Osmaston Grange

About the service

Osmaston Grange is registered to provide personal care, nursing care and accommodation for up to 80 people across two buildings. At the time of the inspection only one of the two buildings were open providing accommodation and residential care to people either on a permanent basis or for short-term care, as required. Nursing care is no longer provided at Osmaston Grange.

On the day of our visit 30 people were using the service aged 65 and over. The open building in use can support up to 40 people.

People’s experience of using this service and what we found

The provider had a process for monitoring the home which included audits, however we found these had not consistently picked up on areas which required improvement.

Medicines were not always managed safely, and some aspects of safety were not always managed to reduce the risks of harm or impact on people’s dignity.

Lessons in some areas had been learnt, however there was not a system or ongoing approach to ensure areas of concern did not reoccur.

Partnerships had been developed with health and social care professionals, however, there continues to be an inconsistent approach to ensuring peoples care needs were being met.

There was sufficient staff to meet people’s needs and they had received training for their role. However, training in managing behaviours which challenged had not been made available which would have supported some staff in this area.

Staff understood how to raise a safeguarding’s and we saw any concerns raised had been investigated. Relatives were overall positive about the experience their family members received.

The provider completed notifications and responded to any concerns we raised. There was a positive culture within the home and environmental improvements had contributed to making the home feel more welcoming.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was requires improvement (published 20 April 2021) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made, however further improvements were required, and the rating remains requires improvement and the provider was still in breach of the regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. These were in relation to concerns we had about infection control and the environment. We saw improvements had been made in these areas, however identified other areas which required further monitoring. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This report only covers our findings in relation to the key questions

safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Osmaston Grange on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety and oversight relating to the governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Osmaston Grange is registered to provide personal care, nursing care and accommodation for up to 80 people across two buildings. At the time of the inspection only one of the two buildings were open and provided accommodation and residential care to people either on a permanent basis or for short-term care, as required. Nursing care is no longer provided at Osmaston Grange. On the day of our visit 25 people were using the service.

People’s experience of using this service and what we found

The provider used a range of audits and systems to monitor the service; however, these had not always identified areas which required improvement. Care plans had not been updated or risk assessment always completed to cover all aspects of people’s care. This meant we could not be assured people would receive the care they required for their current needs.

On our last inspection we raised concerns about measures in place to manage COVID-19. At this inspection we found staff had received training in relation to COVID-19, however, other areas in relation to infection control had not been maintained. We found areas which required further improvements, in relation to cleaning touch areas, equipment cleaning and maintenance.

Medicines stock inaccuracies had been identified at the last inspection and this inspection, measures had not been put in place to address these concerns. This meant we could not be assured people had received their prescribed medicine as required.

There were sufficient staff on site, however they were not always deployed to ensure people’s needs had been met. We found some elements of the rota had not always been covered which had an impact on the level of care or other duties required.

People and relatives were consulted on aspects relating to the home and the care the people received. The staff worked in partnership with health and social care professionals to support peoples ongoing needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 16 October 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 2 September 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and Good Governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service continues to be Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Osmaston Grange on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (Good Governance)

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Osmaston Grange is registered to provide personal care, nursing care and accommodation for up to 80 people across two buildings. At the time of the inspection only one of the two buildings were open , providing accommodation and personal care to people either on a permanent basis or for short-term care. Nursing care is no longer provided at Osmaston Grange. On the day of our visit 30 people were using the service.

People’s experience of using this service and what we found

We found some concerns in relation to the services practices in keeping people safe and in providing oversight. Risk assessments had not always been updated when people’s needs changed, and this had an impact on their care. Some people had inappropriate footwear, and this placed them at risk of falls or damage to their feet. Lessons were not always learnt or shared with staff following safeguards or incidents.

People received their medicine; however, we noted some recording and stock errors which had not been identified by the providers audit. We also identified a delay in the ordering of topical creams. Other audits had not identified the areas within the home relating to infection control or safety in relation to the homes flooring or equipment.

Polices used by the provider had not incorporated national guidance about the national pandemic. The provider shared with us their specific policies around this area, however not all the updated guidance had been included or implemented within the home.

Infection control measures had not always been followed in line with Covid 19. This related to

inappropriate face coverings, areas for changing and the guidance in relation to visitors.

