This inspection was carried out on 2 October 2018 and was unannounced.

Osbourne Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Osbourne Court accommodates up to 69 people in one purpose built building. At the time of the inspection, 64 people were living there.

The service had a manager who in the process of becoming registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

The manager was new in post, they had previously been the deputy manager. People were positive about the management and the running of the home. There were systems in place to monitor the quality of the service and address any shortfalls. We found that there were links with the community.

People’s medicines were managed safely and people felt safe. Individual risks were assessed and staff knew how to work safely. People were supported by staff who were recruited safely. However, feedback about staffing levels were mixed. Staff worked in accordance with infection control guidance. However, there were areas of the house that needed a deep clean.

People were supported by staff who were trained and felt supported. Staff worked in accordance with the Mental Capacity Act and people had access to health and social care professionals when needed. People received the appropriate support with eating and drinking. However, the mealtime experience needed further development to make the experience more enjoyable.

The environment was currently undergoing a refurbishment programme and lessons learned were shared at team meetings.

People were treated with kindness and respect. People’s relatives were involved in the reviewing of their care. However, the service needed to develop systems to ensure people themselves were also involved. We found that confidentiality was promoted.

People received care that met their needs and care plans gave sufficient information to guide staff about how to meet people’s individual needs. People were seen to be enjoying the activities available and complaints were responded to appropriately.

The inspection took place on 22 February 2016 and was unannounced.

Osbourne Court Care Home provides nursing and personal care for up to 69 older people, some of whom were living with dementia. There were 54 people living at the home when we inspected.

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 2008 and associated Regulations about how the service is run. The provider had successfully recruited a new manager since our previous inspection in April 2015. The manager had submitted an application to register with CQC and this was being processed at this time.

At our previous inspection on 07 April 2015 we found that the provider had not ensured that sufficient numbers of suitably qualified, competent, skilled and experienced staff were provided to meet the needs of the people using the service. At this inspection we found that the provider had taken action to address the identified concerns. People received their care and support in a timely manner from a skilled and supported staff team.

People were supported to make their own decisions as much as possible. People received support to eat and drink in sufficient quantities and their health needs were well catered for because appropriate referrals were made to health professionals when needed. Potential risks to people’s health, well-being or safety were identified and reviewed regularly to take account of their changing needs and circumstances.

People praised the care and kindness demonstrated by all the staff team. Staff members were knowledgeable about people’s individual needs and preferences. Visitors were encouraged at any time of the day and people’s privacy and dignity was promoted. We observed sensitive and kind interactions between staff and people who used the service.

There were arrangements for daily activities and entertainment in the home. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open culture in the home and people, their relatives and staff were comfortable to speak with the manager if they had a concern. The manager had succeeded in introducing significant improvements in many aspects of the service provided for people at Osbourne Court Care Home since coming into post. However, the management team acknowledged that there was more to do in order to consolidate the work already achieved. Record keeping needed some improvement in order to help ensure people’s safety and welfare. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 7 April 2015 and was unannounced.

Osbourne Court Care Home provides nursing and personal care for up to 69 older people, some of whom were living with dementia. There were 50 people living at the home when we inspected.

The service has experienced a prolonged period of instability in the local and regional management team which has had a negative impact on the quality of the service provided. A new manager had been recruited since our previous inspection however, had not continued with their employment which meant that the home did not have a registered manager in post. 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 2008 and associated Regulations about how the service is run. The provider had appointed an interim manager to manage this service with support from a senior management team until a permanent manager is recruited to post.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Osbourne Court Care Home however it was agreed with the senior management team that not all applications had been appropriately made and needed to be reviewed.

At our previous inspection on 07 October 2014 we found that people were not protected against the risks of receiving inappropriate or unsafe care, against the risk of abuse or the risks of inadequate nutrition and dehydration. We also found that the systems to monitor and manage the quality of the service were ineffective and we took enforcement action to ensure the provider took the necessary steps to bring about the required improvements. The provider submitted an action in January 2015 which stated that the necessary improvements had been made. At this inspection we found that the provider had taken action to address the identified concerns.

People said they felt happy and safe at the home and staff treated them with kindness, dignity and respect. Relatives were positive about the care and support provided and said that people received care that protected their dignity. Staff members were safely recruited, however, people told us that there were not enough staff members available to meet people’s needs. Staff did not routinely receive supervision and performance monitoring from line managers.

