Care Home: Osbourne Court Residential Care Home

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What the care home does well The staff team at Osbourne Court are caring and have developed good relationships with those who live at the home; they have a sound understanding of the needs of those living at the home. The staff team are new and have rapidly developed a strong team identity and work in line with the aims, objectives and ethos of the home. People living at Osbourne Court can be confident that they will receive support from people they have come to know. Care records including care plans, risk assessments and review notes were all of a constant high standard, records are sufficiently detailed, reviewed and updated when required. It was clearly evident that the management and staff team are committed to ensuring that all of the needs of individual`s at the home are met, this is done through working with those who know the individual well, such as family members, consultation and observation and previous knowledge and an understanding of individual`s and how they wish to be supported. Prior to our visiting the service we recieved 24 surveys. 17 of these were from people who live at Osbourne Court, 5 were from staff who are employed at the home and the remaining 2 had been completed by visiting health professionals to the home. The feedback that we recieved was of overwhelming support and praise for the care and support provided at the home. Additional comments made by people included: `The meals at the home are excellent, varied and wholesome with plenty of choice !`, `Activities are well planned, varied and suit my needs well`, `The care is of a good standard, the home also provides good spiritual help`, `I feel that there are a lot of very qualified staff doing an excellent job, I have worked in other homes and I have never felt that the residents are priority like they are at Osbourne Court`, `There is a warm welcoming atmosphere at the home which everyone always comments on`. The environment provided at Osbourne Court is one of a high standard with good quality furnishings and fittings. The home was purpose built and provides accommodation which is suited to the needs of the people who live there. What the care home could do better: There were no requirements that were made as a result of our visit to this service. The current methodology within The Care Quality Commission is that we are currently not undertaking routine `key` visits to services. A key visit is full and covers all of theimportant National Minimum Standards. This random visit covered many of the standards, however, we are not in a position to award the home a rating at this time. It is important to note that in our view if this visit had been a `key` inspection and we were in the position of awarding a star rating for this service it would have been that Osbourne Court provides a `Good` service with many indicators of quality for those who live at the home. Random inspection report Care homes for older people Name: Address: Osbourne Court Residential Care Home Osbourne Court North Road Stoke Gifford South Gloucestershire BS34 8PE new service which has yet to be given a quality rating The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Odette Coveney Date: 2 6 0 5 2 0 1 0 Information about the care home Name of care home: Address: Osbourne Court Residential Care Home Osbourne Court North Road Stoke Gifford South Gloucestershire BS34 8PE 01179448700 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Richard Mark Williams Type of registration: Number of places registered: Conditions of registration: Category(ies) : Windmill Care Limited care home 58 Number of places (if applicable): Under 65 Over 65 0 26 dementia old age, not falling within any other category Conditions of registration: 32 0 The maximum number of service users who can be accommodated is 58 The registered person may provide the following category of service only: Care Home only (PC), to service users of either gender whose primary care needs on admission to the home are within the following categories - Old age not falling within any other category (Code OP) (maximum of 26 places), Dementia not falling within any other category: (Code DE) (maximum number of places 32) Date of last inspection Care Homes for Older People Page 2 of 15 Brief description of the care home Osbourne Court is a new purpose built service and was registered with us on 20th November 2009 to provide residential care for older people, and residential care for older people who have a diagnosis of dementia. The home is located within the residential area of Stoke Gifford. The home has car parking to the font of the house and has a secure entry system. The accommodation at the home is located over two floors with a passenger lift for those with mobility difficulties. The home has the required communal areas for the number of people who are accommodated at the home. All areas of the home are tastefully furnished with good quality fixtures and fittings. The fees charged at this home are available upon request and are based upon an assessment of individuals needs. Care Homes for Older People Page 3 of 15 What we found: This unannounced random inspection took place over six hours and was completed in one day. The manager was present during the inspection and participated fully in the process. Evidence was gained from a whole range of different sources, including:- Information provided by the manager in the Annual Quality Assurance Assessment questionnaire (AQAA), this had been completed by the manager prior to our visiting the service, through our directly speaking with people who live and work at the home, a review of individuals care records, a tour of the home, an examination of some of the homes records and observation of staff practices and interaction with the people who live at Osbourne Court. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. We also also took this opportunity to discuss with the manager the new Health and Social Care Act 2008. The manager was able to demonstrate to us their understanding of their responsibilities in order to comply with the new legislation. Choice of Home: The home has in place a detailed, well written Statement of Purpose. We saw that information was included within this document about the rights of those who live at Osbourne Court. People would be respected in relation to their rights, ensuring they will be treated with dignity and respect, with their right to privacy and maintaining their civil rights being upheld. The Statement of Purpose also detailed the staffing arrangements for the home, the range of services, which can be provided, and how individuals will be supported with their health, personal care, social and emotional aspects of their life. The information within this document was fairly comprehensive and contained clear information for residents and their relatives about the services and facilities provided at the home. Furthermore this document contained information about the admission process into the home and how to raise issues of concern and showed to the reader how these would be responded to. The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life. We saw in care records for the most recently admitted people into the home that there is a full and detailed admission process at Osbourne Court. This is to ensure that the prospective needs of residents can be met. This whole process is thoughtfully and sensitively carried out. The homes detailed pre-admission assessment covers a number of important areas including individuals background circumstances, peoples medical history, memory and communication needs. This comprehensive tool covers the needs, wishes and choices of the whole person and does not just focus on the physical care needs of those in their care. Whilst the assessments completed are well written it is recommended that the home review their pre-admission and comprehensive assessments in order to ensure that they record that individuals mental capacity and ability to make decisions about their life have been fully considered and discussed. Care Homes for Older People Page 4 of 15 The manager spoke to us about the admission process for people coming into the home and it was evident that the whole process is tailored around the needs of the individual. We spoke to a number of relatives whilst we were at the home. People told us about the admission process for their parents. They told us that their relative was visited by the manager prior to their admission into the home, a full assessment was completed and they were provided with information about the services, faciltities and staff skills in order to assist them in making their decision as to whether Osbourne Court would be able to cater to their needs. Family members told us of the difficulties in moving their relative into a care environment and how their fears had been overcome due to the understanding and caring approach of both the manager and the staff. People told us that their relative had settled in well at the home and that they had noticed significant improvements in their relatives wellbeing, examples given to us were that their relative was much more alert and awake, My mother in law since coming into this home is much more mobile and aware of her surroundings. We did not review the contractual arrangements for people living at the home, these are also known as the terms and conditions of the placement. The manager confirmed to us that all residents had been issued with contracts and that all of these documents contained clear information for people about their rights and the rights and responsibilities of the service provider. Health and Personal Care: The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed and there is an ongoing assessment and monitoring of individuals needs and the service is tailored accordingly. Care records reviewed showed that the registered manager carries out a full preadmission assessment prior to a new resident moving into the home. The care records for the last three residents to move into the home contained very clear assessments that formed the basis for the working care plans. We also saw that staff had completed a comprehensive assessment which covered important area such as background history, medical history, memory needs, communication and providing a safe environment. Daily records showed that individuals visit the home prior to their admission and that their admission into the home is tailored around their needs and wishes. There is a trial period of four weeks, which can be extended if required. This period of time allows time for the resident to settle, for consultation with the individual and for a full assessment to be undertaken in order to ensure that the home are able to meet their needs. The home have developed comprehensive person centred care plans based on wishes and choices of the people who live at the home This has been completed from the information provided by the individual, (where they are able) or from information provided from family members. Information to develop the care plans is also gathered during the assessment process, the trial period and as part of the ongoing placement within the home. The daily records maintained within the home provide clear evidence that individuals current and changing needs are identified and met. Clear information was also in place to show the involvement of specialist services and professionals, ensuring a multi-disciplinary approach. The home have in place a comprehensive Dementia Care strategy, this