Osborne House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

We assessed all quality statements within the key question of Safe. The service had a system for recording and reporting safeguarding. The manager shared learning with staff from incidents and was working to reduce falls people had. Staff were recruited, inducted and trained to support people’s individual needs. Regular testing of equipment took place. There were gaps in some of the mental capacity assessments and best interest decisions completed. The quality of some risk assessments was variable and there were some gaps in the risk assessments we viewed. The manager started to address some of these areas during the assessment process.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The care home had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.

The manager promoted an open culture. Accidents and incidents were reported and recorded. Where people had a high number of falls, ways to reduce these were considered including medicine reviews and new shoes for one person.

Where bruising, skin tears and wounds were identified, body maps were not routinely being completed for these. Visual records at the point of identification are important, where investigations or more information is needed into how the bruising or skin tears occurred, it can also provide a timeline for staff and professionals to follow of events. The manager told us staff took photos where needed and this was shared with the district nursing or GP for the purpose of care and treatment.

Learning outcomes were identified and shared with staff. Where staff needed additional support, this was done through 1:1 meetings or competency checks.

Staff told us the registered manager discussed learning from accidents and incidents with them. A staff member said, “All accident and incident reports get reviewed by the manager, monthly reports are analysed. We go through in team meetings and look at how we can reduce falls for people”.

A professional working with the service told us, “They [staff] always ask for advice when needed and do their upmost to try and implement any suggestions not just from clinicians but also family.”

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. There was continuity of care, including when people moved between different services.

People were accepted into the service safely. Preadmission assessments were carried out by a manager. The service had good relationships with health and social care professionals. A health professional visited the service weekly, information we reviewed showed staff recorded concerns to be raised with the visiting professional and the outcome of these visits from the professional were documented. The service had good links with the local Mental Health Team, referring into the service for support when a need was identified.

Relatives we spoke with told us about how information about the person was shared before their relative moved into the service. One relative told us, “Before [Name of person] actually moved into the home the manager asked us lots of questions about likes, dislikes, medication, what worked, what didn’t, it was thorough.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

The service completed Mental Capacity Assessments (MCA) for people who could not make a decision about their care. Mental Capacity assessments and best interest decisions were completed. However some people's assessments had not been completed fully, they did show how the assessor had tried to involve the person in the process and did not include who had been consulted as part of the best interest process. We were told management were aware Mental Capacity Assessment’s needed updating and this was ongoing work.

The service reported safeguarding concerns and reviewed concerns monthly.

Staff had been trained in safeguarding, they told us they knew how to keep people safe from avoidable harm and abuse. One staff member told us, “Yes, I’ve had online safeguarding training yearly. Any concerns I would give to my manager. Things get looked into. We get feedback on safeguarding outcomes in staff meetings.”

Relatives we spoke with told us they felt their family were safe. One relative told us, “They seem to have people with different types of dementia, but I have never seen a carer get upset or not know what to do to calm a situation.”

Where people were being deprived of their liberty, referrals had been made to the local authority. The manager monitored people’s Deprivation of Liberty Safeguards (DoLS) authorisations.

The service did not always work well with people to understand and manage risks. Risk assessments relating to the health, safety and welfare of people were not always being completed or lacked sufficient detail. For example, people who had been assessed by speech and language therapist (SALT) (and are at risk of choking), people who had diabetes, people who had emollient creams applied and people who had epilepsy.

For example, Risk assessments for people who had been assessed by SALT, did not consistently contain specific information relating to how the person should be supported and the risks of choking for people on modified diets. Foods people should avoid were not clearly identifiable on people’s care plans. We raised this with the management team during the assessment but were not given any further information. We did not find anyone had come to harm as a result of this.

Staff had completed training in the areas where specific risks were identified and could explain the actions, they would take to support people if they were concerned. One staff member told us, “Risk assessments are clear in the detail. They change quite a lot. We review risk assessment regularly. They can change quite frequently due to people’s needs.”

Feedback we received included “[Name of person] fell out of bed a while ago. They called me, kept me updated and put things in place, a crash mat. They explained they can’t use bars on the bed any longer, but they have done what they can do. We [the family] feel they keep a close eye on them.”

The provider detected and controlled potential risks in the care environment.

Checks were in place relating to the safety of the building, such as fire equipment, portable appliance testing (PAT), hot water system, electrics, and water temperature checks. The service employed a maintenance person who managed any work that was required at the home.

A staff member told us “The environment is safe. We report things if anything is broken. There is a communication book with maintenance. Things gets fixed promptly.”

The service had suitable qualified, skilled and experienced staff, who received effective support, supervision and development. Records we reviewed showed the provider had a safe recruitment process. This included completing Disclosure and Barring Service (DBS) checks. The service recently employed a training manager who was implementing various face to face training for staff to develop their learning. The registered manager and training manager had recently undertaken Level 3 safeguarding training to enable them to deliver this to the staff team and for other providers of care. We saw evidence of this during the assessment. Training records were kept for staff and monitored for compliance. However, this did not include training and competency for the registered manager. We were unable to ascertain the training they had. A staff member told us “Training we do every year online. Yesterday I completed IPC training. I have the training I need to do my job”.

The home detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. Housekeeping staff followed a daily cleaning schedule. Regular infection prevention control audits had been carried out and the service had risk assessments to follow in the event of any outbreaks of infection in the service. Staff had been trained in infection prevention and control.

A relative told us told us “I have seen carers wearing the occasional mask, gloves when they are assisting residents to the bathroom.”

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People had their medicines reviewed where necessary.

People’s medicines were stored and administered safely. People’s medicines and topical creams were labelled when opened. There were body maps for people who had creams applied for staff to follow correct application. We found risk assessments for the use of flammable emollient creams were not being routinely completed. We raised this with the manager during the assessment, action was taken to complete these.

Care plans had protocols in place with the GP surgery for people who had covert medicine, outlining why these were given covertly and signed off appropriately. Families were involved in the process.