People received their medicines safely and had access to healthcare professionals such as GP’s, dentists and chiropodists when required. People were provided appropriate levels of support to help them eat and drink where necessary and staff helped and supported people patiently and worked at a pace that best suited their individual needs.

Staff were caring and attentive to people’s needs and interacted with them in a warm and respectful manner. People were given choices in such areas as food, activities and where they wanted to spend their time. Staff respected people’s privacy and their visitors were always welcomed at the home.

People were involved in planning their own care and staff members were responsive to their needs. People’s care needs were reviewed regularly to ensure the agreed plan of care continued to meet their needs. There were a variety of activities available in the home if people wished to join in. People were supported to go out of the home for walks and to visit the local shops and there were arrangements to respect people’s faiths.

People were encouraged and supported to raise concerns and the manager closely monitored and sought feedback about the services provided to identify areas for improvement.

At this inspection we found the service to be in breach 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 the report.

This inspection took place on 07 October 2014 and was unannounced. The last inspections of this service took place on 02 May 2014 and 01 September 2014 during which we found the provider was not meeting the requirements of the law in relation to how the quality of the service was monitored. At this inspection we found that shortfalls remained in this area.

Osbourne Court Care Home provided nursing and personal care for up to 69 older people, some of whom may be living with dementia. There were 68 people living at the home when we inspected.

At this inspection we found the service to be in breach of Regulations 9, 10, 11 and 14 of the Health and Social care Act 2008 (Regulated activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

The home did not have a registered manager and has not had one since December 2012. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others.  At the time of the inspection applications had been made to the local authority in relation to people who lived at Osbourne Court Care Home and may be considered to have their freedom restricted. The provider had acted in accordance with the Mental Capacity Act, 2005 DoLS.

The manager made appropriate referrals to the local authority safeguarding team when needed. However, staff members did not demonstrate that they could recognise the signs of abuse or how to respond to incidents if the manager was not in the home. This meant people were not always safeguarded from the risk of abuse.

Referrals were not always made to health care professionals for additional support when needed in a timely manner. This meant that people did not always receive support from the appropriate people when their needs changed.

We found that people’s health care needs were assessed however; people’s care was not always planned or delivered consistently. In some cases, this either put people at risk or meant they were not having their individual care needs met. For example, people were not always repositioned effectively in line with their pressure care management plans and people were not always supported to eat and drink enough to meet their nutrition and hydration needs.

The service was not operating an effective recruitment procedure to ensure the right people were employed to provide care and support for people by not checking applicants’ work history or validating references.

People who used the service and their relatives told us they felt their privacy and dignity was respected and they made positive comments about the staff team. 

The manager investigated and responded to people’s complaints, according to their complaints procedure. However, some relatives had told us immediately prior to this inspection, that they were not satisfied with how their complaints had been dealt with.

The manager carried out regular audits and developed action plans. These were reviewed by the regional manager and relayed to the provider. However, we found that where matters of concern had been identified by these audits there had not always been actions taken in a timely manner to reduce the risk of harm for people.

At a previous inspection of Osborne Court Care Home in May 2014 we had found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

We revisited Osborne Court Care Home on 01 September 2014 and we found that, while some improvements had been made, the provider remained in breach of the regulations.

The home manager, new in post in February 2014, had not been provided with the appropriate induction, supervision, support and training to ensure he had the necessary skills and knowledge to fulfil the role.

Audits and quality monitoring processes now had action plans completed to indicate who had the responsibility to drive forward areas of improvement and in what timescales. However, it was noted that these improvements were not always effectively completed or sustained.

During our inspection of Osbourne Court Care Home we set out to answer five key questions. These were whether the service is 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 findings during the inspection, discussions with people who used the service and their relatives. We also spent time looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was planned and delivered in a way that was intended to ensure people’s safety and welfare. There was a programme of staff training and supervision in place which meant that the staff team were supported to provide safe care.

Is the service effective?

We asked people who used the service if their health needs were met. One person said, “Oh yes, if I am feeling at all unwell I only have to mention it and they get me the doctor if I need it.” We saw that people were referred appropriately to specialist professionals. This was confirmed by one person who stated that staff had made appointments for them for the dentist and optician. It was clear from our observations that the staff team had a good understanding of people’s care and support needs and that they knew them well.

Is the service caring?

