager from the company provided and have referred to this in the report. Yew Trees care home was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying and working at Yew Trees the views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at Yew Trees talking with the manager, senior managers, staff and the owner.A tour of Yew Trees was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Yew Trees was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to two residents was looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of inspecting that helps us to look at services from the point of view of the people who receive a service. We track residents care to see whether the service meets their individual needs. The term preferred by people consulted during the visit was residents. This term is, therefore, used throughout the report when referring to people living at Yew Trees. A brief explanation of the inspection process was provided to manager at the beginning of the visit and time was spent with the manager on conclusion of the visit to provide verbal feedback. We have not received any complaints or safeguarding matters about this service. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The management arrangements have changed since the last visit to Yew Trees. A new manager was appointed in January 2010 The manager has made changes to the way care and support is provided to residents and also supported staff in their development to provide a further improved service to residents. We made a requirement on the last inspection that the manager must ensure that all the necessary pre employment checks including appropriate references and Criminal Record Bureau checks are obtained before any person starts work at the home. This is to minimise the risk of the service users being exposed to staff who are not suitable to Care Homes for Older People Page 8 of 31 work with vulnerable people. We were able to confirm that recruiting procedures were correct and all the necessary checks had been undertaken before staff started work at Yew Trees. Policies and Procedures have been reviewed,localised and updated.Risk Assessments have been reviewed and a comprehensive system implemented.Quality Assurance monitoring has been introduced. Since we last visited in June 2009 new carpets have been fitted to the hallways, stairs and landing. One bedroom has been redecorated and new bedding has been purchased for all residents bedrooms. The hallway to bedroom one,two and three has also been redecorated. New flooring has been fitted in one of the toilets which has also been redecorated. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed and are able to visit the home prior to making any decisions about their future. Evidence: The statement of purpose and service user guide have been updated in order to ensure that information provided to prospective residents is up to date. Staff told us they are given up to date information about the needs of the people they support or care for.We asked residents if they received enough information to help them to decide if Yew Trees was the right place for them, before they moved in. One resident responded, yes. and told us that they had been given written information about the homes terms and conditions. We were told in the AQAA completed in March 2010 by the Manager,We actively encourage people who come to view the home to visit a couple of other homes so they Care Homes for Older People Page 11 of 31 Evidence: can compare the care available for their family member.We encourage visits at times that are flexible without an appointment and at any time convenient to them.We spend as much time as they need to explain how we work and what they are likely to expect.We encourage people to spend some time with us and have a meal if they wish and a chat to the other residents who already live at Yew Trees.We provide a brochure that explains our service,ie welcome pack,terms and conditions and complaints procedure. A relative told us, I would like to say that the friendliness and cheerful staff welcome any one who visits and makes sure you are comfortable during your visits. I have visited two previous homes and they could learn a lot from Yew Trees. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have their health care needs assessed, recorded and recognised.They receive support to maintain their health and are treated in a respectful manner. Evidence: We asked staff what the home does well. One staff member told us, Looks after and care for residents.Another member of staff said, I feel the home provides good care for the residents.A further member of staff said, support independence for residents. The care of residents is excellent. Four comment cards completed by residents told us that staff are alwaysavailable when they need them and staff listen to them and act on what they say. Two residents responded, usually to the same question. A resident said, they look after all my needs and the staff are friendly and helpful.In response to our question what could the home do better. Residents told us,At the moment nothing that I can think of Look after me very well.Ive always been satisfied. Everything is OK. Care Homes for Older People Page 13 of 31 Evidence: A resident told us that the home needed to, read the name labels on clothes to make sure they get out of the wash and back to the right person. The Manager told us, All residents are consulted on their preferences to health care and are supported to appointments when their families are unable to do so.All residents care plans are reviewed on a monthly basis identifying and updating their heath and personal care preferences.We offer a choice of GP and wherever possible residents own GP contact is maintained. We have weekly contact with District Nurse teams and work alongside them to meet individual needs/preferences. Each resident had an individual care plan in place,which is kept under review.Those looked at contained relevant information about the needs of the resident. Residents receive appropriate support to,as far as possible,maintain good health. We were told that the care plan was being amended and a new care plan format was to be introduced. The change to the care plan will enable the recording to be more person centred and further develop the information contained in the current care plan. The recording in the daily reports has been enhanced with more detail contained in the record on how staff have supported residents. This format is to be changed now staff have received guidance and direction from the manager in what detail to record. This is to demonstrate the care and attention staff provide to residents in sufficient detail. Life history books have been put in place through Age Concern and these provide staff with a lot of information about residents past lifes and interests. Staff are to build on these to further enhance the information they have on residents. Staff are allocated to a named