Derwent Lodge Care Centre

Derwent Lodge Care Centre is a nursing home for up to 65 people. Most people using the service were older adults. Some people were living with the experience of dementia. At the time of our inspection 62 people were living at the service.

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

People were happy with the care and support they received. They had good relationships with staff and felt their needs were met. Their relatives felt good care was provided and they were involved and well informed.

There were enough suitable staff. The staff were happy and well supported. They had a good range of training and opportunities to meet with their managers. The staff explained managers worked alongside them and provided consistently good leadership.

Medicines were managed in a safe way.

There were procedures for identifying, investigating, and responding to complaints, safeguarding alerts, and other adverse events.

There were effective systems for monitoring and improving the quality of the service. The provider had made improvements since the last inspection. The managers carried out audits which included gathering feedback from people using the service, staff, and other stakeholders.

The risks to people's safety and wellbeing were assessed and planned for. People were enabled to take positive risks and do things for themselves when they were able and wanted this.

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.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 March 2023).

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 and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 17 January 2023. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they 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.

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 good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Derwent Lodge Care Centre is a care home with nursing for up to 65 older people, some who may be living with the experience of dementia. At the time of the inspection, there were 62 people living at the service. The accommodation was on three floors in separate 'units' (Diamond, Rainbow and Star) each with a dedicated team of staff.

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

Some of the practices around medicines management needed to be improved. For example, some medical supplies and equipment had passed the expiry date and therefore may not have been effective. The provider's own audits had not identified this.

Some equipment was not thoroughly cleaned, and some practices increased the risk of the spread of infection.

The provider took action to correct the issues we identified and also put in place systems to help prevent the reoccurrence of these incidents.

People using the service and their relatives were happy with the care they received. They liked the staff and had good relationships with them. People were treated with kindness and respect. There was a relaxed and friendly atmosphere. People were not rushed and were able to make choices about how they spent their time.

There were enough suitable staff, a rigorous recruitment process and in-depth training. Staff felt supported. They had enough information for their roles, there was good communication and they worked well as a team. The staff found the management team approachable and helpful.

People's care was well planned, and they were involved in making decisions about this. Their preferences were known, and they had opportunities to take part in a range of different social activities. Their nutritional and hydration needs were met. The staff worked closely with other professionals to make sure people's healthcare needs were monitored and met.

The registered manager and management team were knowledgeable about the service. They were aware of their responsibilities and legal requirements. There were suitable systems for auditing the service, for dealing with complaints and other adverse events and for making the improvements.

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.

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

Rating at last inspection

The last rating for this service was good (Published 23 October 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment at this inspection.

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.

Derwent Lodge Care Centre is a care home with nursing for up to 62 older people, some who may be living with the experience of dementia. At the time of the inspection, there were 61 people living at the service. The accommodation was on three floors in separate 'units' (Diamond, Rainbow and Star) each with a dedicated team of staff.

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

At this inspection we only looked at some aspects of the service and have not made judgements about other areas.

We identified a small number of concerns, which included people being able to access to potentially unsafe areas within the home, including a room containing lift machinery. The staff secured these areas promptly during the inspection. Following our visit, the deputy manager assured us they had spoken with staff to remind them to always make sure the environment was safe. There was no indication anyone had been harmed.

There had been improvements at the service. In particularly, we found medicines were managed in a safe way and there had been improvements to infection prevention and control.

Risk to people's safety and wellbeing were assessed and planned for. The staff responded appropriately following changes to people's needs, when new risks were identified and after accidents and falls. They worked closely with other healthcare professionals to make sure people received the care and support they needed.

There were appropriate systems for dealing with safeguarding alerts and complaints. The provider was open and transparent making sure they shared information about how they investigated these and the outcome of their investigations. The staff learnt from things that had gone wrong through regular team and individual meetings and reflective practice with the registered manager.

There were effective systems for auditing the service, including regular clinical meetings where people's needs were discussed. The registered manager worked closely with the staff. They had regular contact with relatives and other visitors making sure they updated them with relevant information and asked for their opinions.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (Published 10 March 2020). Following this inspection, we issued warning notices in relation to safe care and treatment and good governance. The provider completed an action plan to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 February 2020 (published 10 March 2020). Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they 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 'Is the service Safe?' and 'Is the service Well-led?'

The ratings from the previous comprehensive inspection for the key questions 'Is the service Effective?', 'Is the service Caring?' and 'Is the service Responsive?' 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.

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

Follow up

We will request an action plan from the provider to understand what they will do to continue improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Derwent Lodge Care Centre is a care home, with nursing, for up to 62 older people. At the time of our inspection 53 people were living at the service. Some people were living with the experience of dementia. The service is managed by Bondcare (London) Limited, a private organisation.

