Archived: Osbourne Court Care Home

Osbourne Court Care Home is a residential care home providing personal care to up to 69 people. The service provides support to older people, some of whom are living with dementia, in one adapted building. At the time of our inspection there were 23 people using the service.

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

People’s safety was well managed for the most part. The management and staff team had worked to improve systems that raised awareness and promoted safety. There were some points raised as part of the inspection in relation to robust risk assessment, checks and controls and swift action was taken on the day of the inspection visit to address these.

The management systems in the home were now in place. The embedding of these systems was still ongoing to help ensure they were proactive and not reactive, sustained any improvements and continued to learn from any lessons, both historical, and current. Care plans were a work in progress as they did not hold all information needed, and some handwriting was difficult to read, but the management team were aware of this and working on addressing it. Some communication and end of life care plans needed more development. Action was taken to address this following the inspection.

Feedback about the management was positive, staff felt there was support, guidance and leadership which had improved the morale and culture in the home. The new manager started at the home after the last inspection. They had worked with the senior managers and staff team to drive improvement.

Infection control practices were in place and staff were working in accordance with guidance. Medicines management was monitored and where we identified some areas for improvement, this was addressed on the day of the visit. This mainly related to record keeping.

People, relatives and staff told us that staffing had improved at the service. The use of agency staff had reduced, and people’s needs were seen to be responded to appropriately. Staff told us they felt trained and supported.

Staff were aware of people’s needs and risks. In addition, they carried a sheet which detailed key information they needed to be aware of.

People’s privacy and dignity was promoted. Staff spoke with people nicely and people told us staff were kind and helpful. People told us they were involved in making choices about their day and their care. Relatives told us they were also involved as needed and they were happy to approach a member of the management team should they need to or if they needed to make a complaint.

People had access to food, drink and call bells throughout our inspection. Staff carried out checks on people and offered drinks. People were also able to participate in activities as they wished. The activity team were working with people developing plans and activities they would enjoy.

There was redecoration ongoing. This meant that the upstairs unit was closed. The management team advised that when this was completed, further work to ensure the building was more dementia friendly would be considered.

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

Rating at last inspection

The last inspection for this service was not rated (published 20 July 2022). The last rating for this service was inadequate (published 11 May 2022).

This service has been in Special Measures since 20 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection and was prompted in part due to concerns received about standards of care, response to changing health needs, management and staffing. A decision was made for us to inspect and examine those risks. As a result, we undertook a comprehensive inspection to review all the key questions.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Osbourne Court Care Home is a residential care home providing personal and nursing care to up to 69 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 30 people using the service.

Osbourne Court Care Home accommodates up to 69 people across two separate floors, each of which has separate adapted facilities.

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

Some people had unexplained skin tears due to how personal care was delivered and during support with moving and handling. In addition, some skin tears were unexplained. In many cases these had failed to be reported internally and had not been reported externally, to the local safeguarding authority or the Care Quality Commission (CQC), as required.

While we found that the provider’s management team had been taking action to address these concerns which were raised at previous inspections, they had not resolved the issues.

The home was being managed by the deputy manager with support from the provider’s regional management team. There was positive feedback from staff about the approach and changes being made in the service.

People told us they felt safe. Staff were seen to be working in accordance with guidance and supporting people in a positive way.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 11 May 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about the care people were receiving, their safety and the safe leadership of the home. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Enforcement

We have identified breaches in relation to safeguarding people from the risk of abuse, notification of incidents and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Osbourne Court Care Home is a residential care home providing accommodation with personal and nursing care to up to 69 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 34 people using the service.

Osbourne Court Care Home accommodates up to 69 people in one adapted building over two floors.

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

People’s safety was not always well managed. We saw records had missed entries in regard to repositioning and the use of thickener in people’s drinks. We also found that fire drills were not fully completed and records to be used in the event of a fire were not accurate.

Infection control practices were in place and staff knew what they needed to do. However, we were told by relatives and professionals, and we also observed, staff did not always wear PPE appropriately. The service was experiencing another COVID-19 outbreak.

