Archived: Osborne House

Osborne House is a residential care home providing personal care to 8 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

Osborne House is a two-storey building with communal dining, kitchen and lounge areas, a conservatory and large enclosed garden. There are wet rooms on each floor for showers that are shared. Some rooms have en-suite facilities. There is an office within the building at the front of the house and a separate laundry and staff room area.

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

People and relatives told us they liked the changes to the environment and staff practices. There were still improvements to be made which the manager had plans in place to address.

People were supported by a staff team who had the appropriate training and skills to meet their needs and were dedicated to providing a person-centred approach to care. They had assessed people’s needs and written care plans to support these, which were in the process of being further developed.

People told us they felt safe and were happy with the care being provided and the way staff treated them. The staff team had a good understanding of abuse awareness and how to safeguard people.

People said they had plenty to eat and drink and choices about menus and how they spent their time. We observed warm and kind interactions and staff who demonstrated patience and compassion.

People’s medicines were being safely managed and they had access to a wide range of health professionals to ensure their needs were correctly assessed and supported.

There were better communication systems in place and people, relatives and staff felt able to raise any concerns with the manager who they said acted quickly to resolve any problems or to offer additional support. Relatives were happy with the changes that had taken place and the care being delivered.

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.

The new manager had implemented new quality assurance and auditing systems to better monitor the care provided and quickly identify any concerns. While there were still areas to improve upon, the service was now being managed well and the manager and staff team were keen to learn.

We have made a recommendation about further developing systems and care planning to ensure they are fully person centred. We have also made a recommendation about the completion of outstanding environmental repairs and replacements.

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 04 May 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 04 May 2020. 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

This inspection was carried out to follow up on action we told the provider to take at the last 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 coronavirus and other infection outbreaks effectively.

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.

About the service

Osborne House is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

Osborne House is a two-storey building with communal dining, kitchen and lounge areas, a conservatory and large enclosed garden. There are wet rooms on each floor for showers that are shared. There is an office is within the building at the front of the house.

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

People and relatives told us they felt safe as they had staff there to meet their needs. However, we found that people were not safe. People were being supported by staff who did not have the appropriate training, skills and knowledge to safely meet people’s needs. Systems and processes to keep people safe were not in place.

The registered manager had not supported staff to develop their skills or assess their competency. This meant staff did not have the knowledge of people’s health conditions and the associated risks. Staff tried to be caring and relatives told us staff acted with kindness; but staff were not empowered to use their initiative to ensure people were warm and safe.

People did not have risk assessments or care plans that showed assessment and guidance about how to meet their individual needs in-line with best practice guidance. People were at risk of harm from injury because staff used incorrect moving and handling techniques. Risk of choking had also not been addressed because the registered manager did not ensure the correct advice regarding dietary or medicine needs was in place.

The registered manager did not assess quality of care delivery, operational systems and processes. The provider did not have their own systems in place to check overall quality, systems and processes. Neither the provider nor the registered manager recognised the need for effective systems or were able to identify the concerns we highlighted during this inspection. This meant areas of concern were not identified and there were no plans for improvements.

People’s relatives told us they were kept informed about care needs and overall, were happy with the care being provided. However, there was no evidence that people or their relatives were supported to have a voice about the care they received.

The environment was not suitable to meet the health conditions of some people living at the home because people’s mobility needs meant they were restricted access to some areas of the environment as ramps made it unsafe for them to do so. Some areas were also in need of repair and redecoration.

People were not supported to access the community or to maintain community contacts. There were no structured or ad-hoc activities taking place and interactions with people were mainly task led. People who were actively seeking to go out during the inspection were not supported to do so as there was not enough staff. People who were observed to want company were not given it as staff were busy with tasks.

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 did not support this practice.

We made recommendations about making access to and the design of the environment better for people living with dementia. We also made recommendations about how to support people with making decisions about their care.

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 good (published 06 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the registered manager, governance, safe manual handling, food and nutrition, records, staff training and support, insufficient pressure care management, non-reporting of falls and pressure ulcers, poorly detailed care plans and risk management and a failure to seek medical treatment for people in a timely manner. A decision was made for us to inspect and examine those risks.

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

Since our inspection visit, the provider has taken action to mitigate some of the urgent risks and is working with another provider for support to address other risks identified.

Enforcement

We have identified breaches in relation to ensuring people are supported safely, poor record keeping and care planning, failure to meet people’s individual preferences and interests, lack of registered manager and provider oversight and quality assurance systems, safe administration of medicines, provision of safe environment and sufficient staffing levels along with staff training and competency.

We are mindful of the impact of 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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 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.

Special Measures

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.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. There was sufficient numbers of staff to support people safely. Staff took appropriate precautions to ensure that people were protected from the risk of acquired infections. People’s medicines were managed safely, and there was evidence of learning from incidents.

People’s needs had been assessed regularly and they had care plans in place that took account of their individual needs, preferences, and choices. Staff had regular supervisions and they had been trained to meet people’s individual needs effectively.

The requirements of the Mental Capacity Act 2005 were being met, and staff understood their roles and responsibilities to seek people’s consent prior to care and support being provided. Where required, people had been supported to have enough to eat and drink to maintain their health and wellbeing.

People were supported by caring, friendly and respectful staff. They were supported to have maximum choice and control of their lives. The policies and systems in the service supported this practice.

The care that people received was being regularly reviewed. Staff regularly sought the input of the person receiving care to ensure the care provided continued to meet their individual needs, and in a person centred way.

The provider had an effective system to handle complaints and concerns.

People on end of life care were supported by the home and staff to remain comfortable and have a dignified and pain-free end to their lives.

The service was well managed and the provider’s quality monitoring processes had been used effectively to drive continuous improvements. The registered manager provided stable leadership and effective support to the staff. They worked well with staff to promote a caring and inclusive culture within the service. Collaborative working with people, their relatives and other professionals resulted in positive care outcomes for people using the service.

Further information is in the detailed findings below

We noted that the provider worked with other health care professionals to promote people's well-being. One visiting professional said 'Staff have a very professional approach."

We checked both the environment and surrounding grounds and saw they were secure and suitably maintained. Overall this meant that people were protected against the risks associated with unsafe or unsuitable premises. One member of staff said, 'It's an ancient building but it's in good nic.'

Our observations and the records seen, regarding equipment, demonstrated that equipment used in the home was properly maintained and suitable for its purpose.

As part of this inspection we looked at the recruitment records for five staff who worked at Osborne House. We noted that personal files were well organised. They contained documentation which provided a clear audit trail which demonstrated that appropriate checks had been undertaken before staff commenced employment.

Records were kept securely and could be located promptly when needed. Personal information relevant to both staff and people was kept in a locked room. This meant that records were stored safely and maintained confidentiality.

Our observations during our visit to Osborne House on 16 January 2013 concluded that there was a very positive interaction between people living there and the staff team. People who used the service presented as relaxed and confident to approach staff. There was lots of friendly speech, smiles and appropriate contact from staff toward people who used the service. Staff were attentive to people's needs and discreet and respectful in meeting personal care needs.

We saw people being supported to maintain and improve upon their skills. We observed people being included and involved in conversation. Family members were involved in people's lives and decision making. Osborne House attempts to maintain familiar patterns and routines for the people who use the service. We saw evidence that the individuality of people who used the service was respected. We saw that social activities take place and that people's religious and spiritual needs were supported.

During our visit we observed that staff at Osborne House demonstrated a high level commitment to the people living there. We spoke to staff who reported that they enjoyed their work. We observed that staff delivered care in a dignified, friendly, respectful and committed manner.