Care Home: Yew Tree Nursing Home

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What the care home does well Yew Trees provides a safe purpose built environment for people to live in. There is an informal, relaxed and friendly atmosphere in all areas of the home, and staff were observed talking and laughing with the residents. We were told by relatives and individuals that they had been provided with sufficient information about the home to assist them to make an informed choice prior to moving in. The manager encourages people to visit the home before making up their minds. All people are assessed before moving into the home to ensure that the home can meet their health and physical needs safely. People using the service told us that they have their health and personal care needs completed in a polite and courteous way, and their preferences about their care is respected. The staff told us that the home is committed to them receiving training, and that they have the skills and knowledge to meet the care needs of the people living there. We were told that the activities organiser was off sick, but this had been excellent and they are hoping that they return to work when feeling better. The home has a thorough recruitment procedure in place so that only people suitable to work with vulnerable people are employed. People living at the home receive a well-balanced and varied diet that meets their nutritional and dietary needs The home is managed in the interests of the people who live there. The health and safety of the people who use the service are protected by the policies and procedures in the home. What has improved since the last inspection? Following the last key inspection the home was given two requirements around recruitment and risk assessments. Several recommendations were made for good practice. Yew Trees have worked to address the requirements and put in place the good practice recommendations. The Annual Quality Assurance Assessment received from the home provides clear information in what the home have done and their plans for further improvement. This inspection made no requirements and the overall rating given is excellent which shows improvement. The home has updated their Statement of Purpose and Service User`s Guide, which is now available in alternative formats and is easier for people enquiring or using the service to understand. Care plans have been reviewed and people using the service have been involved with the update, this assists in providing care records which are person centred for the individual person. What the care home could do better: The home has a thorough recruitment procedure in place, but it was recommended that all new staff provide a full employment history from leaving school. Key inspection report Care homes for older people Name: Address: Yew Tree Nursing Home Yew Tree Place Romsley West Midlands B62 0NX     The quality rating for this care home is:   three star excellent 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: Christine Potter     Date: 1 7 0 6 2 0 0 9 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 30 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Yew Tree Nursing Home Yew Tree Place Romsley West Midlands B62 0NX 01562710809 01562710592 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Yew Tree Nursing Home Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 35 Dementia (DE) 35 Physical disability (PD) 35 Date of last inspection Brief description of the care home Yew Tree Nursing Home is a large, detached purpose built property that was originally built in 1993 for 29 older people. In June 2006 the premises were extended to provide accommodation and nursing care for a further six residents. Therefore, the home is currently registered for a maximum of 35 older people. Some of the people may also have a dementia illness or a physical disability and the home have opened a small dementia unit. Care Homes for Older People Page 4 of 30 Over 65 0 35 0 35 0 35 Brief description of the care home The home is situated on a level site within a green belt area in a quiet part of the village of Romsley. The village shops, a Post Office and a public house are in close proximity to the home. The home has a large garden which is accessible to people who use wheelchairs. The home also provides adequate space for car parking. People are accommodated on the ground and first floor of the home in single bedrooms. There is a combined lounge/dining room on the first floor and two combined lounges/dining rooms on the ground floor. There is also a small lounge on the ground floor. The home also provides a treatment room, a hairdressing room and a staff training room on the first floor and a nurses station on the ground floor. In addition to the two staircases, the home also provides a passenger lift to enable the people to access the accommodation on the first floor more easily. The home provides its own catering and laundry service. The stated aim of the home is to enable older people to continue living as independently as possible by receiving care and support consistent with their incapacities and disabilities. Information regarding the home is available in the Statement of Purpose, The Service Users Guide and Inspection reports. These documents are available on request from the home. For information about the fees please contact the home directly. Care Homes for Older People Page 5 of 30 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: three star excellent 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: We, the commission, undertook an unannounced inspection of this service, which means that the home did not know we were coming. This was a key inspection which is an inspection where we look at a wide range of areas. Before the inspection an Annual Quality Assurance Assessment document was posted to the service for completion. The Annual Quality Assurance Assessment is a self assessment and a dataset that each registered provider has to complete each year and send to us within agreed timescales. The document tells us about how providers of services are meeting outcomes for people who use the service and is an opportunity for them to share with us what aspects of the service they believe they are doing well. Some of the providers comments have been included within this inspection report. Information was gathered from speaking to and observing people who lived at Yew Trees. Three people were case tracked, this involved discovering their experiences of Care Homes for Older People Page 6 of 30 living at the home by meeting and observing them, looking at medication and care files, and reviewing areas of the home relevant to these people in order to focus on outcomes. Case tracking helps us understand the experiences of people using the service. Surveys were sent out and we received 13 completed surveys from residents and three completed surveys from relatives. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 30 The home has a thorough recruitment procedure in place, but it was recommended that all new staff provide a full employment history from leaving school. 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 30 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 30 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. There is sufficient information available for people to decide whether Yew Trees Nursing Home is right for them. There are opportunities for people to visit the home before making up their minds. The home carries out assessments of peoples needs before they move in, so that staff can provide the care that is needed. Evidence: The last inspection report recommended that the home update their statement of purpose, the Annual Quality Assurance Assessment states that this has been completed. The home provides written information in the form of a service user guide to help people decide whether they wish to live at Yew Trees Nursing Home. We were told by relatives that they had received the information and met the manager who had gone through all the details with them prior to making their choice. We saw copies of the service users guide in the reception area of the home, and a copy in the residents bedrooms. The home has the ability to have the documents made available in other formats including large print and audio. In the reception area of the home is the Care Homes for Older People Page 11 of 30 Evidence: certificate of registration, insurance information and a copy of the homes most recent inspection report. To assist visitors to the home they have photographs of all the staff on display. The last inspection report recommended that the home review the pre admission assessment for peoples needs prior to them moving into the home. The Annual Quality Assurance Assessment returned to us from the home confirmed that this had been completed. We looked at the pre admission assessments for three people who had recently moved into the home. The assessments provided sufficient information for the service to decide whether they would be able to meet the persons needs if they chose to move into the home. People using the service and relatives confirmed that the manager had visited and assessed their relative prior to them being admitted to the home. This assessment gives staff the information they need so that they can provide the support and care that people need, as soon as they move in. We spoke to staff and they were able to demonstrate the residents care needs. They also stated that they were provided with sufficient information about new residents to enable them to meet their care needs. We received 13 completed surveys from people using the service who confirmed that they had received enough information about the service. An example the home is outstanding the surveys also confirmed that they had been provided with a contract of the homes terms and conditions following admission to Yew Trees. Copies of signed contracts were seen in the peoples care files. One person confirmed that they had been assessed prior to admission, and visited for a trial session before making up their mind about the home. They told us that they were pleased with the choice of home and stated that there is not anything that is not done well. All staff we spoke to were able to demonstrate the individuals care needs. They also stated that they were provided with sufficient information about new people to enable them to meet their care needs. The Annual Quality Assurance Assessment completed by the manager provided us with the appropriate information and included that all prospective people were assessed prior to admission. The assessments were usually carried out by the registered manager and or the care manager in the individuals own home. Information included in what the home could do better stated to provide pre-admission documentation in large print and audio form to allow people with visual impairments to access the same information. The homes plans for improvements in the next 12 months include to introduce a more formal introduction to the home in conjunction Care Homes for Older People Page 12 of 30 Evidence: with the service user guide already provided. Send out a post admission survey form within the first eight weeks, and continue to update our working practices to include resolution of any problems or shortfalls identified therefore continually improving the process. Care Homes for Older People Page 13 of 30 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. The health and personal care people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The last inspection report rated these standards as good and recommended that care plans should be set out in such detail to specify the action that has to be taken by care staff to ensure all aspects of the individuals care needs are met. This as been actioned, and all staff we spoke with demonstrated good understanding of people needs. Since the last inspection the home has developed a small dementia unit which has been decorated and furnished in accordance with guidelines of caring for people with a dementia type illness. The manager is in the process completing a degree course in dementia care, and other staff have attended training courses to assist them in understanding the needs of people with a dementia type illness. They have developed additional information in the individuals care plans to assist the staff working on the dementia unit which are based on the strengths of the individual. Care Homes for Older People Page 14 of 30 Evidence: We looked at three peoples care records in detail and these showed that each person had an individual plan of care. They showed that personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons records. For example a diabetic persons care plan stated to monitor their blood glucose levels two times a day, and the records were in place of the results showing this was being followed. We spoke to the resident who confirmed that the staff were monitoring their diabetes and the blood glucose results had been better following admission into Yew Trees. The manager told us that people are encouraged to be involved with their care plan and the review of their own care, and we saw in the records that either the person or their relatives had signed to say that they agreed with the care plan. Following the previous inspection in 2007 it was recommended that more hoisting equipment in order to promote the individuals healthcare. The home now employs a physiotherapist to assist them in ensuring that all staff use the correct techniques when moving people and that they have the correct