CQC report explained · a nursing home
What the CQC found at Derwent Lodge Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2023
Rated Requires Improvement; inspectors found better medicines management but ongoing risks in care planning, repositioning and staffing, and the home is no longer in special measures.
This was an unannounced focused inspection on 12 July 2023. Inspectors spoke with 10 people, 4 relatives and 7 staff, and reviewed care records, medicines records, staff files and management audits.
The main concern was risk management. Some risk assessments and care plans were not updated when people's needs changed. Repositioning records did not always show that care was given as planned, and some pressure-relieving mattresses were set incorrectly. Staff belongings and prescribed thickening agent were also accessible.
There were improvements in medicines management and governance since the previous inspection. Medicines were stored securely and given by trained staff. However, audits still did not identify all the improvements needed, and most people said staff were often busy and they sometimes waited for care.
The overall rating remains Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other key questions were not inspected at this visit, so their previous ratings were used. The home had been in special measures since 1 December 2021, but it is no longer in special measures because it is no longer rated Inadequate.
Medicines management
Medicines were stored securely, stock balances checked correctly and administration was carried out by trained staff whose competence had been assessed.
“Medicines were administered by staff that had undertaken training and had their competency assessed.” from the report
Clean environment
Inspectors found infection prevention measures in place and the home appeared clean and well maintained. People also said the home was clean.
“The home was clean and cleaning schedules were in place to help maintain this, however they were not completed every day.” from the report
Positive relationships
People and relatives gave mainly positive feedback about the care and management. Staff said they were supported and enjoyed their work.
“Feedback regarding care was mainly positive. People told us staff were "Really good", and "Kind".” from the report
Learning from incidents
Accidents were recorded and reported, and actions were taken to help keep people safe and prevent further accidents.
“The registered manager worked hard to ensure lessons were learnt from incidents and measures were taken to help prevent further accidents.” from the report
Risk assessments and care plans
seriousSome records were out of date when people's needs changed. This included incorrect information about a catheter and changes to how medicines should be given.
“Although risk assessments had been completed, they were not always updated when people's needs changed.” from the report
Repositioning and mattresses
seriousRecords did not always show that people were repositioned as often as planned or with the required number of staff. Some pressure-relieving mattresses were not set correctly.
“Repositioning records did not all reflect that people received this support as frequently as care plans advised.” from the report
Staffing pressure
needs fixingMost people said staff were very busy and they sometimes had to wait for care. Rotas showed staffing levels were not always maintained at the usual level, so inspectors recommended keeping staffing under review.
“Most people told us they often had to wait for care.” from the report
Weaknesses in audits
needs fixingThe home completed audits, but they did not always identify missing improvements, including problems with care records and as-required medicine guidance.
“Although a range of audits were completed to monitor the quality and safety of the service, they required further development to ensure they effectively identified all improvements required.” from the report
- 01How will you make sure risk assessments and care plans are updated immediately when a resident's needs change?
- 02How do you check that residents are repositioned at the planned frequency and with the required number of staff?
- 03How do you check that pressure-relieving mattresses are set correctly for each resident?
- 04What staffing levels will be in place at busy times, especially mealtimes, and how will you respond if the usual level is not met?
- 05What actions have you taken to improve audits so they identify missing care records and problems with as-required medicines guidance?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried forward from the previous inspection. This explanation was written from the published report of 22 August 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2022
Derwent Lodge Nursing Home was rated Requires Improvement, with an Inadequate Safe rating, and remained in special measures because serious safety problems were not fully fixed.
This was an unannounced, focused inspection on 28 March 2022. Inspectors checked Safe and Well-led, reviewed care and medicines records, spoke with staff and managers, and contacted people and relatives.
Some things had improved since the previous inspection. Care plans had better information about day-to-day needs, the new manager had improved oversight, the home was clean, and recruitment checks were in place.
However, people were still at risk. Medicines could not always be accounted for, some clinical information was missing, wound care and fluid monitoring were not reliable, and some people and staff felt staffing levels were sometimes too low.
The overall rating improved from Inadequate to Requires Improvement. The Well-led rating improved to Requires Improvement, but Safe remained Inadequate. The home remained in special measures and the provider was still in breach of Regulations 12 and 17.
New management
The new manager and regional manager had begun to improve oversight, staff practice and the support people received.
“These new managerial arrangements had started to make a difference.” from the report
Clean environment
Inspectors found the home clean and well maintained. Cleaning and decontamination arrangements were satisfactory during the COVID-19 outbreak.
“The home's cleaning and decontamination regimes were satisfactory in terms of the spread of infection.” from the report
Safer recruitment
The home carried out appropriate checks before employing staff to work with vulnerable people.
“Appropriate pre-employment checks were carried out to ensure staff employed were safe to work with vulnerable people.” from the report
Better day-to-day care information
Care plans contained much better information about people's everyday care needs, although important clinical information was still missing.
“Care plans now contained much better information about people's day to day care needs.” from the report
Medicines were not always safe
seriousSome medicines, including insulin, inhalers and creams, could not be properly accounted for. Records and guidance were not always clear enough to show that medicines were given safely.
“Some medicines however could not be properly accounted for. For example, stocks of insulin, inhalers and creams.” from the report
Clinical information was incomplete
seriousStaff did not always have enough information about people's medical needs. This included missing or confusing information about diabetes and the lack of a syringe driver for possible end of life medicines.
“Critical information about one person's diabetes was missing and other information was confusing to follow.” from the report
Wound and fluid care
seriousPressure wound care plans were not always followed. Fluid intake and output were not always recorded well enough to identify dehydration risks.
“People's fluid intake and output were not always appropriately recorded to enable staff to be confident that people's fluid intake was sufficient to prevent them becoming dehydrated.” from the report
Staffing concerns
needs fixingThe provider had a system for setting staffing levels, but some people and staff said there were times when more staff were needed.
“Some of the staff and people we spoke with however ,felt at times there were not enough staff on duty.” from the report
Infection guidance not fully followed
needs fixingDuring a COVID-19 outbreak, the home had not followed recommended guidance about taking people's temperatures twice daily.
“Guidance in relation to the taking of people's temperature twice daily to monitor for the spread of the virus had not been followed as recommended.” from the report
- 01What specific checks now show that insulin, inhalers, creams and other medicines are correctly recorded and given?
- 02How will you make sure staff have complete information about each person's medical conditions, including diabetes?
- 03How are pressure wounds being treated and checked against the person's wound care plan?
- 04How do you record fluid intake and output, and what action do you take if records suggest dehydration?
- 05What changes have been made to staffing levels and how do you respond when people are waiting for care?
This was an unannounced focused inspection of Safe and Well-led, including infection prevention and control; Effective, Caring and Responsive were not inspected and their previous comprehensive inspection ratings carried over. This explanation was written from the published report of 11 May 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Derwent Lodge Nursing Home
8 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2022Requires improvementup from InadequateSafe: InadequateWell-led: Requires improvement
- December 2021Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- December 2020Goodstayed GoodSafe: Requires improvementWell-led: Good
- November 2019Goodup from Requires improvementSafe: Requires improvementWell-led: Good
- April 2019Requires improvementstayed Requires improvementSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2015
Report published without a new overall rating.
- August 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 21 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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