resident as a key worker and a card is within residents bedrooms to remind them who that is. This promotes the individualisation of residents and personalises the support they receive. Residents receive assistance to take their medication in a safe manner and administration practices observed demonstrated good practice. When we looked at a sample of the medication administration records we identified that in the main they were completed correctly with no gaps in the recording of medication administration. Best practice indicates that when medication is handwritten in the medication administration records that this should be signed by the the staff member making the entry then signed as verified by a second staff member to check that the entry has Care Homes for Older People Page 14 of 31 Evidence: been copied accurately. This further safeguards residents and staff. When administering controlled drugs medication best practice indicates that two staff should sign on administration in the medication administration records as an additional safeguard to residents. We looked at the controlled drugs book which demonstrated compliance with the regulations. We asked that for one resident the manager double check the frequency with the GP that one medication was prescribed. The type of medication is usually prescribed four times a day and was recorded as this. However the written prescription only detailed that the medication was to be administered three times daily. A symbol is used by staff to indicate when residents havent had medication. Some symbols need defining to ensure that an explanation is given when residents dont have there medication as prescribed. This wasnt always completed by staff. So an accurate record was not made on these occasions why residents hadnt had there medication. For one resident medication was prescribed four times a day and it was recorded that the medication was out of stock. The resident was without this pain relief for approximately three days. This shouldnt happen. The manager did tell us about some additional pain relief this resident received which was currently being evaluated in liaison with the GP.When this medication recommenced it was not recorded on the medication administration records the quantity or the date when the tablets were received. Photographs of residents accompany the medication records as an additional means of identification for residents to make sure they get the correct medication. Two residents did not have these photographs. The manager completes a monthly audit of medication which looks at the medication records and also assesses staff competency when giving out medication. Five of the eight staff who have the responsibility to administer medication to residents received medication training on 16th July 2009 and the three other staff are scheduled to have this training on 12th May 2010.This will ensure these staff are competent and confident to administer medication correctly. Residents receive additional health care support services as required,such as visits from the GP,district nurse services,continence advisors,dentist,opticians and other relevant professionals.We spoke with visiting health care professionals and they Care Homes for Older People Page 15 of 31 Evidence: commented that the staff in the home carry out the care and attention they advise and call on them for appropriate health care assessments or advice. Residents told us that they were well cared for and liked the staff who supported them. Throughout the inspection visit,staff treated residents in a respectful and dignified manner. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to develop their own day to day routines; they receive a varied diet and have the opportunity for social activity and interaction. Evidence: A member of staff told us, I find the home does very well in looking after the meals and supporting all the service users in all areas of everyday life.Five residents in their comments cards sent out to them before the visit said theyalways liked the meals at the home and one resident responded, sometimes. Residents have a varied and enjoyable diet. When asked about food,residents were generally pleased with what they received.The home currently display the menu on the dining room door. The menu does not reflect the alternative options made available to residents. Because of this, there may be times when residents may wish for an alternative to the main meal and, without this being written on a menu, they may not know what options are available. We were told and were shown comment cards that had been given to residents to get their views and opinions about the food served at Yew Trees.The menus have been changed since the appointment of the manager in January 2010 and it is planned to Care Homes for Older People Page 17 of 31 Evidence: try to incorporate the ideas and the opinions of residents from the comments received about the menus to accommodate their likes,preferences, and suggestions. The detail in the AQAA completed before our visit told us, Yew Trees has a dedicated activities coordinator who arranges weekly activities.All residents are encouraged to follow their faith and personal beliefs and are supported by staff to access facilities in the community to meet these needs.Outings are arranged to places of interest, involving families and the choice of attending. We asked residents what the home could do better. One resident told us, more entertainment eg singer, more outings,ring and ride,pantomimes.Another resident said the home could do better by having,more outings. The manager told us that regular resident meetings are planned when relatives or friends will be invited. It is planned that activities will be an area which will be discussed to get more ideas for alternative activities and stimulation for residents. Residents are able to plan their own daily routines and where they would like to spend their day.Some residents prefer the comfort of their own rooms,rather than meeting with others in communal areas. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are aware of the homes complaints procedure and are protected from abuse by staff who are trained in safeguarding vulnerable adults procedures. Evidence: We were told by the Manager that, We act on reports in a timely manner and are open to admitting we dont always get it right.When we dont get it right this is changed and used as a learning curve so that we develop and learn from this.Complaints are encouraged to enable us to be informed about concerns early so that they can be addressed quickly and efficiently. Five residents told us that there was someone they can speak to informally if they are not happy and that they knew how to make a formal complaint. One resident said they didnt know how to make a formal complaint. There are written policies and procedures for the safeguarding of vulnerable adults in place.It was confirmed that all staff have received training from Oldham Social Services in safeguarding vulnerable adults. The manager has improved the complaints procedure and ensured that all residents and relatives are aware of how to raise matters of concern and/or complain about the home. Staff have also received direction on the homes complaints procedures and how to act on any concerns raised. During the inspection residents had no complaints to Care Homes for Older People Page 19 of 31 Evidence: make and were content and happy with the support and services they received. We looked at the record of complaints.Thjere were no complaints recorded. We gave advice to the manager that to further develop the complaints procedure the home needed to detail comments,complaints or concerns identified and what has been done by the home to address or put right peoples comments. This will further enhance and develop the service provided at Yew Trees and assist in future developments of the home. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is predominantly appropriately maintained to provide a safe and homely environment for residents. However, some aspects of the physical environment need updating and furniture and furnishings replaced to promote the privacy, dignity, respect and safety of residents. Evidence: Residents told us, the home could improve by, improve their facilities ie shower, toilets, lift.Have a chair lift on stairs, for when the lifts not working so I dont have to stay in my bedroom all day. We were also told, I love being here and I like the freedom that I have but my room could do with being updated ie carpet, sink unit, furniture. I keep being promised it will for two and a half years, but it never happens.One area of improvement a resident highlighted was, Make the garden more inviting to sit out eg clean comfortable chairs, more flowers and colour. More things to encourage wildlife. We were told that there have been problems with the passenger lift breaking down and the service engineers have been out to rectify the problem. The manager told us that staff are aware of a reset button which they should use and have been made aware of what to do if this problem occurs again. The Manager told us, Although areas within Yew Trees are showing signs of wear and Care Homes for Older People Page 21 of 31 Evidence: tear the environment is maintained in a clean and safe manner.There are risk assessments for all areas within the building and covering the exterior of the building in situ in easy to read and detailed format.Regular cleaning takes place for all areas in Yew Trees and a cleaning programme supports this. A quality audit system has been implemented so as to monitor and identify areas for improvement and demonstrate a quality service. We were told that since we last visited in June 2009 new carpets have been fitted to the hallways, stairs and landing. One bedroom has been redecorated and new bedding has been purchased for all residents bedrooms. The hallway leading to bedroom one,two and three has also been redecorated. New flooring has been fitted in one of the toilets which has also been redecorated. We made a requirement when we last visited that,the registered person must ensure that the written risk assessments in connection with unprotected radiators and hot water pipework, particularly in service users bedrooms, fully address the relevant circumstances of the service user who is occupying the room. This is to ensure that as far as is reasonably possible steps are taken to minimise the risk of injury to residents. Some radiator covers have been purchased and fitted since we visited and the home were, on the inspection awaiting the delivery of the last eight. During the visit six more radiator covers were obtained and two were awaiting delivery. Risk assessments have been carried out for all areas of the home in relation to radiator covers as we had asked on previous inspections. This is to safeguard residents from risk of injury. The six radiators purchased on our visit must be fitted and at the time of writing this report we were awaiting written confirmation as to when this would be done.We received written confirmation on 13th May 2010 to tell us, I write to confirm that the covers discussed have now been fitted. The large covers as discussed with Karen are due to be delivered shortly and I will keep you informed about progress regarding these. The remaining two radiator covers must be obtained and also fitted in a timely manner. We were told that an action plan was in place to replace bedroom furniture, vanity units, and carpets in some rooms and this has been proritised to take into account the condition of the furniture,residents comments and observations. We would like to have a copy of the improvement plan for the replacement and upgrade to the building and the timescales when this work is to be carried out and completed. Care Homes for Older People Page 22 of 31 Evidence: Some new windows have been fitted since we last inspected Yew Trees. We looked at eight residents bedrooms.This showed us that some residents had personalised there rooms by the inclusion of ornaments and furnishings that they had brought with them from home or had purchased for there rooms since they came to stay at Yew Trees. Many of the bedrooms need attention and the replacement of furniture, carpets and redecoration.A lot of residents bedrooms do not have a lock fitted to the door which would further promote their privacy and respect of their personal space and belongings. Locks should be fitted to doors which are of a type and design that can be opened easily and that staff can easily access them in an emergency. This needs addressing by the home.Residents should be provided with keys to their bedroom door as a matter of routine unless their risk assessment suggests otherwise.The Manager told us he had arranged for a quote to see how much it would cost to have bedroom door locks fitted in the days after the inspection. Three residents told us the home was, always fresh and clean whilst three other residents responded usually to the same question. The shower room is currently being upgraded and the old shower and fittings removed. It was our understanding that this work is to be completed soon.A relative told us that things do take a long time to be finished and residents have been waiting for the new shower room to be completed for months. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support from staff who are appropriately recruited and trained. Evidence: It was identified in the AQAA that, Staff are flexible understand the needs of the residents and are prepared for change and welcome training.Staff are working towards NVQs and applications for 14 staff to do the Distance Learning Level 2 Health and Safety course has been carried out. We made a requirement on the last inspection that the manager must ensure that all the necessary pre employment checks including appropriate references and Criminal Record Bureau checks are obtained before any person starts work at the home. This is to minimise the risk of the service users being exposed to staff who are not suitable to work with vulnerable people. A sample of staff files were looked at.We were able to confirm that recruiting procedures were correct and all the necessary checks had been undertaken before staff started work at Yew Trees.We were told that staff work supernumerary at the commencement of their employment. Staff told us that there employer carried out checks, such as CRBs and references before they started work.And that there induction, very well covered everything they Care Homes for Older People Page 24 of 31 Evidence: needed to know to do the job when they started working at Yew Trees.Staff said when we asked that there were, always enough staff to meet the individual needs of all the people who use the service. One resident told us. the staff are wonderful. Two members of staff said they felt the home could do better by providing, more training.We were told in the AQAA that all staff had received training in the prevention and control of infection and safe food handling.Four staff currently have NVQ 2 qualifications in health and social care. Formal recording of supervisions and staff appraisals has commenced and the practice of observing staff as they complete duties has been undertaken by the manager. The duty rota has been amended to include the full names of staff and their working hours.In addition,staff are formally deployed by the manager and have specific roles and responsibilities on each duty, which means residents needs are addressed, with staff readily available to support. Staff continue with their training and are progressing with their achievements towards NVQ training at levels 2 and 3.Staff confirmed their training and were observed to be competent and supportive when attending to the needs of residents.This means that residents feel cared for and supported by people they like. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is run and managed in their best interests. Evidence: Since we last visited the registered manager has left there employment at Yew Trees and a new manager has been appointed.The manager has recently attended an interview with the Commission (CQC) and has been approved to be the registered manager. The manager has been in post since January 2010 and has obtained NVQ 4 qualifications and the Registered Managers award. This ensures he has the skills, knowledge and experience to manger the home well. In the last 12 months we were told the home had improved by,Policies and Procedures have been reviewed,localised and updated.Risk Assessments have been reviewed and a comprehensive system implemented.Quality Assurance monitoring has been implemented. COSHH records have been updated. Residents appeared relaxed and communicative with each other and staff.The Care Homes for Older People Page 26 of 31 Evidence: atmosphere at the home was relaxed and pleasant,making Yew Trees a nice place to be.The manager appeared organised and in control.The manager is offering direction to staff and has a clear development plan to continue to enhance practice. Health and safety checks are in place,which promote the safety of residents. Certificates of service confirmed that electrical and gas supplies and equipment are fit for purpose and use.Records confirmed the testing for risk of Legionella had been carried out and up to date certificates of service were in place for the passenger lift and hoists. All accidents are recorded,as is the action taken to ensure the checks to the home are carried out in a timely manner for the safety of residents. Fire safety records detailed that safety checks are routinely carried out and staff complete practical fire drill training.Best practice would be for staff to sign next to their printed name when they undertake fire drill practice training to ensure all staff have undertaken this and regular updates are arranged. Staff receive formal supervision, which supports them to develop and have dedicated time with the manager. The home does not manage any residents individual finances. We looked at a sample of records which are kept by the home to purchase services for example hairdressing and newspapers. Receipts were in place in the main for purchases made on behalf of residents. The hairdresser doesnt currently issue receipts when residents have had there hair done and this must be arranged to account for the money spent on this service. The Manager did tell us that this is something he is chasing up with the hairdresser who visits the home. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 To provide additional safeguards to residnets and staff. When medication is handwritten on the medication administration records that the staff member signs the entry and a second staff member also signs to verify the details copied are correct. When administering controlled drugs medication. Best practice is for staff to sign the medication records and a second staff member signs to confirm and witness administration. Ensure that when symbols are used on the medication administration records that need defining are defined each tome they are used. This will ensure a clear and accurate record is made of medication administration. Ensure that stocks of medication do not run out and residents have their medication at the time and frequency prescribed by their doctor. 2 12 Further develop the activities, stimulation and occupation available to residents by taking into account their wishes and feelings and the feedback received on how they would Page 29 of 31 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations like to spend their days. 3 15 Residents should have access to a daily menu which lets them know what main meal options are available throughout the day,including breakfast and suppers.Alternatives options should also be included on the menu Further develop the complaints, concerns, comments procedure to include the recording of such comments and indicate the action taken to remedy the comments received. Provide to the Commission an action plan for the planned upgrade and improvements to the environment and the replacement of furniture and furnishings including all identified areas for development and detail the timescale for completion and confirmation when the jobs are completed. Fit locks to residents bedroom doors of a type and design that promotes their independence and capabilities and that are easily accessible to staff in emergencies. Provide residents with keys to their bedroom door as a matter of routine unless their risk assessment suggests otherwise. 7 31 Best practice would be for staff to sign next to their printed name when they undertake fire drill practice training to ensure all staff have undertaken this and regular updates are then easily arranged. 4 16 5 19 6 24 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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