Derwent Lodge

The last full ratings assessment of Derwent Lodge was published 6 July 2018; the overall rating was Good. At this assessment the overall rating for Derwent Lodge is Requires Improvement. This is based upon the findings at this assessment.

This assessment was carried out due to the length of time since the last rating.

We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed autistic people and people with a learning disability respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

People were not always protected from avoidable harm. Infection prevention and control practices were not consistently effective, and environmental risks relating to maintenance had not been adequately managed. These issues demonstrated that risks were not always assessed, mitigated or monitored effectively and resulted in a breach of Regulation 12 (Safe care and treatment).

Not all requested staff recruitment records were provided within timescales set at the assessment. This meant that we could not be assured that staff were employed following safe recruitment processes and resulted in a breach of Regulation 19 (Fit and proper persons employed).

Governance systems were not sufficiently effective to identify and address risks and drive improvement. Although audits and monitoring processes were in place, these had not identified and addressed the issues found during the assessment, including concerns relating to infection control, environmental safety and care planning. This meant risks were not always recognised or acted upon in a timely way, placing people at ongoing risk of harm, and resulted in a breach of Regulation 17 (Good governance).

The effectiveness of care and treatment was inconsistent. While people were supported with nutrition and hydration and staff worked with external healthcare professionals, care was not always delivered in line with best practice. Monitoring of a health condition was not consistent and systems to support people to manage their health, including for a person with a learning disability, required improvement. This meant there was a risk that deterioration in people’s health might not always be identified or managed promptly.

People generally experienced kind, compassionate and respectful care. Feedback from people and relatives was positive and staff were observed providing support in a caring way. People were supported to make choices and maintain their independence.

While people were generally supported to access activities and express their views, some aspects of the service required further development to ensure care was consistently responsive. Care plans did not consistently include sufficient detail about people’s preferences, life histories and what was important to them, meaning care was not always tailored to individual needs. Information was not always provided in accessible formats, particularly for a person with additional communication needs, which limited their ability to fully understand and engage with their care.

There were positive aspects to leadership and culture. Staff described management as approachable and felt able to speak up, and there was evidence of partnership working with external professionals to support people’s care and continuity. However, oversight arrangements were not sufficiently robust to ensure sustained improvement or consistent delivery of safe, effective and person-centred care.