The Care Quality Commission
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Archived: Osborne Court Care Home

Overall: Requires improvement read more about inspection ratings

183 West Street, Bedminster, Bristol, BS3 3PX (0117) 953 5829

Provided and run by:
Laudcare Limited

Important: The provider of this service changed. See old profile

All Inspections

11 May 2016

During a routine inspection

The last inspection took place in October 2015 and, at that time, three breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to safe care and treatment, the need for consent and good governance. We issued three warning notices regarding these breaches. In addition to this, we also found an additional two breaches of the regulations of the Health and Social Care Act 2008 relating to staff training and infection control.

Following this inspection the service was placed into special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that provider’s found to have been providing inadequate care should have made significant improvements within this timeframe. 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 at its next comprehensive inspection and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the inspection the provider wrote to us to say what they would do to meet the legal requirements.

You can read the report for previous inspections, by selecting the 'All reports' link for ' Osborne Court Care Home' on our website at www.cqc.org.uk

This inspection took place on 11 and 12 May and was unannounced. The provider had made sufficient improvements to be removed from special measures.

Osborne Court is registered to provide personal care and nursing care for up to 55 people. On the first floor of the home care is provided to people living with dementia. The ground floor accommodated people with both personal care and nursing needs. At the time of our inspection there were 35 people living in the home.

There was no registered manager in place on the day 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. The current manager has submitted their registered manager’s application form for consideration.

In October 2015 we found that medicines were not managed safely. At this inspection the provider had made sufficient improvements.

In October 2015 we found that people’s rights were not being upheld in line with the Mental Capacity Act (MCA) 2005. At this inspection the provider had made sufficient improvements.

In October 2015 the provider had not consistently protected people against the risk of poor or inappropriate care as accurate records were not being maintained. The provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. Where risks were identified, the provider did not consistently introduce measures to reduce or remove the risks to minimise the impact on people within a reasonable timescale. At this inspection the provider had made sufficient improvements.

In October 2015 the provider had not ensured that people were protected from the risk of cross infection. At this inspection the provider had made sufficient improvements.

In October 2015 staff were not consistently supported through an effective training and supervision programme. Although the provider had made improvements, further work was required on this area.

Systems were being operated more effectively to assess and monitor the quality and safety of the service provided. The new management team had been well-received by people, staff and visitors.

Staff demonstrated kind and compassionate behaviour towards the people they were caring for. Staff were knowledgeable about people’s needs. We received positive feedback about the staff and people thought they were caring.

Care records that we viewed showed people had access to healthcare professionals according to their specific needs.

Relatives continued to be welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

26 October 2015

During an inspection looking at part of the service

This inspection took place on 26 October 2015 and was unannounced. The last full inspection took place in March 2015 and, at that time, three breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to safe care and treatment, staffing and the need for consent. These breaches were followed up as part of our inspection.

Osborne Court is registered to provide personal care and nursing care for up to 60 people. On the first floor of the home, care is provided to people with living with dementia and is split into two areas. One providing nursing care and the other providing for personal care needs only. The ground floor accommodated people with both personal care and nursing needs. At the time of our inspection there were 36 people living in the home.

The overall rating for this service is ‘Requires Improvement’. However, we are placing the service in 'Special Measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in Special Measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was no registered manager in place on the day 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. The registered manager left the service in May 2014. Since their departure four people have held the peripatetic manager post. The current peripatetic manager had been in post for approximately three weeks and will remain in post until a new permanent manager is appointed.

In March 2015 we found there was an increased risk of the spread of infections; people were not fully protected because appropriate guidance was not being followed. At this inspection the provider had not made sufficient improvements.

In March 2015 we found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for storing creams and ointments. Accurate records were not kept of the application of these medicines. At this inspection we found that insufficient improvements had been made.

In March 2015 we found that people were not always safe as there were not always sufficient numbers of suitably qualified and skilled staff to support their needs. At this inspection we found improvements had been made regarding staffing levels. However, staff were not consistently supported through an effective training and supervision programme.

In March 2015 people’s rights were not fully protected when decisions were made on their behalf. This was because some people did not have mental capacity assessments completed where they were required. At this inspection insufficient improvements had been made.

People’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. In some people’s support plans we did not see information about their mental capacity and Deprivation of Liberty Safeguards (DoLS) being applied for. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty.

Systems were not being operated effectively to assess and monitor the quality and safety of the service provided. We received a number of negative comments from staff, people and their relatives about the management of the service. The main concern was a lack of continuity in leadership at the service.

The service was not well-led. Despite sending the Commission an action plan advising how they were going to meet the regulations, the provider had not implemented their stated actions. Insufficient progress had been made regarding infection control, management of medicines and the need for consent. We also found an increased number of breaches regarding governance.

The majority of staff demonstrated kind and compassionate behaviour towards the people they were caring for. Staff were knowledgeable about people’s needs and told us they always aimed to provide personal, individual care to people. Feedback from people who used the service and relatives advised that the care was good most of the time and the care staff wanted to provide the best care they could.

People had their physical and mental health needs monitored. Care records that we viewed showed people had access to healthcare professionals according to their specific needs.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

2 and 3 March 2015

During a routine inspection

This inspection took place on 2 and 3 March 2015 and was unannounced. The previous inspection was carried out on 15 September 2014 and there had been a breach of legal requirements at that time. This was in relation to regulation 20 records, as not all records and monitoring charts were completed consistently. This posed a risk of unsafe or inappropriate care and treatment being delivered. During this inspection we saw some improvements had been made and overall records were more consistently recorded. Although some actions remain to be embedded in practice and further action is required to meet the legal requirements.

