Inspection on 07/05/08 for Osbourne Court Care Home

This inspection was carried out on 7th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Osbourne Court Care Home 22/06/07

Osbourne Court Care Home 18/08/06

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Osbourne Court Care Home Park Drive Baldock Hertfordshire SG7 6EN Lead Inspector Ms Vicky Dutton Unannounced Inspection 7th May 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Osbourne Court Care Home Address Park Drive Baldock Hertfordshire SG7 6EN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01462 896966 01462 896967 osbourne.court@fshc.co.uk Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Andrew Williams Care Home 69 Category(ies) of Dementia - over 65 years of age (34), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (69), Physical disability over 65 years of age (69) Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. This home may accommodate 69 older people with physical disability who require personal care. This home may accommodate 35 older people who require nursing care. This home may accommodate 34 older people with dementia who require personal care. This home may accommodate 69 older people who require personal care The home may accommodate one named service user with a learning disability. This condition will no longer apply once the service user ceases to reside at the home. 22nd June 2007 Date of last inspection Brief Description of the Service: Osbourne Court is owned and operated by Four Seasons Homes Ltd, and it is registered to provide personal care and accommodation for 69 older people. The ground floor accommodates 34 residents who may also suffer from dementia, and the first floor accommodates 35 residents who need nursing care. Osbourne Court is a purpose built two-storey building situated in a residential area close to the centre of Baldock. It is adjacent to a health centre and a large superstore, which provide good access to medical and shopping facilities. Accommodation is provided in single rooms. All rooms have an en-suite toilet and washing facilities and there are a number of assisted bathrooms throughout the home. The first floor is served by a passenger lift. There is ample car parking space at the front of the building. There are two small gardens with patio areas to the rear and side of the home. The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current charges range from £420.14 per week for residential care to £538.93 per week for nursing care. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced ‘key’ site visit. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of six and a half hours, with two inspectors present. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff and visitors. Prior to the site visit the home had completed and sent in to CSCI their Annual Quality Assurance Assessment (AQAA). This outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. The views expressed at the site visit and in survey responses have been incorporated into this report. This site visit included a ‘thematic probe.’ This looked at how well people living in the home are safeguarded, through the home’s practices, policies and procedures. The thematic probe took place in all homes being inspected over a short period, and information gathered will from the basis for a future CSCI report. We were assisted at the site visit by the manager, and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The manager is committed to providing a person centred approach to care that recognises and meets people’s individual needs. To achieve this care planning needs to be improved so that people’s individual emotional, cultural, health and care needs, and how these are to be met, are fully identified. Linked to this is the need to show that people’s activity and occupational needs are properly assessed, and appropriate opportunities for occupation provided. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 7 People feel that there is sometimes not enough staff available to assist them. Staffing levels, or staff deployment therefore needs to be kept under review to ensure that people’s needs are consistently met. So that people live in a safe and homely environment more care is needed to monitor the home, and take action to manage issues such as outstanding repairs. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wanting to move into the home can feel confident that their needs will be met, based on a thorough assessment, and that they will have access to sufficient information about the home to help them to make an informed choice. EVIDENCE: A Statement of Purpose and Service users Guide were available in the entrance area. On surveys most people felt that they had received enough information about the home to help them to make a decision about moving in. Previous inspections have identified that staff from Osbourne Court always visit people before they move in to assess their needs, and ensure that these can be met by the service. Pre-admission assessments were available on the files of two people who had recently moved in. These were well completed. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 10 Assessment information was also available from the local Social Services departments who had been involved with the admissions, and were funding the placements. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to receive the personal and health care support they need. EVIDENCE: People spoken with and comments on surveys were mostly positive about the care provided by staff. Someone living at the home said, “You can have everything you want here, you only have to ask.” A relative said, “My [relative] has been in Osbourne Court for over two years and the care they have has had has always been wonderful.” Observations during the day, and discussions with staff showed that they generally had a good understanding of individual people’s care needs. Care staff said that they were always kept aware of people’s needs. One said, “All updated information is available in care plans, there is also a well informed handover on shift changes.” On surveys five out of twelve people said that they ‘always’ received the care and support they needed, four felt that they ‘usually’ did and three felt that they only ‘sometimes’ did. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 12 As part of this site visit five care files were viewed, three on the nursing unit and two on the residential unit. Staff felt that care plans were good. “The care plans at Osbourne Court are informative and are kept up to date really well.” Some observations during the site visit showed that although staff appear to understand and use care plans, this is not always sufficient to ensure that people’s specific wishes or needs, or basic care requirements are consistently met. For example a notice reminding staff not to do someone’s washing, as their family wished to do this, another reminding staff to always knock and introduce themselves. Care plans viewed on the nursing unit tended to be focused on people’s physical needs, and there was limited reflection on people’s social or emotional needs. For example a care plan relating to catheter care made no mention of privacy, dignity or emotional issues. One relating to dietary needs made no mention of any likes or dislikes. This person had only been living at the home for a few days. Care plans were in place relating to seven aspects of care needs. Pre-admission and other assessments identified many significant care needs that had not yet been addressed in care planning. More established care plans did show a greater understanding of individual needs and made comments such as ‘maintain privacy and dignity,’ and ‘explain the procedure before commencing.’ However detail was still often missing. One care plan identified that a person had ‘specific tastes’ relating to food provision, but did not then go on to say what these were to assist staff providing the care. The manager is committed to developing an individual and person centred approach to care. Care plans on the nursing unit are not yet providing a good basis to achieve this. One person’s file referred to the person differently in different care plans sometimes saying ‘the resident,’ sometimes their given name, and sometimes their family name. On the care files viewed there were no care plans in place relating to people’s social, cultural or spiritual needs. On the residential unit care plans were more person centred, and did include care plans relating to ‘social interaction.’ All care plans were regularly reviewed. For those on the residential unit reviews sometimes highlighted changes in care needs that had not been then transferred to the relevant care plan. For example one person’s evaluation identified that they now needed more help with their personal care. This was not then indicated on the care plan to ensure that this happened. Good daily records were being maintained to show that ongoing care was being provided. Staff were asked how they involved people or their families with the care planning process to ensure that all their needs and wishes were understood and being met. One member of staff said that usually it would be the families who are involved. They would read the care plans and sign that they agreed with them. On the five files viewed a ‘care plan agreement form’ was only found on one file. Risk assessments for relevant areas of care were in place such as for moving and handling and the use of specialist beds or bed rails. The manager confirmed that no staff have received specific training relating to the safe assessment for, and use of bed rails. So that people are cared for safely with appropriate equipment used this should be addressed, and other professionals involved Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 13 with the process as necessary. Where people are using specialist beds or bedrails it was noticed that notices are in place on bedroom walls relating to safe practice. This detracts from maintaining a homely environment. The manager said that this was Company policy. People living at Osbourne Court are supported to maintain good health care. A visiting professional felt that staff always asked for visits when needed. Training records indicated that some staff have received training in areas that will assist them in supporting people such as catheter care, stoma care and wound care and dressing management. On surveys out of eleven responses, seven felt that they ‘always’ received the medical support they needed; the rest felt they ‘usually’ did. One person said, “The district nurse and doctor come when needed.” Other people said that they were able to visit the doctor with support from carers or family. Records showed that services such as chiropody and opticians visit the home. The manager confirmed that access to dental care is also arranged. The care files viewed provided a wealth of risk assessments and other assessments for relevant areas such as pressure area care and falls. Procedures to manage care needs such as the management of pain or to assess if someone was depressed were also in place. People’s nutritional needs were assessed and records showed that people’s weight is monitored. At the moment nutritional records to show what people have eaten are only maintained where cause for concern has been identified. Staff