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

Medicines were not always managed in a safe way. The staff did not always follow Bondcare's own procedures for the safe management of medicines and failure to do this placed people at risk. When medicines incidents happened, the staff had not always recorded and reported these so they could be addressed or learnt from.

The provider's systems for monitoring and improving the quality of the service were not always operated effectively because audits had failed to identify or improve problems relating to medicines management.

There were a number of hazards which increased the risk of infection or contamination. These included medicines equipment not being thoroughly cleaned, communal slings stored in bathrooms and toilets and an unpleasant odour in one area of the building.

With the exception of these hazards, the environment was generally well maintained and safe. There was redecoration and refurbishment taking place at the time of the inspection. The staff were working well within the difficulties this work created to make sure people still received the support and care they needed. The work was due to be completed shortly after the inspection.

There was no evidence of discrimination against people or staff who had protected characteristics (as defined under the Equalities Act). However, there were limited visual clues and practices for some people to feel empowered with their identity. Some staff lacked awareness in respect of protected characteristics and what they could do to promote an environment where people felt safe to share their identity.

People living at the service and their visitors were happy with the care they received. They liked the staff and found them caring. Their needs were being met and they were able to make choices about their care and how they spent their time.

The staff were kind and thoughtful in their interactions with people. They knew people's needs well and had established positive relationships with them. They offered them choices, were attentive and had a friendly and caring approach.

People's needs had been assessed and planned for. Care plans and risk assessments were regularly reviewed and had been updated to reflect changes in people's needs. The staff were able to access information about people's care needs on handheld devices and they could use these to alert managers about any concerns they had.

The staff worked with other professionals in supporting people with their healthcare needs. They made timely referrals when people's needs changed. The staff were good at following guidance from others and monitoring people's health.

There were opportunities for people to take part in a range of different social and leisure activities organised by two activity coordinators. There were a range of resources and coordinators planned different events for groups and individual people.

People using the service, visitors and staff knew who the registered manager was and felt they were visible, supportive and had made positive changes at the service. There were a range of different audits and systems for investigating and responding to complaints.

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.

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 rating at the last inspection was requires improvement (Published 14 March 2019).

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

At this inspection, not enough improvement had been made and the provider was still in breach of regulations. The service remains requires improvement.

This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safety and leadership at this inspection.

Full information about CQC’s regulatory response can be seen in our table of actions at the end of the report. We have issued warning notices telling the provider they must make the required improvements.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Derwent Lodge Care Centre is a care home with nursing for up to 62 older people. At the time of the inspection 40 older people were receiving personal and nursing care. Some people were living with the experience of dementia.

The service is managed by Bondcare (London) Ltd, part of the Bondcare Group, a private organisation providing adult social care in the United Kingdom.

People’s experience of using this service:

The provider did not always make sure medicines were managed in a safe way. There was no evidence that people had been harmed by staff practices, although there was a risk that people may not receive their medicines safely if improvements were not made.

Records designed to describe people's care needs, how these would be met and interventions to minimise risks were not always accurate or up to date. This meant that the staff did not always have clear information about how they should care for people and this placed them at risk of receiving care which was not appropriate and did not meet their needs. There was a reliance on the knowledge of staff who were familiar with people and this was not always the case as the provider did source temporary staff to deliver some of the care.

People's leisure and social needs were not always being met. There were some planned activities, and these included visiting entertainers and religious services, but people did not always receive support and as a result some people were bored and needed more stimulation.

The staff did not always focus on people's sensory needs. A number of people living at the service had limited communication or were confused. Whilst the staff had received training about dementia, they did not always implement strategies which met people's holistic needs or considered non-verbal communication.

The environment was clean and well maintained, but further improvements to create better signage and interactive features may benefit people who lived at the service and help them to orientate themselves.

The provider catered for people from different cultural backgrounds, this included providing different food, staff who spoke the same language and staff who knew about what was important culturally for them. However, there had not been any work to promote an LGBT+ (Lesbian, Gay, Bisexual and Transgender) friendly environment. The staff had not had specific training to understand the needs of the LGBT+ community and the care planning and assessment processes did not provide opportunities for people to feel safe about discussing their LGBT+ identity. We discussed this with the manager and provider's representatives and they agreed to look at training and information available for staff to make sure this aspect of people's lives would be given equal status to other aspects of their identity.

The provider had systems for monitor and improving the quality of the service and mitigating risks. Whilst we noted improvements at the service, these systems had not always been operated effectively and further action to make sure the service was always safe, responsive and well-led were needed.

People living at the service and their representatives were happy there. They said that their needs were met, and they liked the staff. We observed the staff were kind, gentle and caring. They knew people's needs and personalities and showed genuine affection for the people who they were caring for. People told us they were able to make choices about their care and that the staff always asked them what they wanted. People were supported to access healthcare services and the staff made referrals to other services when people's needs changed.

