Derwent Residential Care Home

Derwent Residential Care Limited is a residential care home providing accommodation and personal care to 21 older people, some of who were living with dementia. The service can support up to 30 people.

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

We found that improvements had been made following the last inspection. People’s care plans provided good guidance for staff about people and how to support them. There was a training plan and the registered manager had oversight of staff training and support needs. Quality assurance systems and audits helped to identify areas where improvements and developments were needed and records demonstrated these were addressed.

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.

There were systems in place to ensure people were safe. Infection prevention control measures meant people were kept protected, as far as possible, from the risk of Covid-19. The registered manager and staff were proud there had not been an outbreak at the home. Visitors were being welcomed back to the home in line with government guidelines. Throughout the pandemic visitors for people receiving end of life care had been supported.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed.

Recruitment procedures ensured only suitable staff worked at the service. Risk assessments provided guidance for staff about individual and environmental risks. Staff understood the risks associated with the people they supported. People received their medicines safely, when they needed them.

People needs and choices were assessed and planned for. Staff received regular training and supervision which enabled them to provide the care and support people needed. People were supported to eat and drink and choice of meals and snacks throughout the day. They were supported to access healthcare as needed.

There was a positive culture at the service. The registered manager had a good oversight of the home and was supportive to people and staff. People, relative’s and staff views had been sought and acted upon to further improve the service.

Rating at last inspection

The last rating for this service was requires improvement (published 24 April 2019).

At this inspection we found improvements had been made.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This enabled us to look at the concerns raised and review the previous ratings.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from poor care provision. Please see the safe, effective and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Derwent Residential Care home is a care home that provides personal and nursing care for up to 34 older people. At the time of the inspection, there were 24 people living at the service. People were supported with a range of personal needs which included those who lived with dementia, and physical health needs.

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

People’s experience of using this service:

¿ Although the registered manager completed audits of the service and people’s care each month, people’s care plans were not always reflective of their current support needs.

¿ The registered manager was in the process of completing easy read documentation to better people’s understanding of menus and the complaints process, however this had not yet been implemented.

¿ Staff had received training; however, the training plan was not up to date with what training had been received. This meant that there was not full oversight of what training staff had received to meet people’s needs. The registered manager was aware of these areas for improvement and needed further time to implement and embed actions.

¿ For some people who required support to make decisions about their care, mental capacity assessments were not reflective of the decision-making process. There was limited evidence to demonstrate that people’s views, or those involved in their care, had been sought.

¿ People and their relatives told us they felt safe and that there were enough staff to meet their needs. Staff knew people and any areas of risk. There were assessments to address these concerns and how these should be mitigated.

¿ Regular checks were completed on the environment to ensure the building was safe for people and the home was clean, tidy and well maintained.

¿ We observed staff giving medicines to people in a safe and person-centred way. Staff had regular training and competency assessments completed to ensure they had a good knowledge of giving medicines.

¿ People and their relatives were confident that staff had the skills and knowledge to meet people’s needs. Staff were further supported in their roles with regular supervision and annual appraisals.

¿ People had regular access to health and social care professionals to improve their wellbeing. People’s nutritional needs were met and they told us they appreciated the quality, quantity and choice of foods offered.

¿ People took part in activities that promoted their health and social wellbeing. The activities co-coordinator also organised activities that reflected people’s wishes and personal histories.

¿ People and their relatives told us they had not had any reason to raise complaints, however felt comfortable doing so with the registered manager.

¿ Although no-one was receiving end of life care at the time of inspection, staff had demonstrated kindness and compassion when people had previously passed away. The service had received lots of thank you cards from relatives with high praise for the support people had received.

¿ People, their relatives and staff spoke highly about the registered manager and felt that a supportive, team working ethic was promoted.

¿ The registered manager was relatively new to their post at this service and had already implemented positive changes to the environment. They had a clear action plan for how they would rectify areas for improvement.

¿ The registered manager knew the importance of working in partnership and had already organised activities with the community as well as accessing continued support from the local authority.

Rating at last inspection:

At their previous inspection, Derwent Residential Care Home were rated as Good. (Report published 3 June 2016)

Why we inspected:

We inspected the service as part of our inspection methodology for ‘Good’ rated services.

Follow up:

We will review the service in line with our methodology for ‘Requires Improvement’ services.

We last inspected Derwent Residential Care on 14 November 2013 where we found it to be compliant with all areas inspected.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People appeared happy and relaxed with staff. There were sufficient staff to support them. When staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate training was provided to ensure staff were confident to meet people’s needs.

It was clear staff and the registered manager had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and skin pressure areas. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA).

People were provided with opportunities to take part in activities ‘in-house’ and to access the local and wider community. People were supported to take an active role in decision making regarding their own daily routines and the general flow of their home.

Staff had a clear understanding of the vision and philosophy of the home and they spoke positively about their work and the management. The registered manager undertook regular quality assurance reviews to monitor the standard of the service and drive improvement.

We found that care and support was person centred and provided in a respectful and dignified manner. Care plans were detailed and personalised. We examined the systems and processes in place for the safe management of medicines and found these to be effective. We found that staff were supported. We saw evidence of robust quality assurance processes to gather information about the safety and quality of the service.

People told us about what they did during the day, we were told, 'I am able to do what I like here, I can stay in my room, the lounge or go out.'

People told us that staff always offered them help if they needed it. One person said, 'staff are very kind.'

We looked at care plans and saw they were personalised and reflected people's assessed needs. We saw that staff engaged well with people and asked their consent before undertaking any treatment or activity.

We looked around the home and saw that it was generally clean and tidy. There were effective systems in place to reduce the risk and spread of infection.

At the time of our inspection there were sufficient staff on duty at the home. There were systems in place which enabled the home to review staffing levels in relation to the needs of the people who lived at there.

There was a complaints policy and this was on display in the entrance hall. People we spoke with told us they did not have any complaints but if they did they would know who to talk to. One visitor we spoke with told us, 'staff always act on my concerns.'