Archived: Osborne Grove Nursing Home

Osbourne Grove Nursing Home is a nursing home providing personal and nursing care to two people aged 65 and over at the time of the inspection. The service can support up to 32 people.

People’s experience of using this service

We found people were put at risk of harm as systems put in place to protect them from abuse were not followed and not all staff felt the service was well led. We also found areas of medicine management processes in relation to ‘as and when required’ medicines and completion of medicine administration records (MAR) chart needed further action. We have made a recommendation in relation to medicine management in these areas.

Relatives told us people were safe. Staff checks were carried out to ensure they were safe to work with people who used the service. Risks to people were assessed and managed to reduce the risk of avoidable harm. Staffing levels were based on people’s level of need. Systems to manage the risk of the spread of infection were in place.

People’s nutritional and hydration needs were met by the service and people had access to health professionals to meet their health needs.

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.

People’s needs were assessed and used to develop their plan of care. People received sufficient amounts to eat and drink to maintain their health. Staff received training relevant to their role and understood people’s individual needs.

Relatives told us people were treated with dignity and respect by staff who were caring and knew them well. People were supported to maintain their independence where possible. People were supported by staff who knew them well and understood their needs and preferences. Relatives told us they felt their relative was well cared for by staff who understood them well. Relatives were involved and said they were notified by staff whenever there was a change in people’s needs.

People were supported to participate in activities as much as possible. People’s communication needs were taken into account during the assessment process. Relatives knew how to raise a concern if they were unhappy about the service provided to their relative.

Systems were in place to monitor the quality of the service, including internal and external audits. Most staff felt supported and talked about the improvements made to the service since our last visit. However, not all staff felt supported by the registered manager or able to approach them with their concerns.

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

Rating at last inspection

The last rating for this service was requires improvement (published 23 February 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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

Enforcement

We have identified breaches in relation to systems for reporting safeguarding concerns and management oversight.

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.

At our comprehensive inspection in December 2016 we found the service in breach of seven legal requirements. We took enforcement action against the provider and served four warning notices in respect of safe care and treatment, meeting nutritional and hydration needs, person centred care and good governance. We also issued three requirement notices in relation to consent, staffing and submitting notifications. We carried out a focused inspection in March 2017 and found the provider had not made sufficient improvements to fully meet the warning notices. We served four more warning notices and the home was placed in to Special Measures and rated Inadequate.

At our last comprehensive inspection in July 2017 we found the provider had made significant improvements since our last inspection and had complied with three of the four warning notices we had served. The service was taken out of special measures. There had been improvements in safe care and treatment, meeting nutritional and hydration needs, and good governance. However, a warning notice regarding person centred care was not met due to a lack of activities on offer for people and lack of choice in having baths and showers. We rated the service as Requires Improvement.

The provider sent us a service improvement plan detailing how they would make the necessary improvements to the service.

At this inspection we found that the provider had made some improvements, however, this was not enough for them to be rated overall ‘Good.’ This is the third consecutive time the service has been rated Requires Improvement or Inadequate.

There is 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.

People using the service had complex needs and were not able to tell us their experience of using the service. Relatives told us that people using the service were safe. People were protected from the risk of abuse. Staff knew what constituted abuse and understood their responsibility to report abuse. Staff were aware of the whistleblowing procedure and reporting any concerns to external authorities.

Risk assessments documented areas of individual risks, however, how to mitigate these risks was not always documented. Nevertheless, staff understood about risk management and how to manage risks posed by people using the service. The provider followed safe recruitment practices. There were sufficient staff on duty to meet people’s needs.

Systems were in place to manage and administer medicines, including individual ‘as and when required’ protocols. However, we found medicine administration record charts were not always completed accurately. People were not always protected from the risk of the spread of infection. Infection control procedures were in place and staff were provided with the necessary personal protective equipment. However, we found staff did not always follow appropriate. infection control procedures.

There were systems in place for reporting and recording incidents and accidents and learning from incidents took place. Safety checks were carried out to ensure the building and equipment used to carry out care was safe for people using the service.

Staff received regular supervision and an appraisal, which included a review of their performance and training needs and setting of objectives for the coming year. Staff received training relevant to their role.

People’s nutrition and hydration needs were met and people were provided with a choice of meals that met their religious and cultural needs. People’s spiritual and cultural beliefs were respected and staff supported people to celebrate their faith.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were given choice and staff asked people for their consent before providing care. However, Deprivation of Liberty authorisations were not always notified to the CQC as is required. People had access to healthcare professionals to ensure that their health needs were met and well-being maintained.

Staff treated people with dignity and respect and staff encouraged people’s independence. People’s confidentiality was respected and records relating to people using the service were kept in a lockable cabinet.

We observed people were comfortable with staff who were caring for them. The registered manager operated an open-door policy which enabled people to approach the management whenever this was needed.

People’s needs were assessed and reviewed before joining the service.

Complaints were dealt with centrally at the service’s head office, records showed that these were dealt with in line with the service’s complaints policy. This showed that the service responded to complaints.