equipment. Staff confirmed that they had sufficient equipment to move people as assessed. We received surveys from 13 people using the service, and these stated that the home always seeks medical advice when necessary comments included: the home does everything well including medical, care and friendliness, there isnt anything that isnt done well. Always very helpful nothing is too much trouble. Receive excellent medical attention The care records showed that doctors and other specialists had been contacted whenever someones health had given them cause for concern. A good range of specialist equipment is available to assist the staff in meeting the health and personal care needs of the people. A good range of pressure relieving equipment was observed in use included in the individuals health care needs assessment. Staff told us that the home had sufficient pressure relieving equipment to care for the residents assessed as being prone to skin pressure damage. The home has good procedures in place for the management of medication. Medication is stored safely, and accurate record keeping enables the home to know which medications have been given and at what times. We looked at three peoples medication records and they had been completed by the nurse who administered the medication. The manager completes a monthly audit of the medication system and these records were looked at and support that the nurses are adhering to the homes Care Homes for Older People Page 15 of 30 Evidence: medication policy. Peoples privacy was seen to be maintained by the staff, they were knocking on doors before entering and speaking to people courteously. Residents and relatives confirmed that all staff respect their privacy and dignity comments included: staff meet the individual needs of the residents well, dignity and privacy are always maintained. Everyone appeared contented during the inspection and were seen enjoying the activities, visits from family, watching television and reading newspapers. There was a friendly relaxed atmosphere throughout the home, and all staff were polite and courteous and enjoying laughter with people. Staff told us that hey were provided with sufficient information about the residents care needs to enable them to look after them. They also confirmed that they were given time to look at the residents care records for additional information about individuals health needs. The Annual Quality Assurance Assessment received from the home provided an accurate assessment of how the service are complying with the standards and included: They have maintained their commitment to deliver a person centred approach to planning life long care, consulting and involving the individual and their families in partnership with the staff. We have updated all our nursing policies and procedures to take into account all relevant guidelines. Training of staff in clinical specialist areas continues to be a priority. We work closely and in conjunction with other healthcare professionals where clinical risk assessments indicate their intervention is needed and specialist equipment is identified as being required for example physiotherapists, dieticians and tissue viability nurse. Recorded in what they could do better they recorded that the care plan documentation could be more time specific in review. The Annual Quality Assurance Assessment informed that in the last 12 months they have improved by staff are now trained and have an awareness of the Mental Capacity Act code of practice and incorporate this in assessment and planning. The pre admission assessment forms have been reviewed and improved to include person centred planning for those individuals requiring dementia care. The manager has commenced the Dementia Care Diploma with Dementia Care Matters linked with Surrey University. Specific training in dementia care is now included in their annual training programme. Care Homes for Older People Page 16 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have the opportunities to be involved and stimulated by a wide range of interesting activities and access the gardens. The dietary needs of the residents are well catered for with a balanced diet and a varied selection of foods. Evidence: The last inspection report rated these standards as good and recommended that the peoples individual social and leisure activities and interests should continue to be developed. The Annual Quality Assurance Assessment received from the home informs us that this is ongoing. Yew Trees employs a full time person designated for the social activities for the residents. Activities are arranged over the seven days for the people. Since the last inspection the home as developed a dementia care unit The service understands and actively promotes the importance of respecting the human rights of people using the service, with fairness, equality, dignity, respect and autonomy all being seen as central to the care and support being provided. All residents and staff recognised the value and the benefits of having varied activities and flexible lifestyle. All the residents referred to the activities organiser by their first name, and were most upset to know that they were off sick and hoping that they would be well enough to Care Homes for Older People Page 17 of 30 Evidence: return to work soon. The staff told us that they take an active part in the activities, so that they can continue with them when the activities person is not there, and a carer is taking responsibility for maintaining the activities program. We were told that some of the residents went to a local garden centre last week which they enjoyed. The home have provided large televisions and a WII game console which we were told the residents enjoy. Individuals confirmed that they enjoyed the daily newspapers and staff were seen assisting people with them during the day. To assist with the planning of a varied program of activities they hold regular meetings with the residents and have an agenda and minutes from these meetings are maintained. Religious services are held for the residents faith for those who wish to participate. Lists of forthcoming events are displayed in the reception area of the home, together with photographs of activities completed by the residents. The home has large well maintained gardens with seating area for the residents to use when the weather permits. Residents told us that they when they move into the home, they are asked questions about what time they prefer to get up, go to bed, whether they prefer male or female carers. The home then respects their wishes, and if they decide to stay up late this is respected by the staff. From the surveys returned and comments from visitors on the day of the inspection, all were complimentary about the home. All said that the staff were