This inspection visit took place on 12 December 2016 and was unannounced.

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

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

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

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

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

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

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

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

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

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

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

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

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

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

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

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

This is a summary of what we found-

Is the service safe?

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

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

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

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

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

Is the service effective?

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

Is the service caring?

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

Is the service responsive?

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

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

Is the service well-led?

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

We spoke with five people who lived at the service. They all told us that the staff were approachable, polite and respectful. Our own observations supported this view. People we spoke with all told us the routines in the home were flexible, and they said they could get up or go to bed when they chose to. We saw at lunchtime that tureens of vegetables and gravy boats were placed on the tables to enable people to serve themselves. This was one example of how the home tried to encourage choice.

All of the people we spoke with told us they received the care they needed when they needed it. They all said that their health was looked after well and said the staff were attentive and responded to changes in their health by seeking medical advice. One person told us, "I get very good care. The GP is called very quickly and prescriptions are picked up very quickly." People we spoke with all told us there were regular activities at the home, and they said they could choose whether to join in or not. They said there were trips out and entertainment was also provided at the service. People told us there was enough to occupy them.

The people we spoke with all told us they felt safe at the service and had never seen anything which would worry or concern them. One person told us, "I feel safe here, to be honest there are not many people who have difficult behaviour, and the staff are very good. I have never seen anything which has worried or concerned me. If I did I would talk to (the acting manager) about it, she would sort it out I am sure."

No-one raised any concerns about the competence of staff and they all said the staff were kind and caring. One person commented, "the staff are kind and caring, they seem to know what they are doing and they understand me and what I need. (The acting manager) is very aware of the staff and what they do, she is around a lot and is always talking to us, finding out how things are. I have no worries."

People told us the acting manager and the provider were on site at the home every day. They told us that the provider always had time for them and spent time chatting to them about their experience of the care provided. They told us that residents' meetings were held regularly and they were encouraged to share their views. A relative told us that any issues he raised had always been acted on straight away. All of the people we spoke with said they were happy living at the home.

We carried out our inspection on 29 April and 8 May 2015. The inspection on 29 April 2015 was unannounced and we returned on 8 May 2015 this was announced.

The Yews is a care home that provides accommodation for up to 27 people. On the day of our inspection there were 22 people using the service. The registered manager told us that two people had recently returned to their own homes following a respite stay. Also a double bedroom was currently being used for single occupancy.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our last inspection on 2 June 2014 we asked the provider to take action to make improvements to protect people living at the home. The provider was not meeting three Regulations of the Health and Social Care Act 2008.

People were not having their mental capacity assessed to see what decisions they were able to make about their care and welfare. This meant that decisions about people’s lives may not be made in their best interests.

The provider had not made arrangements to ensure that everyone using the service had an up to date and relevant care plan. This meant staff did not have the information they needed to ensure people received the care they needed when they needed it.

Although the provider had systems for the safe management of medicines in place they were not being used by staff. So people were not protected from the risks associated with unsafe use and management of medicines. Accurate recording of medicines administered and audit of stock levels were not carried out.

Improvements had been made in the delivery of people’s care and people received the care and support they needed and wanted. People’s needs were assessed and plans were in place to meet those needs. Plans were regularly updated to ensure they remained relevant to people’s needs. People had their risks to health and well-being identified and plans were in place to manage identified risks. Plans of care were person centred and showed how people preferred to receive their care.

People received their regular medicines as prescribed. However, medicines were not always safely stored. We informed the registered manager and provider on the day of our inspection who said they would take immediate action to address this.

People we spoke with and relatives were happy with the care and support provided. People felt safe at The Yews. People also said that care staff knew their individual needs and wishes.

Care staff were caring and kind in their approach to people who used the service. They understood people’s individual needs and treated people with dignity and respect. People were involved in discussions and decisions about their care and treatment. People also said they knew how to complain and they would feel confident complaints and concerns would be dealt with by the registered manager.

Care staff received the training and development they needed to develop their practice and keep up to date with changes in legislation. Staff recruitment procedures were robust and appropriate checks were carried out before staff started work. Care staff had the time they needed to get to know people and understand their individual preferences.

Staff knew how to protect people from avoidable harm and understood local safeguarding procedures. This meant that any concerns or allegations of abuse would be reported to the appropriate authority.

People had been asked for their consent to care and treatment and their wishes and decisions respected. The provider understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008.

People were supported to access healthcare professionals when they needed to. Visiting healthcare professionals said that staff contacted them in a timely manner and followed their advice where they could. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided.

Systems were in place to assess and monitor the quality of the service. The provider made arrangements to gather the views and opinions of people who used the service. People’s complaints and issues of concern had been responded to promptly and outcomes were recorded identifying what action had been taken. Internal audits were being used effectively and had recently identified shortcomings in the administration of medication. The registered manager and deputy manager had put a strategy in place to make improvements.