Archived: Osborne Court Care Home

People's experience of using this service and what we found

There had been significant improvements following the inspection of August 2019. Positive changes had been made to the management and provider oversight of the home. The provider maintained a stable management team. The registered manager, deputy and unit manager had been in post for over two years. This had helped to stabilise the home with a steadfast team of nurses and care staff employed. This meant the delivery of high-quality and person-centred care had constantly improved.

People were provided with a care which was safe. Risks were assessed and mitigated to keep people safe from abuse and avoidable harm. People received their medicines when they needed them. There were enough staff to meet people's needs. The registered manager used a dependency tool to calculate staffing levels. This was increased when people’s needs changed and in line with the occupancy of the home. The home followed appropriate recruitment practices and ensured staff were properly checked before they began working at the home. The home was clean and tidy throughout with high touch point cleaning taking place throughout the day. Accident and incidents were reported, recorded and analysed with lessons learnt shared with staff to prevent recurrences .

Staff were enthusiastic and happy in their work. They felt supported within their roles. Staff described working together as a team, they provided person-centred care and helped people to achieve their potential. There was a programme of audits in place to assist the management team to identify and address shortfalls. As a result, the home continuously improved.

Rating at last inspection

The last rating for this service was Requires Improvement (published 22 October 2019). At our last inspection we found there had not been a consistent management approach and the provider oversight had not always been robust. Although this had improved since the previous inspection in August 2018 there was still room for improvement. We needed to be satisfied the short-term strategies in place would be sustained. At this inspection we found improvements had been made.

Why we inspected

We carried out an inspection of this service on 27 and 28 August 2019. We rated the service requires improvement in Safe and Well Led due to the shortfalls, which we identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Osborne Court Care Home on our website at www.cqc.org.uk.

Osborne Court is a care home that provides personal and nursing care for up to 55 older people. The service is provided in purpose-built accommodation over two floors. At the time of the inspection, 31 people were living at the home.

People’s experience of using this service and what we found

Improvements required from the inspection of September 2018 had been addressed. However, since that inspection we found the arrangements in place to ensure the service was well led from provider level down had been unsatisfactory. There had not been a consistent management approach over the last year and the provider oversight had not always been robust. This had improved in recent months however there was still room for improvement and we needed to be satisfied the short-term strategies now in place would be sustained. These measures had been put in place to help prevent potential risks to people’s safety.

There was an element of frailty of the service and a lack of confidence in the service provision from community health and social care professionals including the local authority. Long-term plans would help address this, including a permanent registered manager. Staff told us, “We need a permanent manager, the interim manager is listening and easy to talk to”, “It has been frustrating but I do feel the interim arrangements have increased morale and things are improving day by day”. One relative told us, “Communication is a bit hit and miss but this hasn’t had an impact the care my dad receives”.

At the time of the inspection there were no permanent nurses employed and there was a high number of care staff vacancies. The lack of clinical oversight, monitoring and review had compromised effective record keeping and care documentation did not reflect a person-centred approach. Monitoring the quality of the service had not been robust enough to ensure good quality care that protected people’s safety.

Despite the improvements required people felt they lived in a caring home. We were introduced to people throughout our visit and they welcomed us. People appeared relaxed and comfortable in their home. We received positive feedback from them and family. One person and a relative told us, “It’s nice here, the staff are nice and “They genuinely care. They go the extra mile”. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner.

Why we inspected

This was a planned inspection based on the previous rating.

Rating at last inspection The last rating for this service was requires improvement (published September 2018). The service remains rated requires improvement. They had improved in three out of the five key questions. This service has been rated requires improvement for the last three consecutive inspections.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in July 2017 the service was rated Requires Improvement. We found breaches in four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to management of medicines, management of risks, people’s care and treatment, staff supervision and quality assurance systems. We issued requirement actions. Following the inspection, the provider sent us an action plan telling us how they would make the required improvements.

We carried out a comprehensive inspection on 7 and 8 August 2018. At this inspection, we found sufficient improvements had been made and the legal requirements had been met. We found further improvements were needed and where improvements had been made, these needed to be consistent and embedded in the service.

Overall, the service has remained as Requires Improvement.

There was a registered manager in post. 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.

Sufficient numbers of staff were deployed at the time of our visit. Records showed sufficient numbers were not always deployed. Staff performance was not always effectively monitored.

There were improvements in the management of medicines. Further improvements were needed to make sure shortfalls were promptly identified and addressed.

Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

Incidents and accidents were recorded and showed that actions were taken to minimise the risk of reoccurrence.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. People were being treated with dignity and respect and people’s privacy was maintained.

An activity programme was offered and provided entertainment and engagement to people in communal areas and in their rooms.

Systems were in place for monitoring quality and safety. These had not always been effective and did not identify all shortfalls.

The inspection was unannounced. Osborne Court provides nursing and personal care for up to 55 people. At the time of our inspection there were 37 people living in the home.

There was no registered manager in place at the time of our inspection. 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. One of the provider’s area resident experience care specialist’s was taking overall management responsibility for the home. They are referred to in this report as the interim manager.

Most people told us they felt safe in the home. However, we found medicines were not always safely managed and risk assessments and risk management plans were not always fully completed. Staff understood their responsibilities with regard to keeping people safe from avoidable harm and abuse.

People‘s healthcare needs were not always met. Staff were not always provided with sufficient information about actions to take when people’s needs changed. Staff were not always provided with sufficient support and supervision.

Staff demonstrated a kind and caring approach and they treated people with dignity and respect. Staff knew people well and were able to tell us about people’s likes, dislikes and preferred routines which were reflected in their care records.

The programme of engagement and activity varied within the home. People living in one area of the home were engaged and occupied. In another area of the home people were not provided with sufficient activity during the day.

There was no registered manager in post. Most people were not aware of the management arrangements in the home. Staff expressed concerns with regard to the lack of consistent leadership and management.

We found four breaches of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report. We also made recommendations for further training to be provided for Deprivation of Liberty Safeguards (DoLS) and diabetes management.