Quality assurance systems were in place to monitor the quality of the service and audits took place. However, these audits were not always effective as they had not identified or addressed the issues found during our inspection. Care records relating to people using the service were not always accurate and the provider failed to notify the CQC of authorised Deprivation of Liberty Safeguards as legally required to do so.

We found the provider was in breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. This was in relation to good governance, and failure to submit notifications of authorised Deprivation of Liberty Safeguards as required by law.

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.

This inspection was an unannounced comprehensive inspection and took place on 26 and 27 July 2017. Osborne Grove Nursing Home is registered to provide accommodation and personal and nursing care for up to 32 people. The home is run by the London Borough of Haringey. There were 17 people living at the home at the time of this inspection. No further admissions were planned at the time of the inspection.

There was a registered manager in place. 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.

At this inspection, we found the provider had made significant improvements since our last inspection and had complied with three of the four warning notices we had served. There had been improvements in safe care and treatment, meeting nutritional and hydration needs, and good governance. A warning notice regarding person centred care was not met due to a lack of activities on offer for people and lack of choice in having baths and showers. We found some improvements had been made in these areas but the warning notice was not fully complied with. More people were now supported to have a bath or shower and the provider had bought specialist equipment to enable others to use the shower safely which they planned would happen soon after our inspection. The range of activities in the home was limited but the activities coordinators spent time with individual people each day reading, giving hand massages or chatting to them which was positive for people’s wellbeing. The manager had introduced trips out at the weekend which people said they appreciated. Small groups had been out to places such as Epping Forest, local parks and the Princess Diana memorial.

The standard of care had improved and the oversight of care by the management team had also improved. They had introduced care records in people’s rooms so staff could record the care they had given a person (for example, supporting them to wash, have a drink, change position) at the time they gave the care. Nurses and the management team checked the care records daily. This meant that record keeping was better and the management team could pick up any problems promptly. This reduced the risk of people becoming constipated, dehydrated or sustaining a pressure ulcer as those aspects of care were monitored daily.

There had been improvements in the management of medicines. We made two recommendations about storing medicines at a safe temperature and reviewing written guidelines for medicines that were taken as and when required, to ensure staff knew exactly when a person needed the medicine and what dose.

The provider had bought new equipment to help them provide safer care. People who were at risk of pressure ulcers had the appropriate beds and pressure relieving mattresses and personalised chairs to help support them to sit safely.

The provider had increased staffing levels and support and supervision given to staff.

Staff had recently attended training in supporting people with personal care and eating. We saw good practice from staff supporting people with eating their meals which reduced the risk of choking for those people who had difficulties chewing and swallowing. The quality and choice of food had improved since our last inspection. People who were underweight were now receiving good support. Staff were following advice from dieticians and those people were having extra snacks and the cooks were preparing daily milkshakes and smoothies in between meals. We made a recommendation that staff receive further training in assessing nutritional needs using the recommended assessment tool. We also made a recommendation that people's advanced care wishes are updated so that medical staff know how to respond in an emergency.

Staff were caring and people had no complaints about how they were treated in the home.The management team planned further improvements including reorganising people’s files and reviewing all care plans to make them more person centred in the weeks after the inspection. Relatives told us they had seen improvements in recent months. The management team were working well together and had made recent improvements in safety, quality of care, food, record keeping, staff morale and cleanliness in the home.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Prior to this inspection, we carried out an unannounced comprehensive inspection of this service on 6 and 7 December 2016. At that time, we found breaches of seven legal requirements. We rated the service as ‘Requires Improvement’ and we served four enforcement warning notices on the provider, London Borough of Haringey. These were in respect of safe care and treatment, meeting nutritional and hydration needs, person centred care and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We carried out this focused inspection on 22 and 30 March 2017 to check that the provider had followed their action plan and to confirm that they now met the legal requirements relating to the four warning notices.

This report only covers our findings in relation to the four warning notices. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Osborne Grove Nursing Home on our website at www.cqc.org.uk.

Osborne Grove Nursing Home is registered to provide accommodation and personal and nursing care for up to 32 people. The home is run by the London Borough of Haringey. There were 19 people using the service at the time of this inspection. Commissioners had imposed an embargo on new people moving into the home due to concerns about the quality of care provided until improvements were made. No further admissions were planned at the time of the inspection.

There was a registered manager but they had been on extended leave since 1 December 2016. 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 temporary manager at our last inspection on 6 and 7 December 2016 had left as had their line manager. A new management team had been in place for a few weeks at the time of this inspection. The new manager had been in post since January 2017 and was applying for registration. A deputy manager had been in post since December 2016 and a nurse consultant to oversee the management of the home since February 2017.

At this inspection, we found that the provider remained in breach of legal requirements relating to safe care and treatment, meeting nutritional and hydration needs, person centred care and good governance, despite some evidence of addressing matters relating to our warning notices. None of the warning notices were fully complied with.