Medicines were not always managed safely. We found minor shortfalls on the day of our visit. However, the local authority had been supporting the home with medicines and had identified a number of significant concerns. These were reported as safeguarding concerns.

The management systems in the home were in place, however had not been effective to address the shortfalls. There were mixed views from relatives and staff about the management and leadership in the home. There was ongoing work since our last inspection and the local authority had also raised concerns for the service to work through. We found that there had not been enough improvement and as a result people were at risk of harm.

Lessons learned were recorded and actions implemented. However, progress was slow. The management team told us that there had been several areas to work on, but they were committed to making the improvements. There had been work done to develop relationships with visiting health and social care professionals and they were keen to work in partnership with them.

People told us that their needs were met, and staff were nice. They told us they felt safe. Relatives gave mixed views about the standard of care but also told us staff were friendly. Concerns mainly related to staffing levels and lack of permanent staff in the home and they said this impacted on people’s care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We observed staff supporting staff in a way they liked and offering choice. We also saw that there was work ongoing in relation to mental capacity assessments and best interest decisions. However staffing shortfalls at times hindered people’s experiences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 September 2021).

We imposed conditions to help drive improvement at the last inspection and the provider has been providing us with their improvement plans in accordance with the requirements of the conditions.

At this inspection we found there was insufficient improvement and the conditions remain in place.

Why we inspected

We received concerns in relation to staffing, unsafe care and the environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 Inadequate based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing, notifications and governance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Osbourne Court Care Home is a care home providing accommodation for up to 69 older people, including people living with dementia. At the time of the inspection there were 40 people living at the home.

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

People told us they felt safe and that staff were kind. Risk assessments were in place to help promote people’s safety. However, these were not always up to date and staff did not always work safely or in accordance with these plans. Staff did not always support people safely when they were at risk of choking.

Unexplained injuries were recorded, investigated and any actions were taken to respond to these. However, these were not always reported to the local authority or to CQC. This had been a concern at previous inspections and had not been resolved.

Several staff had not attended a fire drill and some staff were not clear on evacuation procedures. Staff training needed to be completed with only 60% of training achieved for the home.

People and their relatives told us they felt there were enough staff to meet their needs. We saw examples of staff responding to people and meeting their needs promptly. However, we also found instances where their needs had not been met and staff approach was not person centred. Further training and development was needed to support people with behaviours that may challenge. The management team acknowledged that care plans still required work to ensure accuracy and guide staff in having a person-centred approach. However, we found that progress was slow in completing this work.

Infection control in relation to managing Covid-19 was not robust. Staff and members of the providers management team were observed not following guidance and wearing masks correctly. Staff were observed carrying out communal staff Covid-19 testing in dining rooms even though there was a designated testing room. There remained some areas of the environment that needed replacing, repairing or decoration to ensure they could be cleaned effectively. Work was slow in regard to refurbishment even though it had been raised previously by CQC and the local authority.

The manager started in December 2020. Some people knew who they were, some relatives said they had seen them in passing. Staff were unable to give any examples of the changes since they started. They told us they do see the manager around the home. Governance systems were in place, but they had failed to identify or address the issues found on this inspection.

The manager was working with the local authority to reflect on the current practice within the service to ensure that lessons were learned and to make improvements where needed. However, progress was slow and there were a number of actions outstanding and reoccurring.

Rating at last inspection

The last rating for this service was requires improvement (published 28 October 2020).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the care people were receiving. A decision was made for us to inspect and examine those risks.

As the combination of previous risks and new information we received covered all the key lines of enquiry in Safe and Well Led, we widened the scope of the inspection to become a focused.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Please see the safe and well led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Osbourne Court Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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

Osbourne Court Care Home is a care home providing accommodation for up to 69 older people, including people living with dementia. At the time of the inspection there were 48 people living at the home.