People who used the service told us that staff treated them with respect and courtesy. We noted that the staff team interacted with people with warmth and respect. For example we saw a staff member kneeling beside a person gently exploring why the person was low in their mood. The staff member demonstrated empathy and showed a good depth of knowledge of the person they were supporting. People told us that they were happy with the care that they received and that their needs had been met. A person told us that when staff assisted them with personal care they were, “Very good to me, they lift me gently and they all know what they are doing like second nature. I think the staff are trained really well, there’s no fussing they just get on with it.”

Is the service responsive?

Records confirmed that people’s preferences, interests and diverse needs had been recorded and that care and support had been provided in accordance with people’s wishes. People who used the service told us that staff listened to them and took their views seriously. For example, one person told us, “They listen to me, if I am not ready, not feeling well or just want to be left alone a while they say ok and come back later.”

Is the service well led?

The service had undergone a period of instability with management arrangements in the previous twelve months, the current manager had been in post at Osbourne Court Care Home since February 2014. People who used the service, their relatives and staff members had positive things to say about the improvements that had been made to the service since February. People said that the new manager was approachable and caring. We found that there were monitoring systems in place to assess if people’s needs were consistently met to their satisfaction. However, we found that where there had been shortfalls identified through these audits the manager had not developed action plans to ensure issues were addressed. This meant that there was not an effective system in place to manage risks to the health, safety and welfare of people who used the service and others. People told us that they knew how to make a complaint and would be confident that their concerns would be taken seriously.

At our previous inspection in January 2013 we found that people’s views and experiences were not always taken into account in the way the service was provided and that people’s privacy and dignity were not well respected in the home. We asked the provider to make improvements. The provider wrote to us in February 2013 describing the improvements they had made and told us they would be fully compliant with this standard by the end of March 2013.

During our visit on 31 May 2013 we observed that most staff provided care in a way that showed people were being treated with respect and given choice about how they received their care. One nurse told us, “Things are a lot better in the home now, the new manager has made a real difference.”

We spoke with seven people living in the home and with five relatives. One person we spoke with told us, “Things are quite good now, but I need to ask for explanations”. A relative we spoke with told us that, “Most things are there if you ask for them”. Another relative told us that, “Staff are always approachable and friendly”.

We observed some good practice. For example, we heard a member of staff talking to people kindly and engaging with one person in conversation that was not task related. However, we also observed some poor practice. For example, we heard a member of staff encourage a person to drink but when the person refused the staff member said sharply, “You just need to have a drink”.

Overall, people we spoke with were happy with their care.

When we inspected Osbourne Court on 27 September 2012, the outcomes experienced by people were not meeting their needs in five outcome areas. We carried out an inspection on 16 January 2013 to monitor improvements. We talked with seven people who used the service, a relative and two visiting friends. We also spoke with staff, the manager and the regional manager.

Some people who used the service had complex needs which meant they were not able to tell us of their experiences. We spent time observing everyday life to help us to understand care experience at the home. People were positive about staff. However, we found that at times staff were not listening to people and providing their care in the way they preferred. Staff had written inappropriate comments about people and were not protecting their confidentiality adequately at staff handover meetings.

People’s needs were assessed and they and their relatives were involved in planning their care. People had individualised care and treatment plans. People were protected from abuse by safeguarding procedures.

There were an adequate number of staff on duty to meet the needs of people who used the service. They were skilled, competent and knowledgeable.

The quality assurance system was working effectively. People and their relatives had opportunities to express their views. These were considered and taken into account in the running of the home.

We spoke with ten people who used the service. There were positive views expressed. Most people said that staff were nice and comments included, "All very friendly" and "Kind and pleasant". However there were also some negative comments. One person said, "Staff in general are very good, one or two are average" and another person told us,"Some are a little bit short and sharp".

People said they were satisfied with their care and found staff helpful, however we found serious shortfalls in the care outcomes people experienced. One person told us that they were independent in almost all aspects of their care but did need some help with dressing. They said they waited a long time for staff to come when they called them to do this.

No evidence was presented as to how staff protect peoples' valuables from being stolen. One person told us they, "I feel safe but I get worried because of a couple of people who walk in my room and won't go".

We asked people how long staff took to meet their needs. One person said that in the evening it took more than fifteen minutes for their call bell to be answered by staff.

The Registered Manager was accountable to the provider through various audits of the quality of the service. However we found that people's views were not necessarily sought or responded to by staff. Of the ten people we spoke with no person knew who the Registered Manager of the home was.