We inspected Osborne Lodge Rest Home on 11 and 20 February 2015 in response to some concerns we had received. This was an unannounced inspection. We also checked to see if the provider had made improvements necessary to meet the breaches of the regulations we had previously identified.
At our inspection in July 2014 we found the provider to be in breach of regulations relating to care and welfare, staff recruitment and quality monitoring of the service. The provider sent us an action plan and said they would be meeting the regulations by 30 January 2015. At this inspection we found improvements had recently been made following a restructure of the service and the appointment of a new manager and operations manager (The management team) who had already identified concerns and areas for improvement. An action plan had been produced and remedial action was already underway. However, there was still work to do to fully meet the regulations relating to care and welfare.
Osborne Lodge Rest Home is registered to provide accommodation and personal care for up to 24 older people, most of whom were able to communicate with us verbally. The home had communal areas such as a lounge and dining room, as well as the majority of bedrooms, provided on the ground floor. There was a smaller first floor which housed the remaining bedrooms. Several of the bedrooms had access via sliding patio doors to a semi private personal patio area and direct access to the rest of the garden. The home has it’s own minibus which was used regularly to facilitate trips out.
The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager had only been in post for a few weeks but had started the process of applying for the relevant checks to be completed prior to their application to the Care Quality Commission (The commission) for their registration.
People were protected from possible harm. Staff were able to identify different types of abuse and what signs to look for. They were knowledgeable about the home’s safeguarding processes and procedures and who to contact if they had any concerns.
There were systems in place to manage, record and administer medicines. However, procedures to manage the disposal of unwanted medicines required improvement. Systems to record changes on people’s medicine administration charts (MAR) were not safe.
There were sufficient staff on duty to meet people’s needs. Call bells were answered in a timely way and people told us they did not have to wait for help when needed. The new manager had reviewed staffing requirements and was in the process of recruiting new staff with experience of supporting people with dementia.
The home was clean and tidy. New cleaning schedules had been implemented and housekeeping staff told us that these had made cleaning the home much easier. Refurbishment of the hallway was underway and carpets were due to be replaced when completed.
Some, but not all staff had received appropriate supervision and training. The new manager had identified what training was outstanding, and was in the process of implementing training and supervisions for remaining staff. A spot check supervision process had been put in place which the manager carried out to assess staff attitudes and approach to providing care.
Care staff understood the importance of gaining consent from people before providing any care or support. However, they were not knowledgeable about the principles of the Mental Capacity Act 2005 in relation to assessments of capacity, or the Deprivation of Liberty Safeguards (DoLS). There were no mental capacity assessments for people. Whilst people living at the home had mental capacity, staff told us two people had been assessed for possible dementia as they sometimes became confused.
People were supported to maintain their health and had access to healthcare when required. However, we noted some concerns in relation to recurring urinary tract infections in four people. Care plans did not include information on how to prevent or manage these infections. Other care records such as risk assessments were not up to date. The new management team had identified that care plans and risk assessments were not fit for purpose and had started to address this.
Not everyone had received an assessment of their needs before moving in to the home. Care plans were not person centred and there was little information about people’s life histories. This was in the process of being addressed.
People’s nutrition care plans did not always include sufficient details about their dietary needs, such as a lack of information to guide staff in how to support people with diabetes.
However, people were supported to eat and drink a variety of food and drink. People ate independently but staff were on hand to help if needed, such as cutting up a person’s meat for them during their lunchtime meal. Food was freshly cooked by the chef and people had opportunities to give feedback about what they would like on the menu. There were jugs of juice or water in the lounge, and people had fresh water in their rooms.
Staff interacted positively with people and were caring and kind. They were reassuring to people when required and supported them at a pace that suited them without rushing. The staff had good natured encounters with people and seemed to know them well. They talked about issues people were clearly interested in. People told us staff treated them with dignity and respect and we observed this throughout our inspection.
A new system had been put in place to monitor and record any complaints that were received. People told us they had no complaints about the service, but if they had, they were confident the new manager would listen to them and respond.
There was a range of activities on offer throughout the week and a programme was given to each person in advance to let them know what these were. Several people went out for lunch and a drive in the home’s minibus and said they had enjoyed the experience. Other activities took place within the home, such as singers, entertainers and quiz games. People were supported to maintain links with their local community including attending church or the local community centre.
The previous manager had not returned a provider information return as requested by the commission. The new management team had implemented significant changes and improvements in the past few weeks such as a restructure of the staff team, audits for medicines, staff training and infection control. People had been consulted about the changes to the home and were asked for suggestions for improvements. For example, about the menus and activities. Care plans and risk assessments for each person were in the process of being re-written to ensure they were person centred and relevant.
Systems had been put in place to monitor and record incidents and accidents and to show if these had been reported to the appropriate authority such as the local safeguarding team or the commission. These systems had only recently been embedded in practice so their effectiveness could not yet be evidenced. As there had not previously been any systems in place, the new manager was unable to show us any historical information in relation to incidents, accidents and complaints.
The culture within the service was open and transparent. Staff told us the new management team was professional and supportive. They were visible and encouraged staff to participate in developing the service. Staff told us managers were approachable and they felt listened to. The new management team had already identified most of the issues we raised with them at the inspection and we could see they were in the process of making the improvements required. They were open with us and were responsive to the feedback we gave them.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the back of this report.