Staff felt there was an open culture they were able to speak with the registered manager and felt listened to. However, we received a mixed response from relatives. Some felt the care met their relative’s needs, others felt the communication and care needs required some further development or direction from the management.

Staff were aware of the importance of identifying and recording any safeguarding incidents and these had been investigated. There were enough staff to meet the people’s needs and appropriate recruitment processes were in place.

The provider had notified us of any events which had occurred at the service and we saw the last inspection rating was visibly displayed within the home.

The provider had worked with relevant health care professionals and developed a positive relationship in meeting people’s needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection. The last rating for this service was Good (Published 11 February 2019)

Why we inspected

We received concerns in relation to safeguarding people and about practices in relation to Covid within the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation safe care and treatment and the governance oversight at this inspection. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection

Follow up

We will request an action plan from the provider and meet with them following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service: Osmaston Grange is registered to provide personal care, nursing care and accommodation for up to 80 people across two buildings. At the time of the inspection only one of the two buildings were open, and provided accommodation and residential care to people either on a permanent basis or for short-term care, as required. Nursing care is no longer provided at Osmaston Grange. The provider has requested that nursing care is removed from their registration. On the day of our visit 18 people were using the service.

People’s experience of using this service:

The provider had not ensured there was enough staff available at meal times, to provide the support some people needed to eat their meal in a timely way.

People were supported by staff who understood their role in protecting them from the risk of harm and safeguarding referrals were made. The risk to people of acquiring an infection were minimised by the infection control procedures in place. Individual and environmental risks were assessed and managed well and people were supported in a safe way to take their prescribed medicine. People were supported by staff who had undergone the appropriate safety checks before they commenced employment.

The meal choices available suited people’s preferences and drinks were available to people throughout the day. Assessments were completed when people were unable to make specific decisions regarding their care. This ensured people were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible. People and their representatives were involved in their care to enable them to receive support in their preferred way. People had access to healthcare services and received coordinated support, to ensure their preferences and needs were met.

Opportunities to take part in social activities were provided to promote well-being and people were supported according to their preferences. People were enabled to maintain their cultural and faith needs and were treated with consideration and respect by the staff team. People were supported to maintain relationships with their family and friends and were able to give their views about the quality of care provided, and raise any concerns about the service.

There were systems in place to monitor the quality of the service. The registered manager was passionate about continuous improvement and was working with the provider to achieve this.

More information is in the full report below.

Rating at last inspection: Requires Improvement (report published 8 September 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, although some further improvements were needed, we saw that significant improvements have been made.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This unannounced inspection took place on 11 July 2018. At the last inspection on 31 October and 16 November 2018, we placed the home in special measures and the overall rating was ‘Inadequate’. This was because the provider has failed to address risks and sustain improvements since 2016. Between 2016 and 2017, Osmaston Grange has been rated ‘Inadequate’ twice. The inspection in October 2016 identified four regulatory breaches and the service was rated ‘Inadequate’ overall. Improvements were seen at the focused inspection in February 2017, but the provider failed to sustain these improvements and at the last inspection we identified five regulatory breaches and the quality of care had deteriorated.

Since the last inspection the provider has sent us a service improvement plan. At this inspection we saw that improvements had been made but further improvements were needed. As the nursing unit was in the process of closing we focused our inspection on the residential unit. However, we spent some time on the nursing unit and our observations and the records seen on this unit are reflected within the report.

We have taken this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service. However, the service remains inadequate in well led and we need to see continued and sustainable improvements

Osmaston Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection the care was provided in two separate buildings across one floor. One building was used to support people with nursing and dementia needs. The other building provided residential care to people and some people were living with dementia. There were communal living and dining areas in both buildings.

Osmaston Grange is registered to provide accommodation and nursing care for up to 80 people. At the time of our inspection there was a total of 28 people living at the service. There were 10 people living on the nursing unit and 18 in the residential unit. The provider had decided to close the nursing and dementia unit and had served notice to people living in this building. At the time of the inspection the dementia unit had closed. Two people that had lived in the dementia unit were being supported by staff in the nursing unit until they moved.

The service had two acting managers, however neither were registered with us at the time of this inspection. 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.

Improvements had been made to the practices in place to monitor the service. However, these were not always effective. For example, the guidance in place for staff to check mattresses was not sufficient. This resulted in us identifying a soiled mattress that was in use.