Osborne Court is registered to provide personal care and nursing care for up to 68 people. On the first floor of the home care is provided to people with living with dementia and is split into two areas. One providing nursing care and the other providing for personal care needs only. The ground floor accommodated people with both personal care and nursing needs. At the time of our inspection there were 47 people living in the home.

A registered manager was in post 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.

Systems were in place to safely manage people’s medicines however improvements needed to be made in this area that included the storing of creams and ointments. Accurate records were not kept of the application of these medicines.

While the organisation had infection control policies in place. Best practice guidance had not been followed. Staff did not follow the latest guidance in relation to handling used laundry. Personal protective equipment (PPE) was not always used by staff. For example plastic aprons were not always worn by care staff when handling used laundry. Therefore the organisation’s infection control policy was not always followed.

Staffing levels were not sufficient during our inspection. Some people were left unsupported for periods of time in shared areas that posed a potential risk to their safety and well-being. Other people did not receive interactions from staff or activity for periods of time.

Staff received training and some staff understood their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. However we found the staff had not always acted in accordance with legal requirements when decisions had been made, where people lacked capacity to make that decision themselves.

Some staff had attended Deprivation of Liberty Safeguards training (DoLS). This is legislation to protect people who lack mental capacity and need to have their freedom restricted to keep them safe. However some staff needed training updates to ensure their skills and knowledge was kept up to date. No one living in the home was subject to DoLS authorisation.

Some people’s care plans lacked evidence of effective monitoring of pressure areas to ensure people received the correct care. This was because some documentation was not always completed fully.

We found the provider had systems in place that safeguarded people. One person we spoke with told us “yes it’s as safe as houses here”. Another person told us “they are nice and if I didn’t feel safe I could say so”.

The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively. Training was provided and staff we spoke with were knowledgeable about people’s needs. One member of staff told us “we get plenty here. I enjoy doing it but it takes up a lot of time. But we need to learn best ways of doing things”.

Staff meetings took place and gave staff opportunities to share ideas and be updated on quality and care delivery.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. The registered manager and regional manager undertook regular audits however didn’t identify the infection control concerns we found.

There were systems in place to obtain the views of people who used the service and their relatives. Meetings and satisfaction surveys were used. Surveys were provided to people living in the home and their relatives.

We found several beaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which now correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

15 September 2014

During an inspection looking at part of the service

During our inspections we set out to answer a number of key questions about a service: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

During this inspection we looked at the arrangements relating to people’s care and welfare and records. This helped us to answer the question is the service effective?

At the previous inspection of Osborne Court on 11 February 2014 we had found that some people's care plans were not always completed or reviewed. The service had not been complying with the regulation in relation to care and welfare. We told the provider and the manager that they must take action to ensure that improvements were made.

There is currently no registered manager in place at this service. However we were informed during our inspection, that the current manager has submitted their application to become the registered person.

We visited Osborne Court again on the 15 September 2014 in order to check on the action that had been taken. Below is a summary of what we found.

Is it effective?

We found that improvements had been made and we judged that the service was complying with the regulation in relation to care and welfare. People’s care plans were completed and were reflective of their current support needs.

However we found some people’s associated care records such as nutritional monitoring charts, repositioning charts and daily records had not always been recorded consistently or fully. Therefore we included records as part of this inspection. We told the provider and the manager that they must take action to ensure that improvements were made.

People and their relatives were happy to speak with us about the care they received. One relative told us “Care is better now than it has been”. “They’ve got more going on now than they had in the last nine months. They do some activities with X, as X needs things to do where they can use up a bit of energy. I can see the difference in X. I’m happy with the care it’s a difficult job.”

We found that not all people’s associated care records such as their monitoring charts for nutritional intake had been effectively completed. This could pose a risk as it could be difficult to see what food and drink people had actually consumed during the 24 hour period. The provider was not complying with regulation 20 in relation to records. We told the provider and the manager that they must take action to ensure that improvements were made.

11 February 2014

During a themed inspection looking at Dementia Services

Osborne Court overall is registered to support 68 people requiring either personal or nursing care. The dementia unit is situated on the first floor and provided support to people who were living with a form of dementia.

At the time of our inspection there were 18 people living in the first floor area of Osborne Court. The registered manager told us that all people in this area were living with a form of dementia and were at various stages of their dementia journey.

We reviewed six people’s care records and observed peoples experiences of care during the day. We spoke with staff and managers about peoples’ care and support. We also reviewed other documents such as people’s recording and monitoring charts. Some people's care plans were not always completed or reviewed. We also found some inconsistencies of recordings in associated care records.

We gained the views of people living in the home and their experiences during our visit. People we spoke with were positive about the care and support they received. Comments included “Nobody makes me get up… I’m well looked after”; I’m happy…never had reason to complain… I’ve had no trouble at all” and “I get on with everyone”.

People’s health was monitored and they had access to community health resources as required. A visiting medical practitioner told us communication had improved between the staff and visiting practitioners in this area of the home. A visiting minister also noted the improvements. They told us “staff are in a better frame of mind, more relaxed and felt better supported now’.

Staff were knowledgeable of people’s needs and the interaction between staff and between staff and people who used the service was friendly and respectful.

We left comments cards at the home for people to complete following our inspection, in order to gain their views. We did not receive any completed comment cards.

Systems were in place to monitor the quality of the service. The auditing system had identified some of the shortfalls that we found during our inspection. The shortfalls related to the care and welfare of people that used the service.