friendly and made them feel welcome when they visited. Relatives were seen coming and going during the day and made welcome by the staff. The home provides varied well balanced meals for the residents and caters for cultural and dietary needs. Currently, meals are based on a four-week menu with a choice of two dishes at both the lunchtime meal and afternoon tea, and we observed evidence that drinks and small snacks are provided throughout the day. The manager told us that for the people on the dementia unit they were offered a choice at the meal time, and were shown the food choices so that they could choose and enjoy their meal. We saw the lunch being served in both the pleasant dining rooms and some people were having their meals in their bedrooms. the meals were served in a relaxed manner and people who required assistance were being helped by the staff in a respectful manner. Care Homes for Older People Page 18 of 30 Evidence: The food appeared appetising, and the people told us that they were enjoying their meal. The comments received the food included: the food is very good the only complaint I have we are given too much food All the residents were appropriately dressed, for the temperature of the home, and in clothes that were suitable for their age. People confirmed that they chose the clothes they wished to wear. We were told by staff that where this is not possible they are guided by what the relatives tell them their preferences would be. Care Homes for Older People Page 19 of 30 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. People using the service are confident that any concerns would be listened to and acted upon. Evidence: People using the service and relatives told us they were aware of the complaints procedure, including how to complain to the Care Quality Commission by way of information provided by the home, for example the service users guide and notices displayed in the homes reception area. Records demonstrated complaints are investigated by the manager, discussed with the owner and responded to within given timescales. The Annual Quality Assurance Assessment received from the home told us that they have received three complaints in the last 12 months, two of these have been upheld and the other was referred to the safeguarding team for review the outcome of this one is not yet known. The last key inspection recommended that the complaints procedure should include all the relevant information. The Annual Quality Assurance Assessment received from the home confirmed that this had been completed. Review of the current accident book showed no occurrences, or trends, in the nature and type of reported accidents, which caused us concern. The homes thorough approach to the prevention and management of incidents, such as falls, was evident through crosschecking with the individual documentation. These showed people Care Homes for Older People Page 20 of 30 Evidence: recorded as having had falls, had all been risk assessed with regard to their mobility and potential for falling. The home operates an open door policy to allow residents and visitors to voice their concerns at any time. Residents and relatives confirmed to us they would have no hesitation in raising concerns they might have. Policies and Procedures on whistle blowing and advocacy information is available on display for everyone, and staff receive abuse training during their induction. We had discussions with four staff, all of whom were able to describe the action they should take if they were in receipt of a complaint, or observed abuse of a resident. Training records confirmed they had all received relevant adult protection training. The Annual Quality Assurance Assessment received from the home told us how the home have improved in the last 12 months and included: Continued development of staff group in relation to the Mental Capacity Act and Deprivation of Liberty. Security locks added to a number of internal doors to safeguard wandering residents from the risk of falling down stairs. Care Homes for Older People Page 21 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment. Evidence: Yew Trees is a purpose built home providing accommodation for up to 35 people in single bedrooms. The accommodation is on two levels with a passenger lift to assist residents with mobility problems to access all areas of the home. The home provides two large lounges with dining areas and quiet sitting areas for people to use. It has specially designed bathing facilities and equipment to assist in meeting the health care needs of residents. There is good provision of specialist equipment, consistent with meeting the assessed care needs of the residents, and the demands of tasks carried out by care staff. Since the last inspection the Annual Quality Assurance Assessment received from the home informed us that the service has carried out essential maintenance work, including the following: replacement windows and cladding, roof repairs, upgrading of the electrical switchboards. installation of stainless steel splash backs in kitchen, refurbishment of staff room, eight bedrooms decorated and refurbished to include new carpets. The home stands in spacious well maintained gardens which people can use if they wish to do so. The home is situated in the village of Romsley close to the local amenities. Care Homes for Older People Page 22 of 30 Evidence: We looked at parts of the home, and individuals bedrooms which were personalised by the individual with ornaments, photographs and pictures. The home has hygienic hand gel placed in prominent places around the home for the staff and visitors to use to further assist in reduce cross infection to the people. The home is in good decorative order throughout and all areas of the home were clean and tidy. People commented that the standard of cleanliness in the home was excellent. The housekeeper told us that there is sufficient time allocated for the cleaning and laundry, all the chemicals are stored correctly and all staff receive training in COSHH (which is the term which relates to the chemicals they use). They keep cleaning and laundry schedules. We were that the manager is very supportive and always has an open door for everyone. All staff pride themselves on the cleanliness of the home and every night domestic staff clean all the large chairs with an anti bacterial cleanser and vacuum the carpets. The home employs a full time maintenance person who maintains the home on a day to day basis. The manager carries out monthly audits which include every room in the home and infection control audits. The staff told us that the home was always clean, and that they all worked as a team and respected everyones job in looking after the home. Staff when asked could not think of any improvements to the home to assist them