Risks to the safety of people on the residential unit were managed well but improvements were needed on the nursing unit to ensure people were supported to keep safe.

Improvements were needed to ensure opportunities were provided for people to socialise and take part in activities of their choice. Improvements were needed to ensure information was provided to people in an accessible format that met their communication needs and cognitive ability.

Staff understood the importance of gaining people’s verbal consent before supporting them and helped them to make their own decisions when required. Where people were unable to make decisions; assessments were in place for most people to demonstrate this and show how decisions were made in people’s best interests. The acting manager was aware where further improvements were needed and was taking action to address this.

People were supported by staff that understood their responsibilities to report any concerns. People received support to take their medicines in a safe way. Sufficient numbers of staff were employed to meet people’s needs and recruitment procedures checked staff’s suitability to work with people.

Staff were clear about what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. People received their medicine in a safe way and when they needed it. Recruitment checks were done before staff started working at the home to check they were suitable to support people.

There was enough staff to support people in a timely way. People felt safe and staff knew about people’s support needs to enable the staff to provide this in a safe way. Staff felt supported by the management team and received the relevant training to ensure people’s needs could be met.

People were supported to eat meals that met their dietary requirements and were supported to access healthcare professionals to maintain their health and wellbeing. Staff had the equipment needed to assist people safely and the adaptation of the home enabled easy access for people.

People liked the staff and their dignity and privacy was respected by the staff team. Visitors were made welcome by approachable and friendly staff. People and their representatives were involved in decisions related to the planning of their care.

People and their representatives were supported to raise any concerns they had and were supported to express their views and opinions about the service provided.

Staff, people that used the service and their representatives all felt that improvements had and were being made to improve the quality of care provided. However sustained care and service improvements have not yet been demonstrated by the provider

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We had previously inspected Osmaston Grange on 11 & 12 October 2016; when the service was rated inadequate overall. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Repeated breaches of legal requirements were found in respect of Regulations 12 and 17. This meant the provider had continuously failed to ensure environmental cleanliness and hygiene and the effective management and oversight of the service; to ensure the quality and safety of people’s care. Warning notices were issued. Breaches of Regulations 11 and 18 were also identified. This meant people were not fully protected from the risk of unsafe or ineffective care; because the provider’s arrangements for staffing and to obtain people’s consent or appropriate authorisation for their care were insufficient. As the overall rating was 'Inadequate' the service was therefore placed in 'Special measures'.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches.

We carried out a focused inspection carried out on 27 February 2017 and 3 March 2017 to check the provider had followed their plan and to confirm they now met legal requirements. At this inspection we found sufficient improvements had been made to rectify the breaches identified during the previous comprehensive inspection. Considerable improvements were found to have been made or were in progress in relation to environmental cleanliness; hygiene and repair. We found significant improvements had also been made to the quality and safety of people’s care through revised management and staffing arrangements. Further improvements to fully embed this were either planned or in progress with reasonable timescales identified for achievement. The service was found to be no longer in breach and was rated ‘Requires improvement’ in the three areas we looked at; safe, effective and well led.

Since the last inspection concerns and safeguarding issues have been raised by relatives, health care professionals and the local authority regarding inconsistent care practices and staffing levels.

At this inspection we found significant changes since the previous inspection with the residential unit now completely separated from the nursing and dementia unit. Each unit now had an acting manager and staff team and was run totally independent of the other. Both acting managers were new in post. We saw some improvements had been made to the physical environment and infection control procedures.

However ongoing concerns were identified, particularly in the nursing and dementia unit, which included inconsistent staffing levels and issues regarding staff recruitment, retention, training and support. We also found shortfalls related to quality monitoring systems, risk management and record keeping, which included poorly maintained care plans and risk assessments.

Communication was not always effective, although the acting manager, in the nursing unit, had held a residents and relatives meeting during their first two weeks in post. Monitoring audits had not been undertaken for two months and care plans, including risk assessments had not been reviewed or updated to reflect people's changing needs. This included shortfalls in monitoring weights, fluid intake, bowel movements and positioning charts.

Accurate records were not always kept. There were gaps in records such as food, fluid and positioning charts. People were not always referred to healthcare professionals according to their individual needs. Care plans were not consistently maintained and did not always provide staff with accurate and updated information they needed to support people. We found inconsistencies in relation to where information was recorded and consequently how accessible this information was to care staff. Whilst the individual records contained care plans and risk assessments relating to all aspects of daily living, we found detailed information about how to care for people was embedded within an extensive set of paperwork and it was not clear as to what the up to date care requirements for each person were.