We found care plans had improved but records of care provided showed that care was not always provided in accordance with the person’s care plan. One example of this was “turning charts”. Where a person’s care plan stated that they were at high risk of pressure ulcers and should be supported to change position or “turn” every two or four hours, charts showed this was not always carried out. There was insufficient evidence that some people at high risk of developing pressure ulcers were supported to change position regularly, especially at night, in accordance with their plan of care.

Two people had care plans stating that they needed to take prescribed food supplements and be offered snacks between meals as there were concerns about weight loss. The food/fluid records showed that they were not always offered these.

Moving and handling equipment to help staff move people who were unable to get up by themselves had improved since the last inspection as staff had attended further training in using the hoists safely and each person had their own named sling for use with the hoist which improved safety and reduced infection control risk. However pressure relieving mattresses to reduce the risks of people sustaining pressure ulcers were not in good condition. There were no records of staff checking them regularly to make sure they were clean and working properly. The manufacturer had recently audited the equipment and found some were not fit for purpose. The provider had ordered new mattresses which were being delivered the day after our inspection.

The home was generally clean and had suitable hand washing facilities but we found some bedroom floors and furniture to be sticky and armchairs in lounges and beds not cleaned regularly which was an infection control risk.

There was not enough stimulation for people and limited opportunity to go outside the home.

Records of the care provided to people were not consistently accurate and complete. This meant that there was insufficient evidence of safe care and treatment.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

The breaches of regulations identified in this report indicate ineffective governance of the service. There were insufficient improvements despite us serving four warning Notices on the provider soon after our last inspection. As a result of the concerns we identified, that the provider was not meeting the needs of people using the service who may therefore have been at risk of harm, we sent the provider a letter of intent after the inspection, outlining our most serious concerns. The letter informed the provider of enforcement action we were considering, and requested an urgent action plan setting out how the provider intended to address these concerns. An action plan was promptly sent that planned to address the most serious concerns. We therefore reviewed our enforcement options, and served four enforcement Warning Notices on London Borough of Haringey to help ensure that prompt action is taken to address the concerns we identified during this inspection.

This inspection took place on 6 and 7 December 2016 and was unannounced. The inspection was prompted in part by notification of an incident where a person sustained an injury and information that moving and handling equipment had been out of use for twenty days. The information about the incident indicated potential concerns about the management of the risk of falls from moving and handling equipment. This inspection examined those risks.

The previous inspection was in November 2015 and at that time all legal requirements were met. We made recommendations at the previous inspection to improve care plans, activities and

stimulation for people living at the home to ensure that people’s needs were met proactively and

responsively. There had been some improvement since that inspection but not enough to ensure people’s needs were always met.

Osborne Grove Nursing Home is registered to provide accommodation and nursing care for up to 32 older people. The home had a registered manager in place however they were on extended leave at the time of this 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. An interim manager started the day before the inspection. This person had worked at the home for several weeks in a different capacity so had some knowledge of it. There was also a “supporting manager” who was working at the home temporarily to assist with a plan of improvements.

At the time of this inspection there were 24 people living at Osborne Grove in three eight-bedded units. The fourth eight-bed unit was closed and no further admissions were planned at the time of the inspection.

People living in the home told us they were happy with the care and had good relationships with the staff. The visitors we met were generally happy with the care too.

People said staff were friendly and polite and they felt well looked after. There was mixed feedback about the food; some said it was good and others said it lacked variety. We also found a lack of choice, and people who were supposed to have fortified meals and extra snacks were not always receiving these.

Most people said they had nothing to occupy them during the day though some were happy to stay in their rooms. We found there was a lack of activities and opportunity to go out for people. There was a full-time activities coordinator but the provider had used them for other duties. They were returning to their full-time role at the time of the inspection.

The moving and handling equipment (hoists) had been out of action for twenty days just prior to the inspection. The equipment had been checked for safety and was working and in use at the time of the inspection but most people had to stay in bed for twenty days which contributed to one person developing a pressure ulcer. Appropriate action had been taken relating to the accident using a hoist to prevent a similar accident happening.

There were breaches of seven regulations at this inspection. This was because we found improvements were needed in the areas of medicines, equipment, food, assessing mental capacity, support for staff, governance of the service, person-centred care, and making notifications to us. You can see what action we told the provider to take at the back of the full version of the report.

All of the people we spoke with told us that they were happy with the care and support provided to them, and that they were treated with respect by staff. Comments included 'I don't have any concerns,' 'It's as good as it gets,' 'It's alright ' no problems,' 'I have always felt involved in their care, 'and 'They do a wonderful job.' Two of the relatives we spoke with told us that improvements had been brought about as a result of concerns that they raised with the management. We observed staff supporting people positively and professionally. People told us that they were happy with the food provided to them at the home, including provision of cultural alternatives.

At the time of our visit there were a number of staff vacancies waiting to be filled at the home, and staff advised that they were working alongside agency workers. Staff confirmed that they received relevant training support and supervision for their roles. Quality assurance procedures were in place, however there was room for improvement in particular areas of the home's record keeping with regard to people's care and support.