This inspection took place on 17, 18 and 19 January 2017 and the first day was unannounced. At our last comprehensive inspection of this service on 26 and 27 January 2016 we found breaches relating to good governance in respect of record keeping. We carried out a focussed inspection of the service on 17, 18 and 21 October 2016 and found breaches relating to safeguarding service users from abuse and improper treatment and safe care and treatment. At this inspection we found improvements had been made in respect of the previous requirements but further improvement was still required with record keeping. Derwent Lodge Care Centre provides nursing care for up to 62 people. There are three floors and the units offer nursing care for older people including those with dementia care needs and people with physical disability needs. At the time of inspection there were 44 people using the service.
The service is required to have a registered manager. 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 2008 and associated Regulations about how the service is run. The registered manager was due to leave the service the week after the inspection and an interim manager had been appointed and was already working at the service.
People were not always protected against the risks associated with the inappropriate management of medicines.
Staff recruitment procedures were in place but were not always being followed to ensure only suitable staff were employed by the service.
Although the majority of staff responded well to people’s needs, activities were limited and care and treatment was not always provided in a way that met people’s individual preferences.
Processes for auditing and monitoring had not been effective in identifying all shortfalls within the service.
Processes for auditing accidents and incidents were not being followed so any themes and trends were not being identified.
The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). DoLS are in place to ensure that people’s freedom is not unduly restricted. Improvements had been made with related care records, however further improvements were required to ensure information relating to people’s mental capacity and DoLS authorisation conditions was identified in the care plans.
Improvements had been made with the care records and the majority were comprehensive and information was clear. Further work was needed to ensure care records were kept up to date.
The environment had not been reviewed to encompass the sensory needs of people with dementia. We have made a recommendation in respect of this.
Staff demonstrated a caring attitude towards people and took the time to make people feel valued and communicate effectively to meet their individual needs. Some care seen on the first floor was task driven and did not meet people’s emotional care needs.
Procedures were in place to safeguard people against the risk of abuse and staff understood the importance of keeping people safe and reporting concerns. Accidents and incidents were being recorded and reported and related documentation completed accurately.
Equipment was being used safely and correct procedures were being followed when moving and handling people.
Systems and equipment were being serviced and maintained. Policies for infection control were in place and were being followed to maintain a clean environment and protect people from the risk of infection.
Staff received training to provide them with the skills and knowledge to care for people effectively.
People’s dietary needs and preferences were being identified and met.
People’s healthcare needs were identified and they received the input they needed from health and social care professionals.
A complaints procedure was in place and people and relatives said they would express any concerns so they could be addressed.
The interim manager was proactive and approachable and was aware of the areas of improvement required within the service.
We found four breaches 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.