The inspection took place on 25 and 27 April 2017. Osbourne Court provides accommodation and personal care and support for up to 58 older people. Many of the people accommodated were living with dementia. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting.

The previous inspection was completed in March 2016 there were no breaches of regulation at that time. However, there were some improvements needed to make sure people were safe. This was in respect of the recruitment of staff and ensuring staff were consistently signing for medicines being given to people. Some action had been implemented by day two of the inspection in March 2016. We found the necessary improvements had continued to ensure people were safe.

There was 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.

At the last inspection, the service was rated Good. At this inspection, we found the service remained Good.

Why the service is rated Good:

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment and safe recruitment processes.

People continued to receive effective care because staff had the skills and knowledge required to support them. Staff demonstrated a good understanding of their roles in supporting people living with dementia. Staff received training and support that was relevant to their roles. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people living at Osbourne Court.

Systems were in place to ensure open communication including team meetings, daily handovers and one to one meetings with their manager. Regular newsletters and friends and family meetings were organised keeping people and their relatives informed about life at Osbourne Court.

The home continued to provide a caring service to people. People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. There was a warm and welcoming atmosphere within the home.

People received a responsive service. Care and support was personalised to each person. People were supported to take part in a variety of activities including trips out. Social events were organised for people, their friends and family. Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided.

The service was well-led. Relatives and staff spoke positively about the commitment of the registered manager and the provider. They told us the registered manager was open and approachable. The registered manager and provider had monitoring systems, which enabled them to identify good practices and areas of improvement.

The inspection took place on 22 and 23 March 2016. Osbourne Court provides accommodation and personal care and support for up to 58 older people. Many of the people accommodated were living with dementia. This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. The previous inspection was completed in May 2014 there were no breaches of regulation at that time.

The registered manager had recently resigned. The deputy had been appointed to manage the service. They confirmed they would be submitting an application but had only been in their new role for seven days. 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 receiving care that was responsive and effective and tailored to their needs. Care plans were in place that clearly described how each person would like to be supported. People had been consulted about their care and support. The care plans provided staff with information to support the person effectively. Other health and social professionals were involved in the care of the people. The staff and the GP were working closing in promoting healthy eating and reducing falls. Safe systems were in place to ensure that people received their medicines as prescribed. However, not all medicines given had been signed for. The manager promptly devised an action plan once checking people’s medicines records.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management. We found that not all staff had gone through a safe recruitment process. By day two of the inspection the new manager had organised a review of all recruitment files. This included organising the information more logically with an index showing what records were in place.

Staff were caring and supportive and demonstrated a good understanding of their roles in supporting people living with dementia. Staff received training and support that was relevant to their roles. Systems were in place to ensure open communication including team meetings and one to one meetings with their manager.

People’s rights were upheld, consent was always sought before any support was given. Staff were aware of the legislation that ensured people were protected in respect of decision making and any restrictions and how this impacted on their day to day roles.

People’s views were sought through care reviews, meetings and acted upon. Systems were in place to ensure that complaints were responded to and, learnt from to improve the service provided.

The service was committed to involve relatives in aspects of running the service. Friends and family meetings were organised. The provider and the manager had organised external speakers including the local GP who provided an insight into the dementia pathway and about healthy eating and how this was being promoted within the home. Social gatherings were organised so family and friends could visit the services. Relatives told us they were made to feel welcome and there were no restrictions on visiting times.

People were provided with a safe, effective, caring and responsive service that was well led. The organisation’s values and philosophy were clearly explained to staff. The registered provider was aware of the importance of reviewing the quality of the service and was aware of the improvements that were needed to enhance the service.

Two people living in the home told us that they had no concerns with how staff looked after their medicines. Some people were able to look after and take some, or all, of their own medicines. We spoke to one person who looked after their own medicines. They told us that they were happy with this arrangement. We saw staff giving some people their lunch time medicines in a safe and respectful way.

We saw that staff had not checked one person's medicines with their doctor to confirm that they were giving the correct dose of all the medicines. The manager took action to address this.

We found that improvements had been made to the recording of medicines administration in the home. There were now appropriate arrangements in place to ensure that records of medicines administration were completed consistently.

People living at the home and their relatives were very happy with the care provided by the home. People told us, “This is my home and I love it here” and “I am very happy at Osbourne Court and couldn’t be better looked after”.

Before staff provided any care or treatment they asked people and made sure that the person consented. Throughout our inspection we observed that staff always asked people about their wishes. Where people could not give consent, the home involved family and the appropriate professionals.

People had individual care plans which ensured their care needs were met. We observed that staff were warm, friendly and polite to people. During our observation on the first floor we noted that the atmosphere was lively and relaxed and staff responded quickly to people's needs.

The premises and equipment were suitable and in good repair. Staff recruitment was carried out safely and appropriate checks were made. There was an effective complaints system and people's concerns were listened and responded to.

There were appropriate systems in place to manage medicines however these systems were not always followed which meant the home could not always be sure people had received prescribed medicines and creams

We carried out this inspection in order to check that improvements had been made .

Our previous inspection in March 2012 identified shortcomings in the dementia unit on the first floor and we focused our inspection on that area.

Due to their dementia most people on the first floor were not able to talk with us about what it was like to live in the home. We carried out an observation to help us understand their experiences.

We observed that there were warm and friendly relationships between staff and people who lived in the home. Staff spoke to people kindly and respectfully and were patient in offering support. We saw that staff paid attention to people’s mood and when one person became upset staff intervened immediately.

