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.