Derwent Lodge Nursing Home

Updated 22 August 2023

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Derwent Lodge Nursing 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. Derwent Lodge Nursing 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This 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 who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager, regional manager and 6 other members of the staff team. We spoke with 10 people who used the service and 4 relatives, about their experience of the care provided.

We reviewed a range of records. This included 5 people's care records and medication records. We looked at 3 staff files in relation to safe recruitment. A variety of records relating to the management of the service, including audits were also reviewed.

Updated 22 August 2023

About the service

Derwent Lodge Nursing Home provides accommodation and personal and nursing care for up to 46 people. At the time of the inspection 33 people were living in the home, some of whom were living with dementia.

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

Risks to people were not always assessed and mitigated robustly, as although risk assessments had been completed, they were not always updated when people’s needs changed. Repositioning records did not all reflect that people received support as planned and pressure relieving air mattresses were not all set at the correct setting for people. Care plans were detailed regarding people’s medical conditions, but other plans were not always updated when people’s needs changed.

Most people told us staff were very busy at times and they had to be patient and sometimes had to wait for care. Staff told us that although they were busy at times, especially mealtimes, they felt there were enough staff to meet people’s needs. Staff rotas showed staffing levels were not always maintained at the usual level the registered manager described during the inspection, although agency staff were used when possible. We made a recommendation about this.

Although a range of audits were completed to monitor the quality and safety of the service, they required further development to ensure they effectively identified all improvements required. New systems in place had led to improvements within the service, such as medication stock checks, recording of thickening agents and care plans regarding people’s medical conditions.

Medicines were managed safely; they were stored securely and administered as prescribed. There were protocols in place to guide staff when to administer medicines prescribed on an 'as required' (PRN), but these required further person-centred detail to ensure staff knew when to administer them. Medicines were administered by staff that had undertaken training and had their competency assessed.

People told us they felt safe living in Derwent Lodge Nursing Home. Procedures were in place to ensure safeguarding concerns were managed appropriately and records showed that accidents were recorded and reported, and appropriate actions were taken to ensure people's safety. Effective infection prevention and control measures were in place, and the home appeared clean and well maintained.

Referrals were made to other professionals when required for their specialist advice and support, to ensure people’s needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

People and their relatives told us they felt the service was well managed and they were always informed of incidents and kept updated regarding any changes in their family members' well being. Staff told us they were well supported and enjoyed their jobs. Systems were in place to gather feedback from people, staff, and relatives.

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 9 May 2022). At that inspection breaches in relation to Regulations 12 and 17, regarding medicines management, risk management and the governance of the service were identified.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made in relation to medicines management and the governance of the service and the provider was no longer in breach of Regulation 17. However, further improvements were required in relation to the assessment of risk and the provider remained in breach of Regulation 12.

This service has been in Special Measures since 1 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 remains requires improvement. This is based on the findings at 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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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 Derwent Lodge Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to the management of risk at this inspection. We also made a recommendation regarding staffing. Please see the Safe key question for further infromation.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.