This inspection took place on 24 and 31 January 2018 and was unannounced.

At our last inspection in November 2016 we rated the service as 'Requires Improvement'. There was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014, because record keeping within the service needed to improve. We saw evidence that care files and risk assessments were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. At this inspection we found record keeping had improved and the service was now meeting legal requirements.

Derwent House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to support up to 65 older people and people living with dementia. The service is divided into two different areas; Derwent House supports people with nursing and residential care needs and Riverview Lodge supports people living with dementia. The service is set in a rural position, to the east of the city of York. There is a large car park to the front of the building providing ample parking on-site for staff and visitors. On the day of the inspection 53 people were using the service.

The registered provider is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run. At the time of the inspection there was a new manager in post who had been working at the service for about four months; they had submitted their application to register as the manager of the service. Shortly after the inspection their application was accepted. We have therefore referred to them as the ‘registered manager’ in this report.

Medicines were stored and administered safely by staff. The recording of medicines received by the service was not always clear and protocols for ‘as required’ medicines were required for some people. We have made a recommendation about this in our report.

People told us they felt safe living at the home. Risks were appropriately assessed and managed. There were sufficient staff available to meet people’s needs and the provider had employed a number of new staff recently, in order to reduce the usage of agency staff. Robust recruitment procedures were followed in order to ensure the suitability of workers.

There were cleaning schedules in place and the service was clean, tidy and free from malodours.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were supported in their role; they received induction, training and supervision. We found staff were knowledgeable about people’s needs.

People were able to access healthcare professionals, such as GPs, when they needed to. Information about people’s health needs and contact with healthcare professionals was recorded in their care files. We received positive feedback about the quality of meals provided and people were appropriately supported with their nutrition and hydration requirements.

People and relatives we spoke with told us that staff were caring, pleasant and helpful. We observed positive, warm interactions between people and the staff that cared for them. People’s privacy and dignity was respected.

Activities were available to people, such as crafts, music sessions and games. The service built li

This inspection took place on 9 and 10 November 2016 and was unannounced.

At our last inspection on 8 September 2015 we rated the service as ‘Requires Improvement’. There were no breaches of regulation but there were a number of recommendations within the report.

Derwent House Residential Home provides personal care and support for 65 older people and people living with dementia, some of whom may be assessed as needing nursing care. The service is divided into two different units; Derwent House supports people with nursing and residential care needs and Riverview lodge supports people living with dementia. The service is set in a rural position, to the east of the city of York. There is a large car park to the front of the building providing ample parking on-site for staff and visitors. On the day of the inspection we found there were 40 people using the service.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run.

At the time of the inspection the registered manager was not at the service, but we were given assistance by the Human Resource manager for the company and we have referred to them as ‘the manager’ throughout this report.

Record keeping within the service needed to improve. We saw evidence that care files and risk assessments were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. These findings evidence a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take at the back of the full version of this report.

We found that the service was clean, tidy and free from malodours, but there were areas where infection prevention and control practices could be improved to demonstrate that staff were aware of hygiene and cross infection risks. We have made a recommendation in the report about this.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.

Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust.

Some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty; the registered manager had completed a standard authorisation application for each person and these had been reviewed by the supervisory body of the local authority. This meant there were adequate systems in place to keep people safe and protect them from unlawful control or restraint.

People were able to talk to health care professionals about their care and treatment. People told us they could see a GP when they needed to and that they received care and treatment when necessary from external health care professionals such as the District Nursing Team or Diabetic Specialists.

People had access to adequate food and drinks and we found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

People knew how to make a complaint and those

The inspection took place on the 8 September 2015. The inspection was unannounced. At the last inspection carried out in January 2014, the home was meeting all of the regulations.

Derwent House Residential Home provides personal care and support for up to 65 older people, some of whom may be assessed as needing nursing care or have dementia care needs. The home has two units Riverview Lodge, which is a newly registered unit for people living with dementia and Derwent House, which is a unit for older people who may also require nursing care. The service is set in a rural position, east of the City of York. There is ample car parking on site. On the day of our inspection there were 38 people living at the home.

The service has a registered manager. 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 2008 and associated Regulations about how the service is run.

People told us they felt safe and there were systems and processes in place to help safeguard people living at the home.

We saw that risks to people were recorded within individual risk assessments. Maintenance and health and safety checks were carried out on the premises to ensure that they were safe.

Recruitment checks were carried out before staff started work to check that they had been assessed as safe to work with vulnerable adults.

There had been issues with staff recruitment which the registered provider was trying to address as an on-going recruitment drive was in place and we saw evidence that the registered provider was trying to recruit new staff. However the registered provider needed to monitor this closely as some people felt that staffing issues were impacting on care delivery.

