About the service:

Yew Tree Lodge is a residential care home that can provide the regulated activity of personal care to a maximum of 16 people. Three of the beds are crisis beds, with the remaining 13 residential (long term stay). The service provides care to people who have a diagnosis of mental health issues. Many of the individuals having experienced periods of stay in hospital and require a level of support prior to transitioning to community based living.

People’s experience of using this service:

¿ Risks were identified for people on long term stay and actions put in place to prevent these. However, no guidance was provided to staff on what action to take, if the risk occurred.

¿ People on crisis beds did not have sufficient risk assessments in place to detail how staff were to support them and keep them safe, on admission.

¿ By day two of the inspection the registered manager had mitigated all risks, and ensured all paperwork was up to date and relevant to people.

¿ People reported feeling safe and well supported by the staff team.

¿ Medicines were managed safely, by competent staff.

¿ Recruitment procedures ensured appropriate staff were employed to work with people and keep them safe, as much as possible.

¿ The service ensured that measures were in place to prevent the spread of infection. The home was clean and tidy. People reported no concerns in relation to cleanliness.

¿ People reported that staff and the management team were approachable. We were told they listened to concerns.

¿ Quality assurance surveys illustrated the service had sought feedback from people, relatives and health professionals, and had made changes, where possible.

Rating at last inspection:

The service was last inspected in February 2018 and was rated Good in all domains. The service did not have anyone using the crisis beds at the last inspection. At this inspection we found that the service required improvements specifically in supporting people in crisis beds. As a result, the overall rating has been amended to reflect this.

Why we inspected:

This was a focused inspection that was prompted by a serious incident that resulted in a person’s death. As the death is currently being investigated, we did not look at this specifically during the inspection. We focused on the domains of safe and well-led for this inspection.

Follow up:

We will continue to monitor all information we receive about this service. This will inform our ongoing assessment of their risk profile and ensures we are able to schedule the next inspection in accordance.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 12 and 14 February 2018, and was unannounced. Yew Tree Lodge is a care home without nursing providing care and support to people with a primary diagnosis of mental health. The service does not provide any nursing care. The service offers 13 residential beds, and an additional three crisis beds, for a maximum of 5 days. At the time of the inspection 12 people were using the provision.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A newly registered manager was in post when we inspected. 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.

The service remained safe. Sufficient staff were employed to manage people’s needs. Staff knew how to safeguard people from abuse and were able to describe the protocols to follow should they have concerns. They further advised of the confidential hotline details the provider had given the staff should they wish to raise concerns confidentially. Staff were involved in medicine management. Systems had been employed by the service to ensure safe medicine management. This had recently identified a couple of concerns that were promptly managed. On day two of the inspection, the inspector highlighted two issues with people’s medicines. These were reported to the registered manager. Staff were competency checked annually and upon returning to medicine management, with monthly audits of medicines completed to ensure people were kept safe.

The service remained effective. Support was delivered by a knowledgeable and trained staff team, who were able to respond appropriately to people’s changing needs. Whilst refresher training courses had not been booked for all staff, this was rectified with competency checks completed until training was made available. Staff were supervised and supported by an effective management team, who made certain they were available to staff at all times. People were supported to have maximum control of their lives through recovery plans that were written by the people for themselves.

The service remained caring. Staff were polite, respectful and ensured they maintained people’s dignity when supporting them. They encouraged open communication and worked on motivating people to increase their independence within the home and in the community. Evidence of using systems of communication that reflected the person’s choice was evident in the service.

The service remained responsive. Recovery plans were individualised, focusing on people’s specific needs. It was recognised by the management that the current IT systems could possibly mean that not all information was made available to staff working with people. The provider had sought to remedy this by introducing a new IT system that would be developed in conjunction with the registered manager. This meant that the information that the staff working with people felt was necessary in supporting people was always made available.

The service took necessary action to prevent and minimise the potential of social isolation. Activities were arranged by the service, with individual programs developed working on reducing people’s isolation individually. People and staff were protected from discrimination. Measures were in place to allow people to be treated equally. Systems to monitor and investigate complaints were in place.

The service was well-led.

This inspection took place on 7 and 15 January 2016.

Yew Tree Lodge is a care home that offers accommodation for people who require personal care. Although registered to provide a facility for up to 16 people, the location currently has 12 people using the service. The location provides support to people who have a primary diagnosis of a mental health issue. The support is broken down into three main categories: crisis beds – for up to 5 days, respite care and long term support.

The home is required to have a registered manager. The last registered manager was in post until December 2015. In the absence of a registered manager, the home has been supported regionally by senior management. Interviews have been conducted and a successful candidate has been appointed to commence employment from February 2016. 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.

As part of this inspection process, the action plans submitted following breaches from the December 2014 inspection were to be looked at to determine whether these had been appropriately met. It was found that the provider had taken sufficient action to rectify these breaches in the area of quality assurance and staff support.

Staff knew how to keep people safe by reporting concerns promptly. Systems and processes were in place to recruit staff who were suitable to work in the service and to protect people against the risk of abuse. There were sufficient numbers of suitably trained and experienced staff to ensure people’s needs were met.