We asked the registered manager how many people were currently living at the home and they told us there were 58. The home was registered to accommodate a maximum of 58 people

We counted the number of peoples care records and the home actually had 59 people living there. The manager told us there had been a planned discharge scheduled for the previous week but it had been cancelled due to unforeseen circumstances. The manager explained that the person was due to move out in three days time and they were currently accommodated in the home’s family guest room and whilst it had a velux window in the ceiling did not provide a view to the outside.

The registered manager had not notified CQC that this had happened. At our request the home agreed to increase staffing at the home and developed a risk assessment and management plan to evidence how the home would continue to provide a safe service for this person. CQC wrote to the manager regarding the breach of the home’s registration.

The purpose of the inspection was 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 the manager, the provider, four members of staff, 16 people who used the service and six relatives. The inspector was accompanied by an expert by experience a person who has had experience of using services or caring for someone who uses this type of service.

Some people living in the home had a diagnosis of dementia. In order to understand their experiences we observed staff interactions with people over the course of our inspection.

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

Is the service safe?

Care plans were person centred and detailed the individual's personal preferences and information to keep them safe. Risk assessments were seen covering all areas of daily living. This included mobilising, personal care, wound care management, eating and drinking. This meant that staff had guidance to support people safely. Staff described how they supported people in accordance with their care plan.

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This minimised the risks to people and helped the service to improve and ensure people’s safety.

The manager told us there was no one presently accommodated that had been subject to an application for a Deprivation of Liberty Safeguard. (DoLS) However, owing to a recent Supreme Court ruling on the definition of deprivation they were reviewing this position. The manager told us that due to people having dementia that they would be making forty applications in respect of Deprivation of Liberty Safeguards. This was due to the people being under continuous supervision and control and they are not free to leave on their own accord. This meant that the provider took into consideration changes in legislation. In addition people’s safety was considered along with their human rights.

We saw that the home was clean and well maintained. People we spoke with told us that this was always the case. However, on the first day we found some areas of concern which included bathrooms being used as storage and sluices that were cluttered. This meant these areas were difficult to clean which potentially increased the risks relating to infection control. Some of the bins for the disposal of waste were not pedal action. This meant staff had to use their clean hands to open the bin. These were all addressed on the second day of our visit.

Is the service effective?

People’s health and care needs were assessed and a plan of care was put in place. Staff were aware of the needs of the individuals living in the home and how care was being delivered. Staff clearly described the impact that dementia may have on a person and how they were supporting people.

There were systems in place to monitor the effectiveness of the care. Care was reviewed to ensure that it was appropriate and suitable for the individual. Care was reviewed at three monthly intervals or as needs changed.

People’s care had been discussed at team meetings to ensure staff were following the care plans that were in place. Staff told us that daily handovers took place to ensure that important information was passed between staff to ensure that the care of people was planned and responsive to their needs. This meant the staff team were continually reviewing the care and support to ensure it was effective.

People were supported by staff that had received relevant training to support people effectively. This included training on supporting people with a diagnosis of dementia.

Is the service caring?

We observed staff meeting the needs of the people they were supporting. Staff were observed treating people respectfully, with kindness and patience.

People told us they were offered choices about the way their care was delivered. A relative told us "the staff are all really caring.”

Comments from people who used the service included “the staff are wonderful, nothing is too much trouble, it is like home from home”, “the home is fantastic I have no complaints and no suggestions for improvement, it is a really friendly place and I am happy”, “I like it here, I am settled and the staff are friendly, you only need ask and they respond” and “I feel safe here and I only need to ask any member of staff and they will respond to my request”.

Staff were attentive to people’s needs. Staff were knowledgeable about the people they were supporting including how their dementia impacted on their life.

We observed staff supporting people sensitively during the lunchtime. The meal was unrushed and people were offered a choice of main meal. Staff were observed interacting with people throughout the meal and responding to requests for assistance.

People’s daily routines had been recorded and care and support had been provided in accordance with people’s wishes. This meant that people were treated as individuals and their preferences were recognised.

Is the service responsive?

People had access to a variety of activities that were taken place daily. Care staff were observed providing activities to people in the home. Activities were tailored to the individuals including people with dementia.

People had access to other professionals including being registered with a local GP who visited the home on a weekly basis. A district nurse spoke positively about the care and support that was in place for people. They confirmed that staff were available to support them and that they had been kept informed of any changes to the persons' condition and wellbeing. They told us the staff followed their advice in relation to the treatment of the person.

Care files included information about how the staff were supporting people with their day to day care needs and staying healthy. The staff described how they supported and monitored people and where they were concerned this was discussed with the GP or the district nurse and relatives. This meant they were responsive to people’s changing needs and monitoring their general wellbeing. Two relatives told us the staff kept them informed of any concerns.

Is the service well-led?

There was a manager in the service that was registered with the Care Quality Commission. They told us they operated an open door policy. We observed people using the service, their relatives, staff and visiting professionals speaking with the manager about their care and support.

The service had a quality assurance system in place. The records that we looked at evidenced that where shortfalls had been identified these had been addressed. A relative told us they had responded to the survey and commented on a leak in a bathroom. They told us this was promptly resolved by the provider.

Regular staff meetings were being held to discuss the care needs and the running of the home. Where actions had been identified these had been followed up. This meant the staff’s views were valued and sought in improving the service.