The staff were happy and felt well supported. They had information about their roles and responsibilities and regular training. They met with their manager to discuss their work, individual needs and any concerns they had. There was good communication between the staff to make sure they were aware of any changes in the service and with the people living there.

The manager and provider had introduced some positive changes at the service. They had a clear action plan which outlined the further improvements which were needed and how they planned to implement these changes. People using the service, staff and visitors spoke positively about the manager and said that they were accessible and friendly. Complaints, concerns, incidents and accidents were investigated, and improvements were made as a result of these. The provider planned to introduce an electronic care planning system, which they had trialled at some of their other services. This would improve the way care was planned and recorded and provide a system where the registered manager and others could monitor whether care had been delivered remotely.

Improvement action we have told the provider to take:

We have rated the key questions, 'is the service safe?', 'is the service responsive?' and 'is the service well-led?' as requires improvement. The overall rating of the service is also requires improvement. We have rated the key questions of, 'is the service effective?' and 'is the service caring?' as good.

We identified breaches of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, person-centred care and good governance. You can see what action we have asked the provider to take within our table of actions.

Rating at last inspection:

The service was rated requires improvement at the last inspection which took place on 12 June 2018. It has been rated requires improvement at the last two inspections.

Why we inspected:

We inspected the service as part of our schedule of planned inspections based on the previous rating.

Follow up:

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

The last inspection of the service took place on 21 November 2017 when we rated the service Requires Improvement in all key questions and overall. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all key questions to at least ‘Good’. The provider supplied us with an action plan stating they would make the required improvements by 28 February 2018.

At this inspection on 12 June 2018 we found that improvements had been made in all areas and the provider had met four of the five breaches of Regulation we had identified at the previous inspection. However, we found that further improvements were needed in order for the service to be rated Good in the key questions of 'Is the service Safe?', 'Is the service Effective?' and 'Is the service Well-led?' We found that sufficient improvements had been made in response to the key questions, 'Is the service Caring?' and 'Is the service Responsive?' and we have rated these Good. The overall rating for this service remains Requires Improvement.

Derwent Lodge Care Centre is a care home with nursing for up to 62 people. The service offers support to older and younger people with nursing needs, including people with physical disabilities. Some people were living with the experience of dementia. At the time of our inspection 32 people were living at the service. There are three floors where accommodation can be provided. However, at the time of our inspection only the ground and first floor were being used.

There was a manager in post who had worked at the home since November 2017. They had started the process of applying for registration with the Care Quality Commission. 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 and associated Regulations about how the service is run.

The systems operated by the provider were not always effective at mitigating risks or improving the quality to required standards.

We have made a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Good Governance. You can see what action we told the provider to take at the back of the full version of the report.

Not all risks to people's safety and well being had been mitigated. For example, we identified some environmental hazards, which the provider rectified at the time of our inspection. The provider had not fully met the requirements of the London Fire Brigade to make sure the service was safe in event of a fire, although they were working to do this.

There were enough staff to meet people's needs but sometimes people had to wait for care. In addition, the staff were concerned that the staffing levels at night did not allow for any contingency. For example, they spoke with us about how some people became agitated at night. They said that when this happened there were not enough staff to care for these people and others safely.

Information about people's mental capacity had not always been recorded consistently or clearly. This resulted in some people's care plans giving contradictory information. Furthermore, the provider had not followed (or not recorded that they had) guidance on involving people's representatives in best interest decisions about the administration of covert (without the person's knowledge) medicines. We have made a recommendation in respect of this.

The environment met people's needs to some extent, although improvements in line with best practice guidance for services catering for people with dementia were needed.

The information in people's care records had not always been recorded in a consistent way. This was partly due to the fact the provider was in the process of updating care records to a new system. The staff on duty demonstrated a good knowledge of people's needs, but there was a risk that new or temporary staff did not have the written information they would need to care for people.

The provider was aware of most areas where improvements were needed and had created an action plan which outlined how they were going to address these concerns. They undertook regular checks and audits on the service. Additionally, there was evidence of significant improvements to the service and the care people received since the provider took over ownership and since the last inspection. There was a positive and open culture at the service. The manager and provider worked closely with others, such as the local authority, to make sure people's needs were being met.

People were happy living at the service. They felt their needs were being met and they liked the staff who cared for them. People felt improvements had taken place and they were able to give their views about the service to the manager, therefore being involved in these improvements. People felt able to raise concerns and told us they were listened to. People's healthcare needs were monitored and they had access to external healthcare services. People had enough to eat and drink.

The staff told us they felt supported. They had the training they needed to meet people's needs and opportunities to discuss the service with each other so that people could be cared for.

People received their medicines in a safe way. There were procedures designed to safeguard them from abuse. Risks associated with their planned care had been assessed and planned for.

