Osborne Court

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to staff not always working within the legal framework of the Mental Capacity Act (MCA.)

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always accurately assess people’s needs and make sure their care and treatment was effective.

Staff ensured people had a risk assessment and a corresponding care plan in place to offer guidance to staff in managing those risks. People’s communication needs were assessed to enable them to engage in their care. We observed staff communicating with people both verbally and non-verbally.

There was an admissions process in place which included completing an assessment pack to obtain all relevant information prior to commencing care at the service.

We reviewed care records in the children’s service and found that staff had ensured people’s needs, routines and preferences were reflected in the documentation, so staff had adequate guidance on how to support people.

Although there were areas of similar practice in the adult’s service, gaps and inaccuracies in people’s records in the adult’s service meant that risk assessments and care plans were not always reflective of people’s current needs. We reviewed 1 person's behavioural care plan, which stated that staff should "not attempt any physical intervention unless necessary" if the person's behaviour became heightened. However, during discussions, one staff member described an approach that was different to the guidance in the care plan. This suggested that guidance in care records was not always clearly understood by staff.

Records were not always detailed. For example, we found in one person’s positive behaviour support plan that there was limited detail on this person’s triggers and sensory needs. Although it was documented that care plans were being reviewed, records were not always accurately documenting specific support needs and left people vulnerable to inappropriate support.

Staff used nationally recognised assessment tools to ensure people received the support they needed. For example, staff used Waterlow Score to assess the risk of pressure ulcer development and MUST (Malnutrition Universal Screening Tool) Score to identify the risk of malnutrition.

Care records included person-centred information about people’s nutrition and hydration needs, including preferred foods. However, referrals were not always made to the relevant professionals. For example, we saw in one person’s care records that it had been identified they required a modified diet to support with their eating and drinking, however, referrals had not been made to the SALT team prior to our assessment. Referrals were quickly made in response to our findings.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us information was shared amongst the team effectively and we observed systems in place to support this. We attended a shift change handover where people’s individual needs and risks were discussed. We reviewed team meeting minutes and found that “service user updates” was a standard agenda at each meeting.

We observed care staff working well together throughout the visit to meet people’s needs without delay.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives.

Staff documented people’s preferred communication style and ensured that people had choice and control over meal and drink choices. People’s preferences were documented in their care records and staff had a good understanding of their likes and dislikes.

People were supported to access different activities whilst using the service, including accessing the community. Relatives told us that there a variety of activities were offered. One relative commented, “[Person] has been on walks, pub lunch, on the bus, McDonalds, activity centre and the farm.”

Changes in people’s presentation or emotional state was recognised by staff and concerns were shared with relatives. One relative commented, “If there are any changes in [person’s] presentation this is immediately raised and changes to care plans are discussed.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent.

Care plans were not always personalised to ensure outcomes could be met ensuring people received safe and effective support. For example, we found in one person’s hospital passport (a personal document designed to help hospital staff understand specific needs including communication style) that there was no information about their communication needs, methods or support required.

Although staff were monitoring people’s physical health, it was not always documented when action was taken following the identification of potential deterioration. For example, one person’s daily records showed that staff had not documented what action had been taken to treat or escalate physical health concerns on 2 occasions. We also found that although this person was identified as high risk in the development of pressure ulcers, information in care records lacked detail. This was raised with management and recognised as an area of improvement. We received confirmation the following day that the person’s care skin integrity care plan and risk assessment had been reviewed and updated.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The service did not always work within the legal framework of the Mental Capacity Act (MCA.) The service had completed mental capacity assessment, which are legal tests to determine if a person can make a specific decision for themselves. Under the act, mental capacity is both “decision specific” and therefore each decision must be considered in its own right. We found examples in care records that mental capacity assessments were not always decision specific. The service had assessed people’s capacity for several decisions in one assessment.

Staff told us they would benefit from further training in completing mental capacity assessments. One staff member commented, “I’m not happy with how we pull together MCA forms… we have done our best, but I do think there is room for improvement.”

Staff understood the importance of consent, and we observed staff asking before supporting people with their eating and drinking. Information on their rights were provided to people in an easy-read format when beginning to use the service.