The inspection took place on 1 June 2017 and was unannounced.

Yewtree Nursing Home is registered to provide accommodation and personal and nursing care for up to 40 people. At the time of the inspection there were 33 people living at the home ranging in age from 56 to 100 years.

There was a mix of double and single bedrooms. Twenty one bedrooms had an en suite bathroom which consisted of a shower, toilet and wash basin. There was a large living room which was also used as a dining room plus other communal areas which people used for activities or to have meals. There was also a separate activities room. A passenger lift was provided in two areas so people could access the first floor.

The service did not have 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 provider had recruited a new manager who was in the process of applying for registration with the Commission. The provider had notified us of these changes.

At the previous inspection of 3 and 4 May 2016 we found the provider had not ensured people received safe care and treatment. This included the maintenance of safe premises and procedures for supporting people who had problems swallowing food. We made a requirement for this regulation to be met. The provider sent us an action plan of how this was to be addressed and at this inspection we found the regulation was met.

At the previous inspection of 3 and 4 May 2016 we found the provider had not ensured staff received adequate support and supervision to enable them to carry out their duties. We made a requirement for this regulation to be met. The provider sent us an action plan of how this was to be addressed and at this inspection we found the regulation was met.

At the previous inspection of 3 and 4 May 2016 we found the provider had not ensured care and treatment was only provided with the consent of people and where people lacked capacity had not acted in accordance with the Mental Capacity Act 2005. We made a requirement for this regulation to be met. The provider sent us an action plan of how this was to be addressed and at this inspection we found the regulation was met.

People and their relatives said they were satisfied with the standard of care provided at the home. For example, one person commented, “I would recommend this place if you need care.” Health and social care professionals also said the service provided a good standard of care.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed risks to people were assessed and the action to be taken to mitigate those risks. These assessments and care plans were reviewed and updated at regular intervals to ensure people’s changing needs were met.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

Medicines procedures were safe.

The home was found to be clean and free from any odours.

Newly appointed staff received an induction to prepare them for their work. Staff had access to a range of training courses and said they were supported to attend training courses.

There was a varied and nutritious menu where people could make choices. Steps were taken to ensure people had adequate food and drink.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks.

The environment and décor had greatly improved since the last inspection. Bedrooms

The inspection took place on 3 and 4 May 2016 and was unannounced.

Yewtree Nursing Home is registered to provide accommodation, personal care and nursing care for up to 40 people. At the time of the inspection there were 30 people living at the home ranging in age from 56 to 100 years. These people had needs such as a learning disability, Parkinson’s disease and dementia.

There was a mix of shared and single bedrooms, 16 of which had an en suite facility. There was a large living room which was also used as a dining room plus other communal areas which people used for activities or to have meals. A passenger lift was provided in two areas so people could access the first floor.

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.

At the time of the inspection there was a programme of refurbishment taking place. Steps had been taken to reduce any disruption caused by the building works by the use of screening. Upon entering the building at the main entrance people and visitors needed to duck to avoid hitting their head on a low ceiling in a corridor leading from the entrance hall. This was also the case in the hallway immediately above the hall on the first floor. The provider told us this was being addressed as part of the ongoing building works. Measures were taken to ensure the equipment and premises were safe but it was unclear how the provider was maintaining safe hot water temperatures to prevent scalding to people and for reducing the risk of legionella.

The garden at the front and rear of the home was not well maintained and there was a risk of people tripping on the long grass.

Medicines procedures were generally safe with the exception there was no guidance for staff to follow of when a person needed an ‘as required’ medicine. The main office was used to store medicines on a temporary basis as the treatment room was undergoing refurbishment. Staff were trained in medicines but this did not involve a formal assessment which involved observation of their competency to do so.

The home was found to be clean and was free from any odours.

Staff received formal supervision of their work but this was infrequent.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Whilst the provider made DoLS applications to the local authority for people who were unable to consent to their care and treatment and whose liberty was restricted, assessments of capacity were not carried out. This meant there was a risk people may have had an application to deprive them of their liberty when it was not appropriate.

There was a varied and nutritious menu where people could make choices. Steps were taken to ensure people had adequate food and drink but the monitoring of those who had difficulties in swallowing was not always effective.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm. Further information needed to be included in some care plans to highlight to staff how people were safely bathed.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

Newly appointed staff received an induction to prepare the

We spoke with four people in the home. One person told us “I like the food, I had chicken today”. We were told “We did exercises today and there is bingo tomorrow”. Another person told us “I like it here” and another told us “I could complain to whoever is in the office”.

However many of the people that lived at Yewtrees were unable to tell us about their experiences. To help us to understand the experiences people had we spent time observing what was going on in the home, how people spent their time, the support they received from staff and whether they had positive outcomes. This was called the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

From our observations we found that overall people had positive experiences. The staff were seen speaking to people in a kind and respectful way. The staff responded promptly to requests for assistance and they ensured people had frequent hot and cold drinks.

We spoke to two visitors who were very complimentary about the home. We were told that the home was very clean and that the staff were very kind. They informed us that they had been very involved in the admission process, had been visited at home prior to the persons admission and that any requests they had made regarding personal care had been acted on. They confirmed a recent barbeque celebrating the Olympic games held in London.

One social work professional visiting told us that the Home “was fantastic for clients”. It was confirmed that any specific equipment needed was provided by the home. We were told it was a very positive move for the client and that the staff were very “open and transparent”.

We carried out this inspection over two days, the second being for a short period only to review the medication policies and procedures.

Some people living in the home had complex needs and were not able to tell us about their experiences. We observed people to be treated with kindness and respect and being given choices throughout the day and people who we were able to speak with said they were happy in Yewtree Nursing Home. One said "I am happy here, the staff are very helpful and treat me with respect and I'm not stressed in any way". The visiting GP told us "It is a super home with amazingly good care. It is clean and the atmosphere is nice, staff are friendly and our care calls are always appropriate".

Relatives told us they were satisfied with the quality of care and confirmed that people's needs had been assessed before they agreed to move and that they had been involved in the admission process. The plans of care we saw were person centred, regularly reviewed and included up to date risk assessments.

Medicines were administered safely and as prescribed by competent nurses.

The recruitment and selection processes in place ensured that all staff had appropriate checks before starting work and undertook relevant training.

Systems were in place to monitor the quality of the service. We found that the provider was responsive when issues were raised and lessons were learnt from incidents.