About the service: Yew Trees is a large, purpose-built establishment owned and managed by Meridian Healthcare Limited. The home provides accommodation and support for older people, some of whom live with dementia. At the time of our inspection there were 42 people living at the home.

People’s experience of using this service:

Since our last inspection a manager and deputy manager had been appointed. The manager was in the process of making an application to register with the CQC. Feedback from staff and visitors was positive about the management of the home. We were told the manager listened and acted upon their views. Staff felt supported in their role and said morale within the team had improved.

People’s medicines were not managed safely. Monitoring records used to help manage areas of risk to people were not always kept up to date and completed in sufficient detail. These areas needed to be improved to help keep people safe and maintain their health and well-being.

People and their relatives felt they were safe and well cared for by competent staff. Staff were seen to be respectful and supported people in a dignified and compassionate way. Opportunities were provided for people to take part in a range of activities. These were to be reviewed as part of the improvement planned for the home. Formal ways of involving people and their relatives were in place enabling them to share their views.

Suitable arrangements were in place to ensure the premises, equipment and hygiene standards were adequately maintained so that potential risks were minimised. The manager and provider monitored all areas of the service to help identify if improvements were needed. Where shortfalls had been identified, action plans were put in place to address these. The new manager was being supported to improve the quality of information being recorded.

We have identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to maintaining accurate and complete records. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Good (21 February 2018)

Why we inspected: This was a comprehensive inspection which was brought forward due to information of risk or concern we had received.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor the service through the information we receive, and future inspections.

This inspection took place on 3 and 4 January 2018 and was unannounced on the first day.

The service was last inspected by the Care Quality Commission (CQC) on 3 July 2017 following which the service was rated overall as Inadequate and was placed in special measures. Services placed in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will inspect the service again within six months. This inspection was conducted to check if the provider had made significant improvements within that timeframe.

The provider sent us an action plan giving details of how they intended to address the requirements and make the necessary improvements. During this inspection we found that the action taken had addressed the findings in those requirements made.

Yew Trees is one of a number of care homes in Tameside owned by Meridian Healthcare Limited, part of HC-One Limited. The service is situated in the Dukinfield area of Tameside and is registered to provide residential care for up to 43 older people.

At the time of our inspection there were 36 people living at Yew Trees.

There was a registered manager in post at the time of the inspection. 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.

Care workers understood their role in keeping people as safe as possible and received appropriate training in safeguarding adults.

At the time of inspection medicines were safely managed.

Staffing levels were sufficient at the time of the inspection to meet the needs of people who were cared for and supported by the service.

Risk assessments were in place to minimise the potential risk of harm to people during delivery of their care.

There was a robust recruitment and selection system in place to minimise the risk of unsuitable people being employed to work in the service.

People were supported to participate in activities that encouraged physical interaction, such as light exercise, and sensory stimulation, such as participating in sing-a-longs, doing jigsaws and reminiscence for people living with dementia, such as use of ‘flash’ cards, photographs and pictures.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant that people who may lack capacity were being appropriately supported to make their own decisions whenever possible.

Staff were provided with relevant training and had access to online information and support. Staff confirmed that the training they received was appropriate and supported them to carry out their job roles effectively. Training also included Person Centred Approaches to Dementia Care giving staff a deeper and clearer understanding of how to support people living with dementia.

At the last inspection in July 2017 we rated the well-led domain as 'inadequate' as we found the management of the service was not, at that time, well-led and staff lacked clear management leadership. At this inspection we found the provider had taken action and was now meeting the legal requirements. Although we saw improvement had been made, we have not rated this key question as 'good', to improve the rating to 'good' would require a longer term track record of sustainable good practice.

This inspection took place on 3 July 2017 and was unannounced. At our previous inspection in April 2015, we found the service was good. However staff were not always supported to fulfil their roles. At this inspection we found that no improvements had been made and there were further concerns. We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the service was not safe, effective, caring, responsive or well led. We are currently considering our options in relation to enforcement and will update the section at the back of this report once any enforcement action has concluded. The overall rating for this service is inadequate which means it will be placed into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Yew Trees is registered to provide accommodation and personal care for up to 43 people. At the time of the inspection 41 people were using the service. People who used the service were mostly living with dementia.

