Archived: Yew Tree Manor Nursing and Residential Care Home

Updated 14 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Yew Tree Manor Nursing and Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Yew Tree Manor Nursing and Residential Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

The first day of the inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who worked with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with three people who used the service and three relatives. We spoke with fourteen members of staff, including the registered manager and deputy manager from the service’s sister home, four nurses, six members of care staff and two agency staff. We also spoke with three visiting health and social care professionals. We spoke with the nominated individual by telephone.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We observed care throughout the home and observed a full medicines round. We reviewed a range of records, including electronic care plans, several of these in detail. We followed up and cross-referenced a number of records relating to nutrition, hydration, choking risks and skin integrity. We looked at multiple staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 14 October 2022

Yew Tree Manor Nursing and Residential Care Home is a care home providing personal and nursing care for up to 43 people aged 65 and over. The home caters for people who may be living with dementia or lack capacity. At the time of our inspection there were 36 people living in the home.

People’s experience of using this service and what we found

People’s individual risks were not always assessed, monitored and managed effectively. Records of people’s dietary requirements, which placed some people at increased risk of choking or aspiration, had not been maintained accurately. Equipment to aid moving and handling of people was not managed safely.

There were numerous risks to people’s safety around the home. For example, there were a significant number of trip hazards and a fire exit was blocked. Health and safety records were in place and up to date.

Staff told us the home was often short staffed as staffing numbers had been reduced. This had a negative impact on people's care as staff did not have sufficient time to meet people's needs.

Staff training records were not up to date. It was, therefore, difficult to ascertain whether staff had completed the required training. Incidents were not always recorded and escalated as required.

Staff files were difficult to locate and information was kept in different places. However, the files included appropriate documentation to indicate staff had been recruited safely.

Medicines were not always managed safely. Medicines audits had not been completed for some time, so issues had not been identified and addressed. Thickeners, used when people required their drinks thickened due to choking risks, were not stored safely and were being used communally, for anyone who required them, rather than for the individual for whom they were specifically prescribed. There were no care plans in place for two people who had medicines administered covertly (hidden in food or drink). Senior care staff, who administered medicines, were only required to complete online training and their competence was not regularly re-assessed to ensure their skills continued to be of a good standard.

The premises were not clean, and basic infection control and prevention requirements were not being followed. There was a backlog of laundry and the laundry room had no system to separate clean and soiled items.

There was an appropriate safeguarding policy in place, which staff were aware of. Staff had completed safeguarding training at induction. It was difficult to ascertain whether concerns had been addressed appropriately, as records were not up to date.

People were not treated with dignity and respect. We observed some people waiting a long time to receive personal care. There were two shared rooms within the home. One in particular offered little privacy for the occupants, as it only had a small portable screen between the beds.

We saw little interaction between staff and people who used the service. Staff did not always have enough information to be able to support people well. There was little evidence to suggest people were asked for their views or involved in decision making around their care and support. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were a number of incomplete or missing care plans and those that were in place had a lack of detail about people’s wishes and preferences. People told us they were not given choices with regard to meals. There was a lack of activities and stimulation within the home.

Although the nominated individual had visited the service in the months leading up to the inspection. They had not taken responsibility for supervising the management of the service or had any effective oversight.

Since the registered manager had left, there had been no system for dealing with correspondence. There were unopened appointment letters for people at the service, which could have had a detrimental effect on their health and well-being

There was no registered manager, deputy manager or clinical lead and no one taking leadership at the home. There was no management oversight, no audits or reviews, had been completed for a number of months. No one at the service had been taking responsibility for submitting notifications to CQC.

The service had not been working effectively with visiting professionals and this had put people at increased risk. This was due to the lack of management and leadership at the home. Complaints had not been monitored for some time.

Staff morale was low and there was currently little engagement from the provider with them. Staff we spoke with said they didn’t feel valued.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 30 April 2020). At this inspection we found the provider was in breach of regulations and the service was rated inadequate.

Why we inspected

The inspection was prompted in part due to concerns received from the local authority, around staffing and the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yew Tree Manor Nursing and Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, person-centred care, consent, dignity and respect, premises and equipment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.