Although as previously documented, two acting managers had recently been appointed; there was no registered manager in post. 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.

People had not been referred to the falls team after suffering multiple falls. We saw records of treatment provided for people who had pressure ulcers did not give information whether the wounds were healing or deteriorating. Air mattresses were not set to the correct setting to be beneficial for people with pressure areas. Safeguarding referrals to the local authority were not always made.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staff did not always have the training they needed to provide appropriate support for people.

The staff did not consistently understand their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. Where people needed decisions to be made on their behalf, best interest records did not record what the decision was.

People were not always provided with personalised care and support and there was a lack of stimulation and meaningful activities.

Quality monitoring systems were inconsistent and where shortfalls in the service had been identified, actions were not always followed up to monitor improvements.

We found six breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during our inspection. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Osmaston Grange on our website at www.cqc.org.uk.

At this inspection we found sufficient improvements were made to rectify the breaches we found at our last comprehensive inspection.

Osmaston Grange provides accommodation for up to 80 older people who require nursing or personal care. This includes some people living with dementia. At the time of our inspection, there were 60 people receiving care at the service. A new manager was appointed at the home in October 2016. At the time of this inspection, their registration application to manage the regulated care and treatment activities carried on at this location, were submitted to us and subsequently approved. A registered manager is a person who has registered with the Care Quality Commission. They are responsible for the day to day management of the regulated activity of personal care at the service. Like providers, as a registered person they have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is managed and run.

Considerable improvements were made or in progress in relation to environmental cleanliness; hygiene and repair. This helped to reduce the risk of infection to people through cross contamination in a way that met with nationally recognised guidance concerned with cleanliness, infection prevention and control.

Staffing arrangements were better managed, sufficient and subject to ongoing management review. This helped to ensure people received safe and effective care. Staff were visible; they acted promptly and provided people’s care in a safe and timely manner when required.

People and relatives were more confident of people’s safety at the service and staff understood how to keep people safe there. Staff were managed, informed and supported to understand and act when required to minimise known risks to people’s safety. Related safety and reporting procedures and revised management checks, together with staff training and care planning improvements; helped to protect people from the risk of harm or abuse.

Revised staff training and knowledge checks, related care planning and management monitoring improvements; helped to ensure that staff understood and followed the Mental Capacity Act 2005 to obtain people’s consent or appropriate authorisation for their care.

Effective arrangements were in place to recognise and address staff training needs. Training was prioritised alongside identified service and care planning improvements either made or in progress. However, staff training and care planning improvements were not sufficiently embedded to continuously ensure this.

People and relatives were pleased with the standard of care provided by staff at the service and related improvements for their consultation and involvement.

People, relatives and most staff were confident in the management of the home. Staff morale and understanding of their role and responsibilities for people’s care, was considerably improved. Although lesser so in one unit of the home where people were living with dementia. Management planning and related staffing arrangements helped to fully ensure this.

Significant improvements were made to the quality and safety of people’s care through revised management and staffing arrangements. Further improvements to fully embed this were either planned or in progress with reasonable timescales identified for achievement.

Management arrangements for ongoing service monitoring and improvement planning were comprehensive and took better account of known and emerging risk indicators for people’s care. This helped to ensure people received safe, effective care that was subject to regular review and included improved consultation with people and their relatives.

Recent and past improvements to the quality and safety of people’s care were not always proactively ensured by the provider; often prompted by external agencies concerned with people’s care at Osmaston Grange. Continued and sustained care and service improvements were not yet demonstrated by the provider.

Osmaston Grange did not have a registered manager. The service is required to have a registered manager. 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 service is registered to provide accommodation and nursing care for up to 80 older people. On the first day of our inspection 68 people were using the service.

The provider did not have effective systems in place to ensure people were protected from the risks of cross infection.

Risk assessments and care plans did not always contain sufficient information to ensure people were cared for in a personalised manner. There were not always up to date and did not contain sufficient information for staff to care for people. Where care plans and risk assessments were in place, they were not always up to date or accurate and not all risks to people’s health and safety were identified and where possible reduced. People had access to healthcare services however, people sometimes experienced delays to receiving their treatment.