There was a new manager who had been in post since March 2017. There were in the process of registering with us. 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 were not receiving care that was safe as there were insufficient suitably trained staff to meet their needs in a safe way. Staff had not received adequate training and support to meet the complex needs of people who used the service.

People were not always safeguarded from abuse as some staff did not recognise that people were at risk of abuse through acts of omission and unplanned restraint. Risks of harm to people were not always assessed, monitored and managed to maintain people's safety.

The principles of the Mental Capacity Act 2005, were not being consistently followed to ensure that people who lacked mental capacity were supported to make decisions which were in their best interests. People were at risk of being deprived of their liberty as some restrictions in place for people had not been agreed through the Deprivation of Liberty Safeguard procedures.

The meal time experience did not support people to eat and drink sufficient amounts to maintain a healthy diet. People who required extra support with eating and drinkin

Most of the people living in the home lived with varying degrees of dementia, which limited the number of people we could speak with in order to obtain their views about the service. We did manage to speak with three people living in the home. One person told us: “I do get asked about things and I don’t do anything I don’t want to.” Another person smiled and pointed to the staff when asked if she felt the staff helped her and listened to her.

We found the provider obtained consent from people who used the service before they provided care and support. When a person had limited capacity to make an informed choice or decision, relatives and other relevant healthcare professionals were involved so that decisions were made in the person’s best interests.

Care plans and risk assessments were in place for each person and these were reviewed regularly to ensure that staff provided appropriate care.

The manager and staff confirmed that they had good working relationships with visiting health care professionals.

The provider had effective recruitment and selection processes in place.

We found from our observations during our visit and from the records looked at, that the registered manager was able to demonstrate to us that there were sufficient numbers of suitably qualified staff on duty.

The provider undertook audits to identify any risks or areas that required improvement. Where actions were identified, the provider took appropriate action.

We haven't been able to speak with many people using the service because most people living in Yew Trees had varying degrees of dementia. We gathered evidence of people's experiences of the service by observing people going about their daily lives and how staff were supporting and interacting with them. We also reviewed various records and information kept in the home such as the complaints log and the latest service user survey conducted in June 2012.

From speaking with the manager and staff it was demonstrated that they had a good knowledge and understanding of people's needs and how best to meet those needs. During our visit we heard staff speaking with people respectfully and politely. We saw staff supporting and assisting people at a pace that was unhurried and met their needs.

Each person using the service had a care plan in place and this was being reviewed on a monthly basis or sooner should the need arise.

We found everywhere to be clean, tidy and comfortably furnished with no unpleasant smells detectable.

This review took place to check the provider had made improvements in relation to some concerns we identified in the last review. At our last visit to the service we spoke to some people using the service. Everyone we spoke with gave us positive feedback about the care they were receiving. Therefore, we did not seek further feedback from people using the service during this review.

Due to the nature of the service provided at Yew Trees we were limited to the number of people able to speak with us and express an opinion about the service. Those people we did speak with told us that it was a good place to live and that the staff provided them with the care and support they needed. Some regular visitors to the home told us that in their view people living in Yew Trees were well looked after.

This inspection was carried out over two days on the 5 and 6 May 2015. Our visit on the 5 May was unannounced.

We last inspected Yew Trees in October 2013. At that inspection we found that the service was meeting all the regulations we assessed.

Yew Trees is a large, purpose built establishment owned and managed by Meridian Healthcare Limited. The home provides care for older people, some of whom have a dementia or physical disability.

There was a registered manager in post. 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.

We found the building to be well maintained, clean, and tidy and odour free.

People we spoke with were positive about the attitude and competency of the staff team. The atmosphere in the home was calm and relaxed and we observed good interactions taking place between the staff and people who used the service.

People told us they felt safe living at Yew Trees and staff spoken with understood their responsibilities in maintaining the safety and wellbeing of the people who used the service.

Staff had access to appropriate training.

We found staff recruitment to be thorough and all relevant pre-employment checks had been completed before a member of staff started to work in the home.

Staff did not receive supervision on a consistent basis. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The registered manager and senior team undertook checks of the quality of service provision.

We looked at the way in which medicines were managed in the home. We found that medicines were managed safely.