About the service:

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 se

The inspection took place on 12 June 2018 and was unannounced.

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 updat

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