We were told that medicines were being left in people’s rooms which is poor practice and meant that people may not be receiving there medicines as prescribed. Although we did not observe this practice we were told this both before and during our visit. We have recommended that the registered provider assesses their medication systems so that they can be assured people are receiving their medicines safely and as prescribed.

The service was clean and smelt pleasant during our visit. Pest control had recently carried out some work and we saw that domestic staff were available.

New staff received an induction when they commenced employment although one staff member told us that this had not taken place.

There was evidence that staff received training to support them in their roles although some further service specific training for example in dementia care may be of benefit.

Supervision was not taking place as frequently as it should have been which the registered manager had identified and was trying to address.

People were supported to make their own decisions and when they were unable to do so, meetings were held to ensure that decisions were made in the person’s best interests. If it was considered that people were being deprived of their liberty, the correct authorisations had been applied for.

People received a varied choice of meals and their likes and dislikes were taken into account. Where concerns were identified regarding people’s nutritional needs, access to relevant professionals was sought.

People had access to health care services which included visits from the GP and district nursing service.

People told us they were well cared for and liked living at Derwent House. People told us they were treated with dignity and respect by staff.

People had detailed care records in place to record how they should be cared for and the support they may require. These records were reviewed regularly.

The home had systems in place to audit the service provided. People’s views were sought and meetings were held to seek people’s views. However staffing numbers were impacting on the quality of records and some of the support systems in place which had led to poor staff morale. We have recommended the registered provider continues to monitor this.

We have made three recommendations during our inspection which will be assessed further in our next inspection of the service.

We undertook this inspection to check if improvements had been made to this outcome area since our last inspection in August 2013. We found that the manager monitored the quality of the service provided to people. We saw that any issues requiring attention were recorded on an action plan. We saw when the issue was dealt with evidence was recorded to say when and how the issue was addressed. This helped to maintain the standard of the service provided to people.

During our visit people told us they were asked for their views. A person we spoke with said “Staff ask if everything is okay for me. I have no issues with the service at all. I would say if there were any issues, they would be dealt with.” A visitor we spoke with said “It is a fabulous place X and I am looked after well. There are no issues with the service we receive.”

We did not speak with many people who live at Derwent House during this visit as the non-compliance related primarily to management and record-keeping. However one person confirmed that their meals were hot, tasty and sufficient. They also told us they received their medicines appropriately, at the times they needed them and were happy living at Derwent House.

We found improvements had been made to the way medicines were managed, in order to promote people's health and well-being.

The service had better systems in place to identify and manage the needs of people who were at risk from not eating and drinking sufficient amounts.

Overall people's care records were well maintained however these could be updated in a more timely way when people’s care needs changed.

We found some improvements had been made for monitoring how the service was operating. However this needs further development and needs to be sustained. This would enable the provider to demonstrate that the quality of service was being kept under review and changes to the way the service was operating were being made when necessary.

We spoke with seven people living at Derwent House, three visitors and a healthcare professional. All were very satisfied with the care and support provided. Two people had lived in other care homes prior to this one and both said that Derwent House was much better in every way. One person said “My time here has gone very quickly because its (the home) a good place to be.” Another commented “The care is marvellous. The staff know what help I need.”

Despite these positive comments we found -

Medication systems were not robust, so the service couldn’t evidence that people were always being given their prescribed medicines safely and at the times they needed them.

The service did not have a robust way of monitoring and supporting people who were identified as at risk of becoming malnourished. This meant healthcare support may not be requested appropriately or in a timely way.

The service did not have systems in place to monitor and assess the way the home was operating. This meant there was no evidence to show the service was being kept under constant review to ensure the health, safety and welfare of the people who live in, work in and visit the home.

Records describing people’s care needs were not always accurate and up-to-date. Other records to demonstrate the service was running well were also not well maintained. Accurate records were needed to evidence the service is running well as well as for staff to check they were providing the right care.

We did not gain feedback from people living at the home during this visit as the inspection was a follow up visit which focused on record-keeping. When we visited the service in April 2012, all the people we spoke with, who lived there, told us they were happy at Derwent House. They told us their care needs were being well met.

We spoke with five people who live at Derwent House. All provided us with positive comments about the home. One person said “I think this home is very good. I miss my own home, but as a second choice then this is very good.” They added. “The food’s good and the home’s clean. The staff are very kind and the residents are friendly.”

A second person told us “The place is fine. The staff are kind and polite. And I feel safe here.” Another said “We are looked after so well and cared for so well, here. That’s the best thing about living here.”.

A third person added “The staff are fine. They’ll do anything to help you.” They explained that they chose which clothes to wear each day, but that care workers showed them different options from their wardrobe, to make it easier for them to decide.

One person said that there were “more plusses than minuses” about living there, although did add that the way care workers spoke to them did vary sometimes. This was the one negative comment we received.

All the people we spoke with told us they would tell someone if another person had been unkind to them. This is important, so that things can be looked into properly and put right, if necessary.