in looking after the residents. The Annual Quality Assurance Assessment returned from the home told us that they are continually monitoring the environment, using the results from the audit. A program of routine maintenance works is kept within the home. Care Homes for Older People Page 23 of 30 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 can be confident staff numbers on duty, and skill mix, are sufficient to meet their assessed care needs, and that recruitment and employment practices are consistent with safeguarding them from abuse. Evidence: At the time of the inspection the home was accommodating 33 people with one person in hospital. A review of recent duty rosters, demonstrated staffing levels to be sufficient to meet the assessed care needs of current residents. Furthermore, the manager is usually supernumerary with good support from an experienced deputy, a full time activities coordinator, kitchen staff, domestic staff, full time maintenance and administration support make up the staff team. Staff told us that they had enough staff on the variable shifts to enable them to meet the health care needs of all the residents. They also confirmed that it is a pleasant atmosphere to work in and all staff are supportive. They acknowledged that they are provided with sufficient information about the residents and have regular handovers where any changes in the residents are reported. Residents and relatives confirmed that they do not have to wait long for the nurse call alarm to be answered. Comments about the staff and people using the service included: I would put my x in here the care is excellent very pleased with the home, friendly atmosphere, all the staff are Care Homes for Older People Page 24 of 30 Evidence: wonderful. The last inspection report required that the home ensure that two written references are obtained in respect of all staff prior to appointment, from reviewing the staff files this has been addressed. A review of staff files relating to the three most recently employed staff demonstrated recruitment practices to be satisfactory, with all elements required by the Care Homes Regulations being completed, and evidence retained on file. It was recommended that a full employment history is provided by the applicant from when they left school. Staff told us that they had been recruited properly and provided all the required information. We looked at the training records for the staff and the service have prioritised in this area. A senior carer is responsible for staff training and confirmed that all staff employed at the home were up to date with mandatory training. All new staff have an induction and copies of these were shared with us. The induction training is split into sections and covers all the main areas. The Annual Quality Assurance Assessment received from the home told us that care staff are encouraged and assisted to undertake NVQ training meaning we now have 18 out of 23 care staff having achieved NVQ levels 2 or higher. The requirement from the last inspection report is now met so removed from the report. Residents told us that they felt that the staff were suitably qualified to meet their care needs. The Annual Quality Assurance Assessment returned by the home told us how they had improved in the last 12 months and this included: Broadened the scope of training to include challenging behaviour, dementia, violence and aggression, person centred planning and Mental Capacity Act and Deprivation of Liberty. Home Manager has completed St Johns First Aid at Work and a management course. Key staff have trained in use of defibrillator, which has been provided to the home by the ambulance service. Care Homes for Older People Page 25 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Yew Trees can be confident that the management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a competent manager Evidence: The last key inspection rated these standards as good and made a requirement that risk assessments must be carried out and recorded to promote health and safety. The home have complied with this so this requirement is removed. The manager Sharon Guise has been in post at the home since 1998. Sharon has completed NVQ level 4 qualification in management and the registered managers award. Sharon is enthusiastic about the home in ensuring that standards and good care are maintained. She is currently completing a diploma in dementia care which will benefit the people in the home. All people using the service and staff complimented Sharon on her excellent management skills and told us she was supportive and always available to talk to. The manager completes monthly audits in medication, wound care, infection control Care Homes for Older People Page 26 of 30 Evidence: and accidents which assists in monitoring the homes performance and also ensures staff are following correct procedures. Feedback is encouraged from the people using the service, relatives and professionals using the service. The comments from the doctors covering the home have been complimentary. Expressions of appreciation by relatives regarding the care of their relative were seen displayed in the home. These included comments such as: We would like to say thank you to you all for taking care of our x, you made x very comfortable. The home have quality assurance systems in place, these include the registered nursing homes system, questionnaires are sent out every six months for feedback. In addition regular resident meetings are held and these discuss various topics. The home does not take responsibility for residents monies invoices are sent to the nominated person for payment. However they do have safe storage available at the home for small amounts of money. The home employs a maintenance person who has a well organised system for ensuring that the safety checks are completed, the fire records requested were available and up to date on the day of the inspection. All staff attend regular meetings, and have supervision six times a year, followed by an annual appraisal. staff told us that they found these useful and a good opportunity to discuss their progress and training needs. The Annual Quality Assurance Assessment received from the home tells us they have improved in the last 12 months by: We have completed the installation of an accounting package. A physiotherapist has been employed to work one day each week with the staff team to undertake residents assessments, monitor progress and deliver manual handling training. Care Homes for Older People Page 27 of 30 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 30 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 Care Homes for Older People Page 29 of 30 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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