Derwent Lodge Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

A new management team were becoming established at Derwent Lodge. Systems were in place to protect people from the risk of abuse and harm. People's support needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. Processes were in place to ensure staff were safely recruited. Recruitment checks included Disclosure and Barring Service (DBS) checks, employment references and identity checks. Staff completed a thorough induction when they started their employment with the provider. Staff received training and their competencies assessed. Medicines were managed consistently and safely in line with national guidance. Staffing levels were appropriate however, we found parts of the day, around the morning, lunch time and the afternoon where staff visibility required reviewing and left people waiting for care and support. This was corroborated with what people were telling us. The management team responded to this and made amendments to staffing allocations to ensure cover was effective at mealtimes and in the afternoon in the lounge.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were supported by staff who knew and understood their needs. People told us they had built good relationships with staff and staff were aware of their likes and dislikes. People had good links with family and staff supported people to maintain this. Staff respected people's individuality and diversity and were aware of people's personal preferences. People and relatives were involved in the development of care plans and reviews; however, one family member told us they were not involved, and another family member told us they would like to be more involved with reviews of care. One relative told us, “Mum is totally safe. Issues raised especially when she was more mobile have been dealt with quickly. Someone will always find any information I need.’’ Another family member said they felt confident that their relative was safe at Derwent Lodge and not had to raise any concerns.

The registered manager told us any lessons to be learnt were communicated with people who used the service, staff, relatives, and external health professionals if required. These were discussed in supervisions, daily flash meetings, general monthly meetings, service and relative meetings and additional training if identified as being required. They told us, they had organisational learning via email or monthly manager meetings. Staff told us, “We feel like we know more, we are informed, things are shared with us meetings are frequent, we have supervisions and support."

Processes were in place to monitor and analyse information and trends from accidents, incidents (including falls) and safeguarding concerns. Lessons learned reports were generated through the governance system. Audits and findings were transferred to a provider action plan and actions cascaded to the staff team. Actions from lessons learned were assigned to staff as needed. Reports showed lessons were learned around pressure care, specific training and ‘React to Red’ (training for care staff in relation to pressure ulcer prevention awareness). Care plans relating to epilepsy were made more robust and personalised. These were discussed within the staff team and actions identified.

People and their relatives told us the provider worked closely with other agencies and health professionals to meet people's specific needs. One person told us, “I feel safe, good and looked after well, my wife visits every day.” Another person told us their grandparent moved into Derwent Lodge 12 months ago and felt their views, “Were considered and valued when their care plan was put in place initially.” Another person told us they found all the staff at Derwent Lodge very easy to speak with to ensure their parents received the right care and a smooth transition. He said the family went to see several homes and the family felt Derwent Lodge stood out as the best one for their parents.

The registered manager told us, before any potential person was admitted, they and the clinical team would complete a robust pre-admission assessment. They would liaise with any health care professionals involved in the person’s current care, for example district nurses. They told us, “We support visits and complete assessments at the home to ensure we can safely meet all the care and support needs of the person before we support a move into Derwent Lodge."

Systems were in place to ensure people received a full assessment of their needs prior to admission and upon admission. The provider involved people and their families in assessments when required. There were protocols in place which guided staff when to make referrals or escalate concerns.

People and relatives told us they received safe care. People spoken with said staff were very good and did their job well. A person told us, “I feel happy and safe I have no complaints. No problem with care here and I can always get support.” A relative said, “It’s a good place they look after her well.” Another family member shared they do not have any safety concerns and if they did, they would feel confident with raising it with the manager.

The registered manager and staff had a good understanding of safeguarding. Staff could explain different types of abuse and what signs and symptoms to look out for. Staff told us if they suspected or saw any form of abuse, they would report it to the nurse in charge or the manager.

We observed staff treat people with care and respect. Information on abuse and speaking up were displayed on notice boards in communal areas.

The provider had a clear process in place to safeguard people against abuse. The staffing rota showed there was leadership presence seven days a week which ensured there was oversight and support, and commence investigations as required. Staff received training in safeguarding, this meant they were able to notice any concerns and report them to their managers. There were safeguarding and whistleblowing procedures in place. This meant staff had guidance to use if needed.

People told us they felt supported by staff who knew them well and were aware of their medical, health and social needs. People were encouraged and supported to be independent with daily tasks and activities but without compromising their safety. One family member told us, “I have always been involved in decisions. The staff call me if there are any concerns, but I am in 3-4 times a week, so they raise anything then as well.” Another family member shared, “I am always invited to discussions about my parents’ care, and it has lifted a weight off the family's shoulders as they are kept fully involved whilst knowing that their loved ones are being well looked after."

Staff told us they had access to care plans and risk assessments. Staff knew people’s needs well and demonstrated knowledge in how to support people safely. For example, a staff member spoke about how they supported people who were at risk of malnutrition and dehydration. They spoke confidently about how they ensured people consumed the right amount of fluids and how they were trained on thickening drinks. Staff told us how they monitored people’s weight and reported any concerns to senior staff, who then made the appropriate referrals to health care professionals. The registered manager said risk assessments were reviewed monthly or sooner.

We saw these care records were updated regularly on the system and observed the registered manager having oversight on the alerts when they were showing up on the system for matters that required attention. We checked the airflow mattress of several people which were set at the correct setting as per their care plan apart from one mattress setting, this was found to have a fault and a new pump for the mattress was ordered and in place upon our next visit. We checked some equipment, such as slings, hoists, and found they were in good working order. We observed the maintenance checks for the equipment being used. We observed the clinical lead and deputy manager meeting with health professionals participating in multi-disciplinary meetings (MDT).