Audits and systems designed to check on the quality and safety of services people received were not effective at identifying shortfalls in the quality and safety of services. Records were not complete and did not accurately reflect people’s needs and wishes.

Staffing arrangements had not been calculated based on meeting the needs of people using the service. Staff were not always deployed in a manner so that people received timely support. Staff recruitment practices had not recorded how gaps in staff employment histories had been considered satisfactory. Some references had not been taken up.

The proper and safe management of medicines were followed and therefore risks associated with medicines were reduced. Records supported that people received their medicines as prescribed.

Staff training was not always up to date and therefore did not equip staff to care for people effectively. Not all staff received supervision on an individual basis and did not feel supported by the management structure in the service.

The principles of the Mental Capacity Act 2005 (MCA) were not fully understood and embedded in the service, nor had the principles of the MCA been followed for people’s decision making. The service did not assess people effectively for Deprivation of Liberty Safeguards (DoLS) applications.

People and staff did not feel listened to and we found people were not always invited to contribute to improvements at the service. Staff interactions with people were mixed. We saw some staff always spoke with people as they walked past, however other staff gave no greeting or acknowledgement to people.

Staff were not always given support when they raised issues of concern and safety. People did not have opportunities to pursue their interests and hobbies and some did not have the opportunity to take part in activities organised by the activities coordinator.

Not all people were supported to dine in a stimulating dining environment. Menu choices offered a balanced and healthy diet, however we saw not all people ate their meals and this was not always monitored effectively.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspection is added to reports after any representations and appeals have been concluded.

Osmaston Grange Care Home provides accommodation for up to 80 older people who require nursing or personal care, including some people who are living with dementia. The care home comprises of two buildings. An older type building accommodates older people who require personal care only. A newer type split level building over two floors, accommodates older people who require nursing care. This includes some people living with dementia, who are mostly accommodated on the lower floor of the unit.

There is a registered manager at this service. 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.

At our last inspection in December 2014 and January 2015, people were not fully protected from risks associated with unsafe medicines practice or insufficient staffing. This was because people’s medicines were not always being safely managed and there were not always sufficient staff to meet people’s needs. These were respective breaches of Regulations 12 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following that inspection, the provider told us what action they were going to take to rectify the breaches and at this inspection we found that improvements were made. Further improvements were in progress to help to ensure that people were consistently supported in a prompt and timely manner when they needed assistance.

At this inspection, there were 66 people accommodated at the service. This included 31 people receiving personal care who were accommodated in the older type building. In the newer build unit there were 19 people receiving nursing care and 16 people living with dementia who received personal care only.

The provider’s arrangements for the prevention and control of infection and the cleanliness and hygiene of the premises, did not fully protect people from the risks of cross contamination. This was because not all areas of the home were being kept clean and hygienic. Staff, were not provided with all of the information they needed and recognised guidance was not being followed for the prevention and control of infection at the service.

Risks to people’s safety were mostly taken into account in the planning and delivery of their care and people’s medicines needs were safely managed.

Staff did not always support people in a prompt or timely manner when they needed assistance. Action was being taken to help improve this through staff development and recruitment and other management arrangements.

Staff recruitment arrangements helped to ensure that staff, were suitable to work at the service and provide people’s care.

Emergency planning arrangements mostly helped to promote people’s safety in the event of illness or injury. The manager agreed to take action to address two areas of their policy guidance that did not fully inform staff, to show related emergency procedures.

Staff followed the Mental Capacity Act 2005 MCA to obtain consent or appropriate authorisation for people’s care. However, processes were not always checked for recorded decisions made by external medical professionals about people’s care and treatment at the service to make sure these were valid. The manager agreed to take action to address this.

Overall, staff understood people’s health and nutritional needs and supported them to maintain and improve this. People’s associated care plans records mostly but not always provided staff with accurate information about this for them to follow.

People were supported to access external health professionals when they needed to and staff usually followed their instructions for people’s care. Action was taken to improve communications where delays had occurred to help ensure that care instructions from external health professionals were followed in a timely way.

People received adequate nutrition, which usually matched their dietary requirements and recorded preferences. People’s dietary needs were assessed and regularly reviewed but not always accurately recorded.

Staff understood risks to people from malnutrition and the actions they needed to take to mitigate this and catering staff mostly understood people’s dietary requirements. We recommended additional education is provided for staff in relation to nutritional risk assessment and food fortification.

