The Care Quality Commission
  • Care Home
  • Care home

Archived: Osborn Manor

Overall: Requires improvement read more about inspection ratings

38 Osborn Road, Fareham, Hampshire, PO16 7DS

Provided and run by:
Osborn Manor

Important: The partners registered to provide this service have changed. See old profile

All Inspections

11 June 2015

During a routine inspection

This inspection took place on 11 June 2015 and was unannounced.

Osborn Manor is a service that is registered to provide accommodation for up to 14 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are stair lifts to provide access to people who have mobility problems. On the day of our visit 12 people lived at the home.

Our last inspection at Osborn Manor was carried out on 1 April 2014. At this inspection we found the provider had not complied with regulations which related to care and welfare of people who use services, safeguarding people who use services from abuse, and assessing and monitoring the quality of service provision. We asked the provider to take action to make improvements. The provider sent us an action plan which said they would be compliant by June 2014. We found some improvements had been made but further work was required to ensure they were meeting minimum standards according to the regulations.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

People were supported by staff to take their medicines. However, the provider policy for medicines management was not always adhered to and we identified gaps in the recording of medicines. These gaps had not been identified by the registered manager and no action had been taken to address these.

Improvements had been made to protecting people from the risk of abuse. People felt safe and staff knew their roles and responsibilities in protecting people. Where concerns required reporting the provider had ensured this was done. Improvements had also been made to the management of risk and the plans of care for people. Clear risk assessments had been developed and provided guidance for staff. Staff were knowledgeable of people’s needs and the support they required.

People told us the staff were kind and caring. No one had any concerns and said they were happy with the care and support they received. Staff respected people’s privacy and dignity and used their preferred form of address when they spoke to them. Observations showed that staff had a kind and caring attitude. People told us the manager and staff were approachable. Relatives said they could speak with the manager or staff at any time.

Thorough recruitment checks were carried out to check staff were suitable to work with people. Staff were supported to develop their skills through training and supervision. The provider supported staff to obtain recognised qualifications. Staffing levels were maintained at a level to meet people’s needs. The provider was looking to introduce a dependency tool which would support them to monitor the staffing levels in the home. We have made a recommendation about the use of dependency tools when determining staffing levels.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider had suitable arrangements in place to establish, and act in accordance with people’s best interests if they did not have capacity to consent to their care and support. The registered manager understood her responsibility with regard to Deprivation of Liberty Safeguards (DoLS) and they had applied for authorisation under DoLS to ensure people were protected against the risk of being unlawfully deprived of their liberty.

People were satisfied with the food provided and said there was always enough to eat. People were given a choice at meal times and were able to have drinks and snacks throughout the day and night. Improvements were needed where people’s nutrition and hydration needs required monitoring and we have made a recommendation about this. Staff supported people to ensure their healthcare needs were met.

The registered manager operated an open door policy. They had introduced systems to support people, relatives and staff to provide feedback on any aspect of the service. This included regular meetings and annual surveys.

At our last inspection we found the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people. There were no audits undertaken to monitor the quality of service provided. At this visit we found improvements had been made however, further improvements were needed. Audits undertaken were not effective in identifying concerns and where actions had been identified these had not always been completed. People’s records needed further work to ensure they reflected all their needs.

We found 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.

1 April 2014

During a routine inspection

At the time of our visit there were 12 people living in the home. We spoke with four people, three staff and reviewed the care records of three people. The registered manager was not available so we spoke with the deputy manager for the home.

We set out to answer our five questions; Is the service caring? Is the service Responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and from looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe. The service had a safeguarding policy which outlined the procedure staff should follow. Staff had undertaken training in safeguarding and understood their role in safeguarding the people they supported. Staff were clear that they would report concerns to the manager to action but if they felt appropriate action was not taken they would report these externally. However we were concerned that one potential incident of a safeguarding nature had not been reported to the local authority responsible for investigating safeguarding. We were also concerned that some behaviours displayed by people had not been assessed, there was no care plan or risk assessment developed to instruct staff on how to manage these behaviours.

Whilst there was a system in place for recording of incidents and accidents, we could not find any evidence of how this information was used to support learning. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes.

Management we spoke with had a good understanding of Deprivation of Liberty Safeguards (DoLS) and their responsibility in this.

We looked at the staffing levels and skill mix within the home. Suitable numbers of staff were on shift throughout the day and night. Staff received a variety of training including; dementia awareness, first aid, food hygiene and the provider encouraged staff to complete the Health and social care Qualification and Credit Framework.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

Is the service effective?

People's health and care needs were assessed with them and they or their representative were involved in their care plans. Some of the care plans had not been reviewed regularly and some people's needs were not included in care plans or risk assessments. Care plans and risk assessments for people were therefore not able to support staff consistently to meet people's needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'They are very good. Whenever I have asked for something I have always got it straight away', 'they always listen to me and are kind a respectful. I would be happy to move here permanently if I needed to'.

People's preferences and interests had been recorded. Because of this care and support could be provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in and outside the service.

People knew how to make a complaint if they were unhappy. The home told us they had not received any complaints in 10 years but if they did they would be fully investigated.

Is the service well led?

All of the staff said if they witnessed poor practice they would report their concerns.

We saw the service had some systems in place to monitor and assess the quality of the service including maintenance, falls, health and safety and 'resident meetings'. However, we could not find a programme of audits in place to monitor other aspects of the service for example, care plans and risk assessments. We found not all actions from health and safety inspections had been carried out in a timely manner.

Annual satisfaction surveys had not been completed to gain people and the representatives views. Whilst staff told us if there was any information to learn or any changes to implement this would be discussed with them in meetings. We could not see any evidence of this and there had been no staff meetings since 2012.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

27 August 2013

During a routine inspection

At the time of our visit there were 12 people living at the service. We looked at care records for three people, spoke to four people and observed people being cared for. We spoke with the manager and two staff members. We also spoke with two relatives.

We saw that people were asked for their consent on aspects of their stay at the home. Where a person lacked capacity to make a decision best interests decisions were made with relevant people.

People's needs were assessed and care plans developed that included people's needs and personal wishes. People that we spoke with told us they were happy with the care and support being provided. Comments included, 'Staff are wonderful', 'Staff are really helpful', 'I'm happy'. Relatives we spoke with spoke highly of the home. One told us 'They are just brilliant'.

We found that current recruitment practices meant that people could be assured all relevant checks had been completed for all people who worked in the service.

The service had a clear complaints procedure in place to ensure complaints were responded to and learning from them. People we spoke with told us they knew who to talk to if they had a complaint.