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

Following the last inspection, the registered manager left the service. At the beginning of the pandemic there was limited management and leadership in the home. This led to concerns and feedback we received was that people’s care needs were not being met. This was addressed when members of their quality team were put in the home to help start making the improvements. A new manager started in July 2020.

People told us they felt safe and that staff were kind and helpful. Risk assessments were in place to help promote people’s safety and the new manager checked that staff worked in accordance with the assessments and accompanying care plans. Unexplained injuries were recorded, investigated and any actions needed taken. However, these were not always reported to the local authority or to CQC.

Some people and relatives said at times the home needed more staff as people had to wait for the toilet for example. People told us they had their needs met. We saw that people looked comfortable and staff were responding to them as needed. The manager and staff knew people well. Care plans had been updated to better reflect people’s needs and help promote their rights and welfare.

The manager and staff team told us that it had been challenging during the pandemic, but they felt it had helped create better teamwork. People told us they had not been affected greatly during the pandemic. There were some delays in visiting due to testing and control measures which needed to be in place, however this was being addressed. Personal protective equipment was worn appropriately by most staff and good hygiene systems were in place. The manager took action in educating staff should they not follow safe working practice.

The environment had improved and there was ongoing refurbishment plans to continue these improvements.

We were told by people, relatives and staff that things at Osbourne Court Care Home had improved and the new manager had implemented training, systems and guidance to help address previous concerns.

The manager was working closely with the local authority to reflect on the current practice within the service to ensure that lessons were learned and to make improvements where needed.

Rating at last inspection

The last rating for this service was requires improvement (published 19 June 2020) and there were multiple breaches of regulation. We issued the provider with a warning notice stating they must make the improvements by 30 April 2020. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook a targeted inspection to follow up on the concerns we had at the last inspection and specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the care people were receiving. A decision was made for us to inspect and examine those risks.

As the combination of previous risks and new information we received covered all the key lines of enquiry in Safe and Well Led, we widened the scope of the inspection to become a focused.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe section of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Osbourne Court Care Home on our website at www.cqc.org.uk.

Follow up

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

Osbourne Court Care Home is a purpose-built residential care home providing personal care to 67 people at the time of the inspection. The service can support up to 69 people.

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

There were failings across several areas of the service resulting in breaches of regulations. Governance systems were ineffective and did not identity issues found on this inspection. Feedback about the registered manager and staff team was mixed. Where issues had been found by the local authority or by internal monitoring, these had not been fully resolved.

People and relatives were not always happy with the care and support they received. People at times did not receive the appropriate personal care. The admission process to the home needed to be addressed so that people had a positive start to their stay. Some staff were friendly, and some were attentive to people’s needs. However, at times staff were not responding to people when they asked for help or showed signs they needed support.. People, their relatives and staff told us there were not enough staff to meet people’s needs. Staff were trained and felt supported.

People felt safe but staffing issues made them feel more at risk. Staff were aware of how to promote people’s safety. Regular checks were not in place to ensure staff worked in accordance with training and in accordance with regulations. Unexplained injuries were not always reported or fully investigated. Equipment was damaged making it difficult to clean it effectively.

The environment required redecoration in some areas. Many walls and areas of woodwork were damaged, and bathrooms were not always accessible or pleasant to use. Some bedrooms and corridors had very stained ceilings from water damage. Some people enjoyed the activities that were provided, others felt they needed to be improved. Aids and tools needed to be considered to assist people with communication.

People told us they food was ok, and they had choice. However, more consideration needed to be given to the mealtime experience and accessibility of drinks and snacks. Weights were monitored, and action taken when needed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The registered manager was not clear on the Mental Capacity Act and Deprivation of liberty safeguards. People were not always treated with dignity or respect and confidentiality was not always promoted. This was because care records were left in corridors.

People were not fully involved in planning their care. People had end of life care plans, but these were clinical and did not explore how people’s emotional wellbeing would be promoted at the end of their lives. Complaints were recorded as being responded to appropriately. Feedback was sought through meetings and there were opportunities to complete surveys. However, relatives told us they had not been approached for feedback directly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good (published 8 November 2018). At this inspection the service has deteriorated to Requires Improvement.