Overall, staff received the training and support they needed to provide people’s care. Revised supervision and induction arrangements were determined to address identified gaps.

People had good relationships with staff that were kind and caring. Staff treated people with respect and promoted their rights and choices in care. People and their relatives were informed and involved in the care provided and made welcome in the home.

Staff, were generally helpful and often, but not always observant of people’s needs or prompt to provide people with general personal assistance when they needed it. Staff acted promptly to seek advice when people’s medical or health needs changed.

Staff understood people’s communication needs and often but not always encouraged and supported people to be as independent as they could be.

People’s care was often personalised and staff mostly understood people’s preferred personal care and daily living routines. People were often but not always supported to follow their interests and engage in their preferred social and recreational activities and staff were often not always fully informed to support this.

People were confident to raise any concerns about their care, but not accurately informed to make a formal complaint if they needed to. Records showed some changes were made from complaints to help improve communication and personal care systems.

The provider’s arrangements to respond to important events at the service and to check the quality and safety of people’s care were not effective. This was because as they were not always proactive or consistent to determine any service improvements that may be needed.

The provider’s arrangements to obtain formal and confidential feedback from people, relatives and visiting professionals were not being followed to help inform and improve the quality of care provision at the service.

People, relatives and staff felt the new manager was approachable and listened to their views and suggestions about people’s care.

Staff mostly understood their roles and responsibilities for people’s care. Recent management instructions about expected care standards and some improvements needed helped to make sure that staff fully understood this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At our last visit we identified that thorough checks on staff's previous employment were not fully explored and recorded, before they began working at the home. The provider has now ensured that full employment histories and any gaps in employment are recorded.

At our last visit we identified several occasions when the numbers of staff on duty were not always sufficient to meet people's needs on an on-going basis. At this visit staffing rotas, discussions with staff, people using the service and their visitors confirmed that the correct staffing levels were in place to support people effectively. One person told us, 'yes, there does seem to be more staff around and they are all very nice.' A visitor told us, 'there has been a big improvement in the last month, I think there is enough staff now, my mother is looked after very well and the new non clinical manager is very good, always available for a chat.'

At our last visit we observed some practices that demonstrated that people's dignity, comfort or safety was not always considered. At this visit we did not identify any of these practices. We observed staff ensuring that people's comfort, dignity and safety was maintained.

Improvements had been made to determine the numbers of staff needed to support people effectively, however the numbers of staff required to achieve this were not always available. Evidence from staffing rotas and discussions with people using the service and their relatives indicated that there had been some improvements. However there were several occasions when the numbers of staff on duty were not always sufficient to meet people's needs on an on-going basis, people gave us examples of how this had impacted on care practices.

All of the areas for repair that were identified at our last visit in April 2013 had been completed. Areas, such as an unused bathrooms and the lift, which were being used inappropriately for storage had been cleared. Part of the communal lounge in the residential unit had been redecorated.

Thorough checks on staff's previous employment was not fully explored and recorded, before they began working at the home.

All of the people we spoke with told us they were happy with the care provided, they told us staff were nice, very helpful and caring.

We observed that staff were generally attentive to people's individual needs but found there was a lack of attention to detail in some instances. This meant that people's dignity, comfort or safety was not always considered; for example, the brakes on wheelchairs were not used consistently when people were stationary, several people were left sitting in basic manual wheelchairs for long periods of time. Meal trays were not always placed in the best position to enable people to eat and drink easily and people's appearance was not always considered to ensure their dignity was maintained.

Discussions with people using the service, relatives and visiting professionals indicated that the numbers of staff on duty were not always sufficient to meet people's needs on an ongoing basis and this had impacted on care practices.

Several areas of the home were in need of repair, although some of these were being addressed at the time of our visit. Some areas, such as unused bathrooms and the lift were being used inappropriately for storage and other areas seen appeared worn or neglected.

A compliance action was left at our last visit which related to staff training. At this visit staff were up to date in mandatory training.

A compliance action was left at our last visit. This was because capacity assessments for people were not in place to ensure their safety when they were unable to make an informed decision for themselves, about an aspect of their life. At this visit capacity assessments were in place. These assessments demonstrated that people's level of understanding in making day to day decisions and the support they needed to make those decisions was clearly recorded.