We observed good caring practice by the staff. People using the service said they were very happy with the support and care provided. Care plans and risk assessments were found to be updated and reviewed in conjunction with external professionals and with each person. People were provided a copy of their risk management, for them to retain should they wish to have a copy.

People told us communication with the service was good and they felt listened to. All people spoken with said they thought they were treated with respect, preserving their dignity at all times.

People were supported with their medicines by suitably trained, qualified and experienced staff. Medicines were managed safely and securely. People were given the opportunity to independently self-administer medicines in agreement with health care professionals.

People received care and support from staff who had the appropriate skills and knowledge to care for them. All staff received comprehensive induction training and support from experienced members of staff. They felt supported by management and said they were listened to if they raised concerns.

Quality assurance audits and governance of documents were found to be completed by the service. This therefore ensured the opportunity to continually assess and make changes where necessary for improvement of the service.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. The provider had appropriate policies in place with regard to seeking consent and considering people’s capacity under the Mental Health Act.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with nine people who use the service. All of them told us they were involved in their care planning. One person said “suggestions about my care are respected and acted upon”. Another said “staff are very supportive of my choices”.

There were effective systems in place to reduce the risk and spread of infection. We observed the home to be clean and tidy. Staff we spoke with had recent infection control training and were able to explain the relevant infection control and prevention procedures.

There were effective recruitment and selection processes in place and the appropriate checks were undertaken before staff began work.

The home had systems in place to deal with comments and complaints and people were made aware of the complaints system. Information about complaints was provided in a format that met people's needs. People told us they were aware of the complaints process and would be happy to use it if they needed to.

We spoke with several of the people living in Yew Tree Lodge. They were positive about the home and the support they receive from the staff. They described a relaxed atmosphere where staff support was available to them, as and when needed, or as part of a planned programme. The felt safe and got on well with all of the staff.

This inspection took place on 4 & 17 December 2014 and was unannounced. We last inspected Yew Tree Lodge in June 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

Yew Tree Lodge provides accommodation and personal care for up to 16 people with mental health conditions. The service supports people on a medium term basis as well as providing respite care and supporting people who may be in a period of crisis for a minimum of 72 hours and a maximum of five days. The aim of the crisis support is to prevent a hospital admission or to support a person who had just been discharged as an in-patient. There were 11 people living at the home, one person using the respite service and one person being supported during a period of crisis.

The home 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. The registered manager was responsible for two services and was not in the home on a full time basis.

Staff had not been fully supported with appraisals and none had been completed recently. Supervisions were not done regularly and some training specific to the needs of people who use the service had not been completed by all staff.

Some people commented that staff were too busy completing paper work at times. Care workers felt there were staff shortages and they did not have enough time to spend with individuals. There were no systems in place to regularly assess and monitor staffing levels to ensure they were sufficient to meet people’s individual needs.

Complaints were not always well managed. Although issues raised with the service in February 2014 were well investigated, a recent complaint made by three people who use the service was not. The provider did not regularly seek the views of people who use the service and others about the quality of service provided. Quality monitoring audits were completed, including health and safety and infection prevention and control. Where areas for improvement had been identified action had been taken. Incident and accident analysis was inconsistent. Although incidents had been reported within the service and analysed appropriately, action was not taken after one incident and one was not reported to CQC when it should have been.

Staff said they knew about whistle blowing and would be happy to raise any concerns within the home, but they did not have the confidence to raise issues with senior managers. Staff said they felt well motivated and they enjoyed working at the home.

People felt safe and said that any concerns they might have about their safety would be taken seriously by staff. Staff knew how to recognise the signs of abuse and what they should do to protect people.

People were supported to take their medicines safely and staff were well trained in safe medicines administration. Although medicines administration was safe, people who wanted to self-administer medicines were not given the opportunity to do so.

People had enough to eat and drink and were well supported to buy and prepare their own food. People had access to health care services and were supported to maintain good health. There were good links with members of the community mental health team and people were able to access other health care professionals such as the GP or dentist.

People were involved in making decisions about their care and were complimentary about the staff and the care they provided. Comments included: “I think the staff are excellent” and “the service does deliver high quality care”. We observed staff supporting people in a very respectful and caring way. They knew the people well and promoted people’s privacy and dignity.

People were well supported to participate in activities outside of the home, such as the cinema or shopping. However, some people said they were bored because there was nothing to do when they were at home. Staff offered people activities in the home, but said they were not well attended by people who use the service.

Care plans were individual to each person and contained all of the relevant information to enable staff to meet people’s care needs. Staff were responsive to changes in people’s health conditions and took appropriate action when necessary.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider did not regularly seek the views of people who use the service, those acting on their behalf or staff. Staff were not properly supported to provide care to people who use the service. This was because staff did not receive appropriate training, supervision and appraisal. You can see what action we told the provider to take at the back of the full version of this report.

We recommend the service considers NICE guidance ‘Managing medicines in care homes’.