should be able to show what all individuals have eaten. This will enable them to demonstrate that a good and healthy diet is being maintained, and identify quickly if any changes are occurring so that appropriate actions are taken. Medication was viewed on both floors of the home (nursing and residential) with common themes emerging. Generally systems were in place that protect people and will ensure that their medicines are managed well and safely. However a number of practice issues were identified. Staff were not able to confirm that protocols were in place for medicines that are prescribed to be taken ‘as and when required,’ (PRN.) This would ensure that these medicines are used consistently by staff. No list of staff trained and authorised to administer medicines along with their identifying initials was in place to provide a good audit trail. Where handwritten entries were made on the medication administration records, (MAR) these were not double signed to show that the information recorded had been checked and was correct. On the residential unit there were some gaps in recording on the MAR. Also on the residential unit it was noticed that the storage area was very warm. There was no indication that temperature in the storage areas are monitored to ensure that medicines are stored in optimum conditions, which is normally below 25 degrees Celsius. Staff confirmed that they had undertaken training through both the supplying pharmacist and as provided by the organisation. During the day of the site visit staff interacted well with people and respected their need for privacy. Staff were noted to knock on people’s bedroom doors before entering. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People will be able to enjoy a lifestyle that meets some of their expectations such as having visitors and enjoying good food. Other aspects of daily life such as activity and occupation may be less suited to meeting their individual needs. EVIDENCE: People living at the home have the opportunity to undertake some activities. An activity co-ordinator works twenty eight hours each week and a member of the care staff team undertakes this role for a further seven hours each week. These hours are worked during Monday to Friday. Documentary evidence and discussion with people living at the home, staff members and visitors confirmed that activities such as Ballgames, trips to Tesco and the local town market, gardening, watching films, 1:1 visits to individuals’ rooms and glass painting take place daily during the week. A sensory room has been developed to provide an additional facility for offering people occupation and stimulation. On the day of this visit an organist played music for some residents in an upstairs lounge. People made some positive comments about this aspect of care such as, “There is a very lively activities Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 15 lady here who tries to get as many residents interested as possible to join in. She is extremely polite and patient,” and “The activity co-ordinator is very good at her job. I enjoy the activities.” Other people felt that more could be done, as in “Fairly good but I would like to go out more,” and “More activities required for the hard of hearing.” A relative felt that the home could improve by: “Maybe they could do a bit more interacting i.e. drawing and encouraging them to talk more and just general keeping their minds active and taking them out for walks or just round the block.” Records of activities were included in a basic manner on a sheet in the care plans. As indicated earlier care plans, (particularly on the nursing unit) are not robust in assessing people’s social and occupational needs. The activity coordinator explained how she uses the pre admission assessments as a basis to explore new residents’ interests with them after they have been living at the home for a few days. In this manner she is able to draw from them any interests that can be encouraged however this detail is not recorded anywhere. A relative did however verify that this process may take place, as one day they had visited to find their relative undertaking a pastime that they had enjoyed doing before moving into the home. People’s personal preferences such as rising and retiring times are recorded in care plans so that staff can offer support at appropriate times. The manager reported that there are multi denominational services are held at the home and various catholic ministers visit people living there. On an activity sheet in one person’s care file it was recorded that they had enjoyed a service with the Salvation Army. Visiting at Osbourne Court is open and relatives’ involvement encouraged. During the site visit it was seen that staff had a good rapport with visiting relatives. On surveys relatives felt that the home ‘always’ helped people living there to keep in touch with them. They also felt that they were ‘always’ kept up to date with any issues concerning their relatives’ welfare. People spoken with confirmed that they enjoyed having visitors at any time. During the site visit staff respected the choices people made. It was noted that people were able to go where they wished, spending time in their rooms and elsewhere. Most people’s rooms viewed were homely, and showed that they could bring their individual personal possessions into the home when they moved in. Information on advocacy services were available to people so that they could seek independent help and support if they wished to do so. Comments on the food provided at Osbourne Court were varied but generally positive. One person said, “The food is absolutely marvellous, you can’t fault it dear,” and another “All nice, like at home.” A relative said, “On the whole the food is very good, [our relative] eats more of a variety here than she did at home which is a very good thing.” On surveys out of twelve respondents, four people said that they ‘Always’ liked the meals, four that they ‘Usually’ did, and four that they ‘Sometimes’ did. A four week rotating menu is followed. A good choice is offered for breakfast and lunch. The menu showed that apart from Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 16 two days each week when a hot tea is said to be variable to chef’s choice, the choice on the menu for tea is various soups and sandwiches each evening. This does not provide much variety. At the bottom of the menu a list of alternatives to the menu are advised such as poached fish, omelettes, salad and jacket potato. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can raise concerns about the service, and be confident that they will be safeguarded from abuse. EVIDENCE: All people spoken with and responses on surveys showed that people know how to raise any concerns about the service and would be confident in doing so. The home’s complaints procedure is on display for people. This needs to be updated to reflect the fact that CSCI no longer take an active role in investigating specific complaints about a service, but that people can refer concerns to the local authority funding their placement who do have this role. Contact details should be given to facilitate this process. A complaints folder viewed showed that any concerns are taken seriously and dealt with appropriately. This site visit included a ‘thematic probe’ into how well people are safeguarded. This meant that we asked people how safe they felt at the home, looked at staffs’ training and understanding of safeguarding, and saw how policies procedures and practice in the home help to keep people safe. The information gathered was fed back through CSCI and will be the subject of a future report looking at how well care homes perform in this area. There were clear policies and procedures in place to safeguard people from abuse. The manager is a safeguarding trainer. Training records viewed and Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 18 staff spoken with showed that all staff had been trained, and had a clear understanding of their role in safeguarding people. One member of staff said, “If I had reason to suspect a person living here was being abused in any way I would immediately report it to my manager. I am very aware of whistle blowing.” One person living in the home said, “I feel very safe here.” Information was readily available to staff to assist them in managing any concerns, and senior staff were aware of the details of the local safeguarding teams. However, neither senior staff or the manager have the autonomy to report any incidents directly to the safeguarding team, but policy is to notify a senior manager in the organisation first. This may cause a delay in taking action. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a pleasant home that is suitable to meet their needs. EVIDENCE: Osbourne Court provides a comfortable home for people. People spoken with were happy with the accommodation provided. As part of this site visit a partial tour of the premises was undertaken. Issues noted were feedback to the manager. This included the need to review the home’s toilet and bathroom areas to ensure that all are fully functioning and safe. A number of bathrooms had sections of tiles missing where access for maintenance had been needed, and some were out of order. Some areas of the home are looking tired and would benefit from redecoration. The manager said that there is an ongoing programme of redecoration, with some of the upstairs bedrooms having been redecorated since the previous inspection. There were notices around the Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 20 building that were not relevant to people living at the home, but geared to provide direction to staff. This included a staff break list on a residents’ notice board, notices relating to the safe use of Christmas lights on a lounge door, and notices on the outside of the laundry door relating to practice. This did not contribute towards providing a homely environment. Observations during the day showed that storage in the home is not adequate. In one lounge area two hoists, weighing scales and wheelchairs were stored. A broken hoist was stored in a bathroom. The manager confirmed that storage at the home can be an issue. Different areas of the home are named after trees, and hallways were colour themed to help people find their way around the different units. Doors to individual bedrooms had the appearance of front doors and were painted in bright colours. On the residential unit there were personal photographs on bedroom doors to help people find their own rooms. On walls in hallways there was a varied selection of stimuli, soft cuddly toys in one corridor and sporting artefacts such as golf clubs and squash racquets in another. These things show that staff aware of the needs of people who have dementia, and are trying to assist them with orientation and provide opportunities for stimulation. Since the previous inspection a sensory room has been developed and a sensory garden is in the process of being developed to further enhance opportunities for people. On the day of the site visit the home appeared clean, and poor odour control was only noted in two isolated areas. On surveys of eleven respondents seven people felt that the home was ‘always’ fresh and clean, the rest said ‘usually.’ One person said, “My room is always clean, lounges and dining room are clean when I go in them.” A relative felt that cleanliness could be improved. In particular they felt that chairs were not properly cleaned following any incidence of incontinence, or underneath cushions. One settee viewed did have crisps and crumbs under the cushions. A suitable laundry area was available that had the potential to provide the recommended ‘dirty in, clean out’ system of work. However one door was blocked with equipment preventing this. Staff were observed to maintain good infection control practice during the day. Staff have had awareness training, and a number of staff are identified as having undertaken external training at a local college in infection control. The manager reported that a new infection control programme is about to be undertaken by staff. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can feel confident that they will be looked after by safely recruited and well trained staff. EVIDENCE: Feedback on staff was generally positive. Some comments made were: “All the nurses are extremely helpful and kind,” “They are very good - top marks,” and “The staff are wonderful.” Staff spoken with and on surveys were very positive about their role, and made comments such as, “We are a well trained team who work together as a team,” and “Osbourne Court are committed to having a good working team of staff and have had a lot of new carers whom all work together well, and have integrated well as a team for the needs of the residents.” Staffing levels were stated to be maintained as follows: On the upstairs nursing unit, seven staff in the morning and five staff in the evening. These numbers include two registered nurses being available as part of each shift. Downstairs on the residential unit staffing levels were said to be one member of staff to every six people. Five staff cover the home during the night. Rotas show staff for the whole home and indicate that staffing levels can be variable, with from nine to twelve staff being recorded on morning shifts and between nine and eleven staff being recorded on late shifts. A number of staff, particularly the registered general nurses, are working frequent double shifts. This is not best Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 22 practice and should be monitored as people are potentially at risk if being looked after by tired staff. People did not always feel that sufficient staff were provided to meet their needs. Some comments were, “You do not always get a response when you press your buzzer,” “Sometimes carers are too busy to attend to my needs,” and “Could do with more staff for the amount of residents on the nursing floor.” A visiting professional said that sometimes communication with staff could be difficult as for many English was not their first language. Another comment from a visiting professional may be reflective of staffing levels they said “Getting through on the telephone to a member of staff is extremely difficult. The telephone has frequently been answered by a resident.” On the day of the site visit, staffing seemed sufficient to meet people’s care needs. This may have been helped by the fact that at the time of the site visit there were nine vacant beds. However, call bells were going constantly throughout the day, and were not always answered promptly. When we tested the call bell system a response came after about five minutes. Of 43 care staff fourteen have achieved a National Vocational Qualification (NVQ) at level two or above. A further three staff are currently undertaking NVQ training. The home has not yet reached the standard of having 50 of care staff trained to NVQ level two or above. The files of three recently recruited staff were viewed. These showed that staff are recruited properly, and that all relevant checks are carried out so that people living in the home are safeguarded. Staff spoken with confirmed that they had not been able to start work until all checks had been completed. One said, “I have worked here for 3 months, I had to wait for Criminal Records Bureau clearance, I was interviewed in October but didn’t start to work here until January” Staff spoken with confirmed that when they started work they underwent a period of induction so that they understood the proper way of doing things. Evidence of an induction programme was seen in staff files viewed. On a survey one member of staff said “The staff I was engaged to work with on my first week of shifts were very good, very helpful, friendly and showed me all I needed to know. I also found doing the induction book for Four Seasons Health Care very informative and educational.” Staff said that they had undertaken a good level of training to help them meet people’s needs. One said “I have received all manner of training sessions since I was employed by Four Seasons Health Care all of which have been excellent and very informative and useful in understanding all individual needs. I have also enjoyed taking part in the training and being part of an excellent team of carers.” A training matrix showed that training in a range of areas is undertaken. All staff have undertaken basic training in person centred dementia care, others have undertaken more advanced training. Three staff have undertaken training in dementia care mapping. This will assist management in assessing Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 23 the quality of dementia care offered by the service, and highlight areas for improvement. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a safe and well managed home. EVIDENCE: Osbourne Court benefits from having an established and well qualified registered manager, and deputy manager. During the day the manager demonstrated that they had a good understanding of people’s needs, and that they were motivated towards continuing to improve the service. People living at the home had a good awareness of who the manager and deputy manager were. A member of staff said, “Our manager, deputy manager and senior members of staff are all of great support.” Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 25 There are strategies in place to monitor the quality of the service at Osbourne Court. The provider carries out an annual audit, which incorporates seeking peoples views through questionnaires. Visits as required by regulation are also carried out on a monthly basis. These visits include talking to people about the service provided. Residents and relatives meetings are held on a fairly regular basis. Comments books are available to people. These elements show that peoples’ views on the service are sought. There are internal quality monitoring processes undertaken such as medication audits. The home completed and returned their AQAA on time. This was briefly but fully completed Some people living at Osbourne Court have their personal monies maintained by the home’s management for safekeeping. The money is mostly kept in a single bank account with a cash float kept at the home for people to access at will. Each person receives a monthly statement detailing all transactions in and out of their ‘account’. Where families/representatives deposit monies for their relatives they have a receipt. The administrator reconciles computer records, cash float and the bank balance weekly and the registered manager checks the balances monthly. This process ensures that people’s monies are managed safely. During the site visit peoples right to privacy and confidentiality was not fully protected by record keeping systems. Records detailing aspects of peoples care were left accessible to all on staff workstations. Filing cabinets containing care files were not kept secure. In a lounge area a bookcase was full of old records relating to people’s care such as medication administration records. After being informed of this the manager cleared the bookcase, and ensured that other records were kept secure. However the old records had clearly been there for some time with no one noticing or taking action. The AQAA completed identified that systems and services are monitored and maintained. Fire records viewed were satisfactory. Regular fire drills and testing and checking of equipment takes place. A fire risk assessment was in place. The fire service have recently confirmed that satisfactory fire procedures are in place. The home’s training matrix showed that staff are kept updated in core areas such as moving and handling, and fire awareness. A number of staff do need update training in food hygiene. The manager said that this is in hand and that some staff are going through workbooks on this subject. Management do need to review some aspects of health and safety in relation to the care needs of people who have dementia. Doors of potentially hazardous areas such as sluices were not kept secure. A relative said that stairs from the first floor were not secured and a potential hazard to people who may wander. The manager was already aware of this particular issue and was going to review it. Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement People must be confident that their care, health and social needs will be met through effective assessment and care planning systems being in place. This refers to: The need for care plans to be effective in identifying all peoples needs, and the actions needed by staff to meet these needs. The need for care plans to have a holistic and person centred approach incorporating social, emotional and occupational needs. The need to demonstrate that as far as possible people have been involved in the care planning process. To promote people’s health and well being adequate nutrition records must be maintained. So that people are protected by their medicines being well and safely managed, the medication practice issues highlighted in the body of the report must be addressed. DS0000068298.V364209.R01.S.doc Timescale for action 01/07/08 2. OP8 12(1) 01/07/08 3. OP9 13(2) 01/07/08 Osbourne Court Care Home Version 5.2 Page 28 4. OP27 18(1)(a) So that people receive proper 01/07/08 care at all times, sufficient staff must be provided to meet their needs. This refers to the need to keep staffing levels under review and provide a consistent level of staffing to meet peoples assessed needs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations So that people are cared for safely with appropriate equipment used, a multidisciplinary approach should be used in assessing people’s need for bedrails. So that people are confident in receiving care that is individual and person centred, management need to continue developing an approach to activity and occupational provision that shows robust assessment and recording processes. People should be consulted regarding the teatime menus to ensure that sufficient variety and choice is provided in line with their wishes. So people know that they live in a homely, well maintained and safe place where their privacy is always maintained, regular audits of the premises should take place. This to ensure that issues are identified and managed. This refers to items raised in the body of the report such as extraneous notices, outstanding repairs, storage of personal information and other storage issues. 1. OP12 2. OP15 3. OP19 OP38 Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Osbourne Court Care Home DS0000068298.V364209.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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