Enforcement

We have identified breaches in relation to person centred care, promoting people's safety, treating people with dignity and respect, consent and governance systems.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

Where we are taking or proposing to take enforcement action but cannot yet publish the actions due to representation and appeals process. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Why we inspected

The inspection was prompted in part due to concerns received about people not receiving care that met their needs. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Osbourne Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Osbourne Court accommodates up to 69 people in one purpose built building. At the time of the inspection, 64 people were living there.

The service had a manager who in the process of becoming registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The manager was new in post, they had previously been the deputy manager. People were positive about the management and the running of the home. There were systems in place to monitor the quality of the service and address any shortfalls. We found that there were links with the community.

People’s medicines were managed safely and people felt safe. Individual risks were assessed and staff knew how to work safely. People were supported by staff who were recruited safely. However, feedback about staffing levels were mixed. Staff worked in accordance with infection control guidance. However, there were areas of the house that needed a deep clean.

People were supported by staff who were trained and felt supported. Staff worked in accordance with the Mental Capacity Act and people had access to health and social care professionals when needed. People received the appropriate support with eating and drinking. However, the mealtime experience needed further development to make the experience more enjoyable.

The environment was currently undergoing a refurbishment programme and lessons learned were shared at team meetings.

People were treated with kindness and respect. People’s relatives were involved in the reviewing of their care. However, the service needed to develop systems to ensure people themselves were also involved. We found that confidentiality was promoted.

People received care that met their needs and care plans gave sufficient information to guide staff about how to meet people’s individual needs. People were seen to be enjoying the activities available and complaints were responded to appropriately.

Osbourne Court Care Home provides nursing and personal care for up to 69 older people, some of whom were living with dementia. There were 54 people living at the home when we inspected.

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. The provider had successfully recruited a new manager since our previous inspection in April 2015. The manager had submitted an application to register with CQC and this was being processed at this time.

At our previous inspection on 07 April 2015 we found that the provider had not ensured that sufficient numbers of suitably qualified, competent, skilled and experienced staff were provided to meet the needs of the people using the service. At this inspection we found that the provider had taken action to address the identified concerns. People received their care and support in a timely manner from a skilled and supported staff team.

People were supported to make their own decisions as much as possible. People received support to eat and drink in sufficient quantities and their health needs were well catered for because appropriate referrals were made to health professionals when needed. Potential risks to people’s health, well-being or safety were identified and reviewed regularly to take account of their changing needs and circumstances.

People praised the care and kindness demonstrated by all the staff team. Staff members were knowledgeable about people’s individual needs and preferences. Visitors were encouraged at any time of the day and people’s privacy and dignity was promoted. We observed sensitive and kind interactions between staff and people who used the service.

There were arrangements for daily activities and entertainment in the home. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open culture in the home and people, their relatives and staff were comfortable to speak with the manager if they had a concern. The manager had succeeded in introducing significant improvements in many aspects of the service provided for people at Osbourne Court Care Home since coming into post. However, the management team acknowledged that there was more to do in order to consolidate the work already achieved. Record keeping needed some improvement in order to help ensure people’s safety and welfare. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We revisited Osborne Court Care Home on 01 September 2014 and we found that, while some improvements had been made, the provider remained in breach of the regulations.

The home manager, new in post in February 2014, had not been provided with the appropriate induction, supervision, support and training to ensure he had the necessary skills and knowledge to fulfil the role.

Audits and quality monitoring processes now had action plans completed to indicate who had the responsibility to drive forward areas of improvement and in what timescales. However, it was noted that these improvements were not always effectively completed or sustained.

Below is a summary of what we found. The summary is based on our findings during the inspection, discussions with people who used the service and their relatives. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was planned and delivered in a way that was intended to ensure people's safety and welfare. There was a programme of staff training and supervision in place which meant that the staff team were supported to provide safe care.

Is the service effective?