document was Care Homes for Older People Page 5 of 15 referred to by staff during our visit and outlines the aims of the organisation and tells the reader about differing definitions of dementia and person centred care. The strategy also records the key principles of the home which are to: develop effective working relationships, undertake detailed and comprehensive assessments, will hold relationships with their residents and their families as paramount, the home will ensure that residents have equal access to services and believe that well being and fulfillment are essential for residents and will ensure the people are given opportunities to feel purposeful. The document also reports that it will nurture, support and develop as a team in order to ensure they are able to provide the skills and care the residents at Osbourne Court require. People living in the home are registered with a local doctors practice. Medicines are supplied to the home using a weekly blister pack system. All the medicines used in the home are given by staff who have been trained and deemed competent to administer them. We checked the medication systems used to make sure that they meet the required standards. The home uses Boots pharmacy for their medications and gets support from them. Good practice guidelines are followed. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines are given from the labeled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. A visitor to the home who we spoke with during our visit told us how happy they were with the care, support and attention their relative recieved, they told us that their mothers health had improved significantly since their arrival at the home, both on an emotional and physical level, they said that she had become more alert, mobile and aware of her surroundings, this person could not praise the service provided at the home highly enough. Those living at the home said: I am very happy living here, Staff here are very kind. Staff have developed sound relationships with those who live at the home and have a clear understanding of the individual needs, wishes and aspirations of those who live at the home, these are well recorded and responded to. Daily Life and Social Activities. The visitors booked showed us that many people living at the home receive regular visits from family and friends, no concerns were raised to us whilst we were at the home, relatives and visitors we spoke with told us that the manager was responsive, kind and listened to them and responded to requests for information. People told us that they are made welcome by the home, that staff are kind and that they were happy with the care their relative receives. The AQAA which was completed by the manager prior to our visit informed us: Activities and engagement are at the heart of everything that we do at Osbourne Court. We have a wide range of planned activities offering a seven day programme of five activities a day with promoting independence held as a core value in all activities. We believe that all team members should feel that it is within their role to deliver activities and to engage with residents whenever they see an opportunity. Care Homes for Older People Page 6 of 15 Any daily life activity is approached by our team as an opportunity for engaging with residents and offering a sense of purpose. We recognise that as individuals we all need a sense of purpose and all to easily when people move in to a group living setting they lose their opportunities to have that sense of purpose. We therefore strive to regularly offer residents opportunities to continue to do the types of activities that they would have done before moving in to Osbourne Court, providing only the support that the resident requires to complete that task as independently as possible. Our team take a creative and open approach to how and what activities to offer in response to feedback received. We recognise all religious festivals and holidays and celebrate any that are reflective of the beliefs of our residents. We hold being part of the local community of Stoke Gifford as one of our central values and regularly support local events and services in the community, as well as inviting the local community to engage with the care home. During our time at the home we saw that board games, puzzles, crosswords and newspapers were all available to people. Staff were engaging with residents and supporting them with baking and craft work on the day we were at the home. We saw that for many people who live at the home the staff had supported people to create a memory box. These boxes are attached to the wall outside an individuals bedroom and contain items such a photographs, ornaments and mementos which are important to the individual and that trigger special memories. Whilst we were at the home we saw residents stop to look at these, people were able to identify their room by the items in their box, for other people they created a talking point and an opportunity to engage with those around them. Complaints and Protection: Those who live at the home would be supported to complain and can confident that their complaint will be listened to. Practices at the Home ensure protection of residents from harm and abuse. The Home has appropriate procedures in place for management of complaints. There is a complaints procedure at the home and this was on display. This document contains information about the Care Quality Commission to enable individuals to contact us if they were not satisfied with the outcome of their complaint to the home. The home maintain a record of concerns/complaints this was viewed by us, as confirmed by the manager there were no recorded complaints at the time of our visit. We have not recieved any complaints abut the service, no-one raised any problems or concerns to us whilst we were at the home. It was clear from observation that people who use the service and their family/visitors felt comfortable with discussing issues with the manager and felt assured that any issues raised by them would be dealt with effectively and in a professional manner. People told us that if they had any concerns they knew who to discuss these with. Care Homes for Older People Page 7 of 15 There is a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidences of abuse occur. Staff have recieved training in respect of the protection of vulnerable adults. We asked a member of staff about their training and about their role and responsibilities in this area. This member of staff was able to describe the types of abuse and what steps they should take if they had concerns. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included two satisfactory references, record of previous employment, and satisfactory Criminal Record Bureau disclosures. Environment. The home is a new build and set in its own grounds. There is parking to the front for visitors and parking to the rear that is used for staff and to allow deliveries to be made. The gardens are small and in courtyard style, with seating in appropriate places. The gardens are secure and the people who live at the home are able to walk round, there is no direct access from the garden to exit the premises. On the ground floor there are 26 single bedrooms, each with en-suite shower, toilet and wash hand basin. The en-suite facilities had been provided with towel rails and storage for personal toiletries, this is good practice. Each shower facility had a seat installed, and appropriate grab rails in place. All rooms are of a good size, and all rooms exceed the space as noted in the National Minimum Standards. Each room is well furnished with good quality furniture and fittings. An over bed table has been provided in each room to enable people to have breakfast in bed if they choose. All rooms are fitted with a call alarm, window restrictors, and heating thermostats to ensure personal choice. Each room is also supplied with a flat screen TV, an accessible telephone, and a lockable space for personal items. On the ground floor there are two large lounge areas. Both of these rooms has been designed to enable a mix of lounge and dining space as necessary. A small kitchen area has been installed in these areas with toaster, microwave, kettle, fridge, sink and dishwasher. Staff stated these could be used by residents with support from staff, and also to prepare breakfast for the people accommodated, to ensure flexible meal times linked to choice for the residents. This is mirrored on the first floor. The first floor of the care home consists of 32 single bedrooms with en-suite facilities. In this area of the home, 12 rooms have been fitted with an electronic monitoring system that can be installed in further rooms if deemed necessary through individual risk assessment. The monitoring system will be used primarily at night for those residents who have a propensity to walk around in the night. Staff will be alerted if they leave their room, or if they are out of bed for long periods of time. Support can then be offered. On this floor there is a further small lounge (in addition to the two already mentioned) to be used by visitors, or for individual sessions with residents, or small groups. A Care Homes for Older People Page 8 of 15 hairdressing salon has been provided that contains good equipment and appropriate seating. Access to this floor is by passenger lift; this was in working order on the day of the site visit. Generally the premises were of a good standard with good quality furniture and fittings. The home was found to be clean, tidy and odour free at the time of our visit, domestic staff are employed at the home and were seen going about their duties in a pleasant manner. Management and Staffing: Mr Richard Williams has over 15 years experience in the provision of nursing care, initially qualifying in 1993 as RMHN. Since that time Mr Williams has gained experience in the health service, and in residential nursing care provision. Mr Williams has extensive experience in managing services and large staff groups. Further experience has been gained in providing teaching services in mental health settings, and in care homes. It is our view that Mr Richard Williams is experienced, appropriately qualified and committed to improving the quality of life for the people who live at the home. People living in the home spoke positively of the care provided. Practice observed was of good relationships between those who live at the home, staff and management. Mr Williams fully engaged with us during this visit and was able to locate all of the necessary information and documents easily. This shows that generally the home has good systems in place and is well run. The management and staff at Osbourne Court have a strong commitment and drive in wishing to provide an excellent service at the home. The home has a number of methods to ensure that peoples needs and wishes are known, recorded and responded to in a person centred way. This is undertaken through such methods an an open and engaging management style, one to one support and time spent with those who live at the home talking with them about their care, staff and care review meetings to ensure that all are consulted. There are clear lines of accountability within the home. Information contained within individual staff files were all of a consistent standard. The files for three staff were reviewed: including a most recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. We were informed by the manager and staff that prior to residents being admitted into the home staff completed a full and comprehensive induction