Risk assessments were person-centred, and outcome focused which contained clear instructions on how to support people safely. These assessments were incorporated into people’s care plans. Risk assessments covered a range of areas including mobility/falls, choking/swallowing, and use of bedrails. People who were at risk of weight loss were weighed regularly and concerns were escalated to health care professionals. From records seen, we could see the provider had processes in place which enabled staff to work closely with other agencies. These included, the tissue viability nurses, speech and language therapists, GP, dieticians and podiatry services.

People told us they felt safe living at the home. A family member said, “It is very clean at the home, a nice environment and (Name) room is clean.” A family member told us they, “Had not had any issues or concerns to recall over the last two and a half years.” Another family member shared, “Not only is the home clean and well-maintained but appreciate how clean and tidy my relative's room is kept for him too."

We observed there to be improvements in the general look and feel of the service from the last inspection. For example, changing sensor mats to remove the leads in the lounge was a huge improvement, the upgrades, decoration and maintenance had improved the service to date and more work was planned to upgrade areas in the home.

Checks and risk assessments in relation to the physical environment were in place. Fire extinguishers were in date. Radiators in people’s rooms were secured to the wall. Window restrictors were in place. We did see a radiator cover in the main hall unsecured, this had been placed there and the securing mounts were not effective, new ones were sourced and secured on the day this was identified. The radiator cover in the dining area felt hot to the touch and was raised with the manager who confirmed a risk assessment was in place and action was to be taken through the refurbishment plan. Staff understood how to report any maintenance issues. There was a maintenance team who promptly addressed identified concerns who were external and a dedicated maintenance person on site as rostered. There were certificates in place which showed the provider kept the building and equipment regularly assessed and maintained. There was an up-to-date buildings fire risk assessment, and all fire equipment were tested on a regular basis.

There were mixed views from people regarding the staffing visibility and levels, some family members told us that their family member was checked on regularly when they were visiting, A number of other people told us staff presence or visibility in communal areas was poor. They told us, “There is a definite lack of staff visibility when I visit in the afternoons. People are just left in the lounge to watch television. There is a lack of attentiveness, for around 2.5 hours in the afternoons, I spend my time constantly searching for staff to attend to residents. The lounge is a big issue and an issue that was present before the new manager. When I do see staff, they are good." Three family members told us their relatives were, “Not changed regularly, and always have to prompt staff or find someone to do it. If I was not here it would not be done, there are not enough staff around.’’ “There is never any staff in the lounge area, and this has been going on for a long time, we have to go and find carers to get help for our family members,’’ and, "There are never enough staff on. If it wasn't for the relatives being around in the lounge, there would be more accidents.” One person told us due to the lack of staff visibility at the time of speaking to them, "I am always afraid I am going to have an accident as I have to wait so long for them to take me to the toilet."

Staff we spoke with felt there were enough staff to support the care needs of people residing at the home. The registered manager and recruitment lead confirmed the service was fully recruited and was currently over recruited to cover staff leave. The provider utilises a dependency model tool to ascertain the level of staffing needed and this tool was reviewed monthly or as required.

We observed on the first day a lack of staff presence in the lounge at lunch time, people’s meals becoming cold before being assisted. On our second visit we observed in the afternoon a lack of staff presence in the lounge and had to look for a member of staff to support a person who had been waiting for a long time. We observed on the family members seeking staff out to support their loved ones in the lounge, as staff were not visible. This was raised with the registered manager and they increased the number of staff to support people over lunch and in the lounge. We observed the call bells being responded to effectively and noted the registered managers response and action to the emergency call bells to support staff attending without delay.

There was a thorough induction process for new starters. Staf training compliance was high, and staff were able to access online training as well as face to face training.

People told us they felt the home was clean. They said staff helped them clean and tidy their rooms to ensure their personal space supported their wellbeing.

Staff told us they had access to personal protective equipment (PPE) and had good knowledge of infection prevention and control (IPC) and handwashing practices. A nurse told us they supported with the regular IPC audits the registered manager and regional manager undertook. The registered managers feedback mirrored the processes we observed such as daily cleaning schedules. The provider had a report which provided oversight of the standard of IPC across the home.

We observed the premises, were clean. The ongoing environmental upgrades was improving the overall ability to clean effectively such as changing cloth chairs to vinyl, new flooring and decoration. The domestic staff were visible and had a good rapport with people and observed assisting people and supporting independence with laundry. People’s ensuite toilets, and shared communal shower rooms and bathrooms were clean. The kitchen and laundry areas were clean and organised, and audits were in place. We observed staff wearing PPE appropriately.

The provider had effective infection prevention and control measures in place this included cleaning schedules and regular auditing.

People told us they received their medicines as prescribed with dedicated trained staff to manage stock control, ordering and safe storage of medicines. We found medicines were managed consistently and safely in line with national guidance. We observed staff being patient and kind during medicine administration. People received their medicines safely and generally as prescribed, for example, medicines that should be given before food.

The deputy manager shared “The clinical lead role is having a huge benefit, and the named nurse role is promoting consistency and continuity from a clinical perspective, the clinical lead and I attend multi-disciplinary meetings, and we can see the improvements in the home and in people’s care as a result.” The deputy manager and clinical lead supported the GP weekly visits.

Medicines were managed by staff who had received the relevant training and who underwent annual assessments of their competency. Appropriate management systems were in place to ensure medicines were managed safely. Medicines were kept securely and administered by trained staff. Electronic medicine administration records (eMAR) contained sufficient information such as allergies of each person to ensure safe administration of their medicines. There were no gaps in eMAR and the stocks we checked tallied with the balances recorded. There were checks of medicines and audits to identify any concerns and address any shortfalls. Staff followed the guidance in place on managing 'when required' medicines for each person and documented the reasons why they had administered the medicines and their effectiveness.