We asked people who used the service if their health needs were met. One person said, 'Oh yes, if I am feeling at all unwell I only have to mention it and they get me the doctor if I need it.' We saw that people were referred appropriately to specialist professionals. This was confirmed by one person who stated that staff had made appointments for them for the dentist and optician. It was clear from our observations that the staff team had a good understanding of people's care and support needs and that they knew them well.

Is the service caring?

People who used the service told us that staff treated them with respect and courtesy. We noted that the staff team interacted with people with warmth and respect. For example we saw a staff member kneeling beside a person gently exploring why the person was low in their mood. The staff member demonstrated empathy and showed a good depth of knowledge of the person they were supporting. People told us that they were happy with the care that they received and that their needs had been met. A person told us that when staff assisted them with personal care they were, 'Very good to me, they lift me gently and they all know what they are doing like second nature. I think the staff are trained really well, there's no fussing they just get on with it.'

Is the service responsive?

Records confirmed that people's preferences, interests and diverse needs had been recorded and that care and support had been provided in accordance with people's wishes. People who used the service told us that staff listened to them and took their views seriously. For example, one person told us, 'They listen to me, if I am not ready, not feeling well or just want to be left alone a while they say ok and come back later.'

Is the service well led?

The service had undergone a period of instability with management arrangements in the previous twelve months, the current manager had been in post at Osbourne Court Care Home since February 2014. People who used the service, their relatives and staff members had positive things to say about the improvements that had been made to the service since February. People said that the new manager was approachable and caring. We found that there were monitoring systems in place to assess if people's needs were consistently met to their satisfaction. However, we found that where there had been shortfalls identified through these audits the manager had not developed action plans to ensure issues were addressed. This meant that there was not an effective system in place to manage risks to the health, safety and welfare of people who used the service and others. People told us that they knew how to make a complaint and would be confident that their concerns would be taken seriously.

During our visit on 31 May 2013 we observed that most staff provided care in a way that showed people were being treated with respect and given choice about how they received their care. One nurse told us, 'Things are a lot better in the home now, the new manager has made a real difference.'

We spoke with seven people living in the home and with five relatives. One person we spoke with told us, 'Things are quite good now, but I need to ask for explanations'. A relative we spoke with told us that, 'Most things are there if you ask for them'. Another relative told us that, 'Staff are always approachable and friendly'.

We observed some good practice. For example, we heard a member of staff talking to people kindly and engaging with one person in conversation that was not task related. However, we also observed some poor practice. For example, we heard a member of staff encourage a person to drink but when the person refused the staff member said sharply, 'You just need to have a drink'.

Overall, people we spoke with were happy with their care.

Some people who used the service had complex needs which meant they were not able to tell us of their experiences. We spent time observing everyday life to help us to understand care experience at the home. People were positive about staff. However, we found that at times staff were not listening to people and providing their care in the way they preferred. Staff had written inappropriate comments about people and were not protecting their confidentiality adequately at staff handover meetings.

People's needs were assessed and they and their relatives were involved in planning their care. People had individualised care and treatment plans. People were protected from abuse by safeguarding procedures.

There were an adequate number of staff on duty to meet the needs of people who used the service. They were skilled, competent and knowledgeable.

The quality assurance system was working effectively. People and their relatives had opportunities to express their views. These were considered and taken into account in the running of the home.

People said they were satisfied with their care and found staff helpful, however we found serious shortfalls in the care outcomes people experienced. One person told us that they were independent in almost all aspects of their care but did need some help with dressing. They said they waited a long time for staff to come when they called them to do this.

No evidence was presented as to how staff protect peoples' valuables from being stolen. One person told us they, "I feel safe but I get worried because of a couple of people who walk in my room and won't go".

We asked people how long staff took to meet their needs. One person said that in the evening it took more than fifteen minutes for their call bell to be answered by staff.

The Registered Manager was accountable to the provider through various audits of the quality of the service. However we found that people's views were not necessarily sought or responded to by staff. Of the ten people we spoke with no person knew who the Registered Manager of the home was.