This inspection took place on 4 & 5 April 2018 and was unannounced.

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

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

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

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

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

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

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

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

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

People and relatives who provided feedback during the inspection showed a positive appreciation for the quality of care and support people

The inspection was unannounced and took place on the 15 March 2017 with a further announced inspection day on 16 March 2017. Yew Tree House is a care home for up 13 older people some of whom may have the early onset of dementia type illnesses. Nine people were in residence on the days of inspection. There are 12 bedrooms one of which can be used as a shared room. Ten rooms are located in the main house over the ground and first floor with a shaft lift for people to access the first floor. Two semi-independent flats are located on the ground floor of an adjacent building on the site and one of these was occupied at the time of inspection.

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

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

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

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

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

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

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

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

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

Staff continuity was very good. New staff received an induction into the service tailored to their specific level of experience. Sixty per cent of the staff team held nationally recognised ca

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

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

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

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

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. Yew Tree House is a care home registered to provide care and support for up to 13 older people. The home is located at the end of the village high street and serves people in the local area and surrounding villages. The majority of people living there had capacity but were unable to cope with independent living and needed some additional support. A few people were living with the early stages of dementia but this did not as yet impact on their day to day quality of life. There were twelve people living in the home, including two people who occupied two ground floor flats in the grounds of the home, and who needed less staff support. The service had also started to offer on a limited basis day care to people in the village; this offered people company, an assisted bath if they wished and also a hot lunch.

There was registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Our observations, and feedback from people and their relatives, showed us that people were well cared for, and that they felt safe. People told us that they were happy with their choice of home and satisfied with the care and support they received from staff. People told us they felt well supported by staff and that they were always available.

The majority of people had capacity to make their own decisions, but staff were not aware of what actions they needed to take when this changed. No one was currently subject to a Deprivation of Liberty Safeguards (DoLS) authorisation but the manager and staff awareness of when an application should be made needed improvement, as they had not kept up to date with recent changes which widened and clarified the definition of a deprivation of liberty.

All essential care documentation was in place but this was not always well completed and minor changes in people’s care needs might not be immediately recorded, this could impact on delivery of consistent care. The service could not always evidence that people consented to the support they received. People were supported to access healthcare at the home or in the community when they needed to.

A system for reviewing care records was not sufficiently robust to highlight these shortfalls. People were encouraged to maintain a level of independence for as long as they could and staff understood this could vary from day to day. People had little occupation and could become bored. There were no tailored activities to support people to continue with hobbies or activities that interested them.

Staff said they were provided with training but records showed updates of training were long overdue for some staff and this could place people at risk of experiencing support for their care needs that was not current or best practice. This is a breach of Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Staff told us how they would recognise and respond to abuse they were aware of the importance of disclosing concerns and were informed about the organisations whistleblowing policy. Most staff had received safeguarding training.

The registered manager had failed to notify CQC of some important events that happened to people at the home as required by the regulations. These were breaches of regulation 16 HSCA 2008 (Registration) Regulations 2009 Notification of death of service user, and also Regulation 18 HSCA 2008 (Registration) Regulations 2009 Notification of other incidents. You can see what action we told the provider to take at the back of the full version of this report.

We found that the processes used by the registered manager and provider to assess and monitor the quality of service quality were not used effectively and showed they were not monitoring some areas of service delivery and quality to ensure people were kept safe and all their needs were fully addressed. This was a breach of Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service provision. You can see what action we told the provider to take at the back of the full version of this report.

During the inspection visit seven people were living at the service. We spoke with five people, a relative, a healthcare professional who was visiting, three staff and the manager.

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

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

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

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

At the time of our inspection there were eight people using the service. People told us that they were happy with their care. One person said “I am very happy here”. A visitor to the service told us “The care is very good”.

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

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

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

We were able to speak with people who use the service and some visitors to the home.

People told us they had chosen to move to the home and had been able to visit before they moved in. They all said they were very happy with the service and that the manager often spoke with them to ask how things were going and to get their views of how the home was being run. One person said “It feels like a family here”.

People told us that their care was provided in private and that they were encouraged to do as much for themselves as possible. One person commented “I am pleased that they let me be as independent as possible, it’s important really”. People told us that they were offered a bath once a week. When asked if they could have one more often than that they were not sure, but everyone said that once a week suited them. People said they were able to get up and go to bed when they wished to and one person said “They never rush me, I can get up when I am ready”.

People told us they were always given a choice of two meals and could always ask for something else if they did not like the two choices offered. They said the food was” Very good”. Most people were happy with the activities that were provided, but one person said “it would be nice to have a bit more going on”. Another person said ”its nice that we have such close links with the church”. People told us that they had sing-a-longs in the home, which they enjoyed, and that there were sometimes quizzes.

Everyone we spoke with said that the staff responded quickly to any changes in their health and that they would arrange for them to see a doctor or a nurse when they needed to. A visitor commented that they were always informed about any changes in the person’s wellbeing and that this reassured them. They said “I know they will call me if there are any problems”.

People told us that their rooms were cleaned daily and their beds changed regularly. They said that they were very happy with the standards of cleaning in the home. People we spoke with said that they saw the staff washing their hands and wearing gloves when helping them with their personal care.

People told us that they felt safe in the home and that they were confident to talk to the manager or the owner if they were worried about any part of their care. People said that they liked the staff that supported them and that they were treated with kindness and respect. One person said “I think there are enough staff, but they are busy and it would be nice if they had more time to sit and chat with us”. Other comments included “The staff are all friendly and it’s nice that they all work well together” and “The staff seem to enjoy their jobs, that makes the atmosphere good”.