People were cared for by kind and compassionate staff. Whilst some interactions we observed indicated the staff were focussing on tasks, these were limited and the provider was taking action to improve person centred care at the service.

The inspection took place on 21 November 2017 and was unannounced. This was the first inspection of the service since the current provider, Bondcare (London) Limited, became the registered owner on 4 October 2017. Previous to this the service was registered with and managed by another organisation.

Derwent Lodge Care Centre is a care home with nursing for up to 62 people. The service offers support to older and younger people with nursing needs, including people with physical disabilities. Some people were living with the experience of dementia. At the time of our inspection 32 people were living at the service. Four people were younger adults who had a physical disability. There are three floors where accommodation can be provided. However, at the time of our inspection only the ground and first floor were being used.

There was a registered manager in post. However, this person was a regional support manager and did not work full time at the service. The provider had recruited a new manager for the service who started work there three weeks before our inspection. They told us that they were in the process of applying to become the registered manager. They told us that once they were registered the regional manager would cease to be registered for the service. 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 and associated Regulations about how the service is run.

People were not always supported in a way which met their needs and reflected their preferences. In particular, their social, emotional and leisure needs were not being met. People had limited variation in their lives and were not supported to pursue individual interests. For example, we observed people spent their day in their rooms or communal rooms either asleep or sitting with no activity. Records for these people showed that this was the same each day.

Information about how people's personal care needs were met indicated that they did not have access to the care and support they needed. For example, we saw that people frequently refused to have their teeth brushed and no action had been taken in respect of this. Records also indicated that people regularly had no support to change continence pads for up to eight hours. Representatives of the provider told us they thought this was a record keeping issue. However, the provider's own governance systems had failed to identify this.

The staff did not always treat people in a kind or respectful way. There were instances where staff talked unkindly about people. The staff tended to focus on the tasks they were performing rather than the person who they were caring for. For example, we witnessed an incident where one member of staff who was supporting a person with a drink handed the cup to another member of staff and said, ''I am going on my break now.''

Some of the staff had poor English language skills and could not understand each other, the people who they were caring for or others who spoke with them. We witnessed a situation which required the immediate attention of a nurse. However, neither a care worker nor the nurse we spoke with understood what we were telling them. Therefore there was a risk that these staff would not be able to understand important information in an emergency situation. Their interactions with the people who they cared for were limited and people could not make them understand their needs.

The provider was not always working within the principles of the Mental Capacity Act 2005 because they had not always ensured that people had consented to decisions or that these were being made in their best interests.

The provider's governance systems had failed to fully identify and mitigate risks or make sufficient improvements. The provider had made improvements to the service, but these had not made sure people received personalised care which met their needs and respected their preferences. The provider's representatives told us that records of care were inaccurately completed, yet no action had been taken to rectify these.

We found breaches of five 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 the report.

People lived in a suitable environment. However, there was limited information available about the service to help people orientate themselves or plan their time. For example, menus were not on display and advertised activities were inaccurate. The environment did not reflect current best practice guidelines about dementia friendly environments. We have made a recommendation in respect of this.

People using the service told us they felt safe at the service and they liked the staff, although some people told us they felt the staff did not take time to speak with them. They received their medicines as prescribed and in a safe way, although some of the staff practices meant that there was a risk this would not always be the case. The environment was clean and there were procedures for controlling the spread if infection but the staff were unsure about some of these and therefore there was a risk that they may not follow the correct procedures.

The risks to people's wellbeing and safety had been assessed and planned for. The staff had a good understanding about how to support people to move around the home. There were appropriate procedures for safeguarding people from abuse.

The provider had assessed people's capacity to make decisions and made applications for lawful authorisation of any restrictions.

People were given the support they needed to lead healthy lives. The staff worked closely with other healthcare professionals and sought their advice when needed. They monitored people's health and responded appropriately to changes in this. People were able to make choices from a range of nutritious food and drink. The staff ensured that people maintained a stable weight and made referrals to appropriate professionals when people were considered at nutritional risk. People had access to ample amounts of fluids and the staff encouraged people to drink.

Some of the staff were polite and caring. They knew people's needs and, most of the time, they respected choices that people expressed.

People knew how to make a complaint and felt confident raising concerns.

People being cared for at the end of their lives were given the care and support they needed. There was clear information about their needs and wishes and the staff worked with other professionals to support people at this time.

The provider had undertaken a number of audits of the service and had worked closely with commissioners to identify where improvements were needed. They had started to make improvements at the service. The provider's representatives told us there had been improvements in staff recruitment, staff interactions with the people who they supported, record keeping and the overall quality of the service. When we discussed our findings at the end of the inspection visit, the manager and provider's representatives told us about some of the plans they had for addressing the issues we identified. The provider had agreed a voluntary embargo on admissions to the home until they felt significant improvements had been made.