programme over a six week period. This induction covered areas such as health and safety, fire safety, care of residents who have a diagnosis of dementia as well as being informed about the values and ethos of the home. Whilst we saw that there were some records in place to evidence that the induction training had been completed recording in this area could be improved. Care Homes for Older People Page 9 of 15 When spoke to staff about the training they have recieved and they told us that training had been of a high standard and had benefited them within their work. Staff told us they had completed training in areas such as fire awareness, health and safety, manual handling, protection of vulnerable adults and dementia care. We also saw staff certificates and training records to confirm that the training had taken place. Whilst the staff we spoke with demonstrated a good understanding of the support and care needs of people it is recommended that staff at the home also complete Mental Capacity Act and Deprivation of Liberties Training in order that they can be fully conversant with the rights and choices of people who are living at the home. Whilst at the home we observed staff and they were seen to be supportive to people who live at the home. It was noted that staff were very patient and asked people who live in the home questions and encouraged them to make decisions, rather that deciding for them and encouraged individuals to make choices. We spent some time throughout the day talking to staff and observing them carrying out their duties and assisting residents. Staff were respectful, warm in manner, good humored and sensitive towards the residents within a relaxed, calm environment. All staff demonstrated a very caring, committed attitude to their roles and responsibilities in ensuring they provide quality of care to the people living at Osbourne Court. During our visit we spoke individually to staff members on duty that said they are happy within their role at the home and said that they felt well supported both by the manager, staff knew who to speak with if they were unhappy. Staff we spoke with were highly motivated and were fully conversant with the support that individuals require at the home and gave sound examples of how individuals are supported on a day to day basis with their care, staff told us about individuals preferences, likes and dislikes. We saw that staff and team meetings occur on a regular basis, the last meeting for staff took place on 1st March 2010. Subjects that have been covered with staff during meetings and training have included the admission process for residents coming into the home, care planning and recording arrangements, medication processes and individual supervision. We also saw that the care and associated needs of individuals who live at the home were also discussed in order to ensure a consistent approach and continuity of service delivery and care to residents. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance assessment (AQAA) is a process that is currently being used for all regulated services The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the registered provider was detailed and outlined areas of what the home does well, with examples of evidence provided, as well as telling us what the home feels they could do better and their plans for continual improvement over the forthcoming twelve months. Within this AQAA there is a section where they can provide to us a summary of what they believe the service does well, within this the home told us: Communication with Staff, Communication with Residents and Families. Dedicated and personalised care . Varied activities programme. Comprehensive Procedure Manuals. Excellent Management/Staff interaction Staff Training and Development. Care Homes for Older People Page 10 of 15 Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary. When we reviewed the information contained within the homes fire logbook, we saw that the home is completing all of the daily, weekly and monthly tests as required. Records of fire drills and staff training were clear and well recorded. What the care home does well: What they could do better: There were no requirements that were made as a result of our visit to this service. The current methodology within The Care Quality Commission is that we are currently not undertaking routine key visits to services. A key visit is full and covers all of the Care Homes for Older People Page 11 of 15 important National Minimum Standards. This random visit covered many of the standards, however, we are not in a position to award the home a rating at this time. It is important to note that in our view if this visit had been a key inspection and we were in the position of awarding a star rating for this service it would have been that Osbourne Court provides a Good service with many indicators of quality for those who live at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 12 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 13 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 14 It is recommended that the home review their preadmission and comprehensive assessments in order to ensure that they record that individuals mental capacity and ability to make decisions about their life have been fully considered. It is recommended that the recording of staff induction training is improved upon to fully evidence that it has been completed and is in line with current good practice. It is recommended that staff at the home complete Mental Capacity Act and Deprivation of Liberties Training in order that they can be fully conversant with the rights and choices of people who are living at the home. 2 18 3 18 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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