Osborne Grove Nursing Home is owned and managed by Haringey Council providing nursing care to up to 32 people. The home is divided into four units Lavender, Carnation, Snowdrop and Magnolia, and arranged on two floors. At the time of our inspection, six people were using the service.

At our comprehensive inspection in December 2016 we found the service in breach of seven legal requirements. We took enforcement action against the provider and served four warning notices in respect of safe care and treatment, meeting nutritional and hydration needs, person centred care and good governance. We also issued three requirement notices in relation to consent, staffing and submitting notifications. We carried out a focused inspection in March 2017 and found the provider had not made sufficient improvements to fully meet the warning notices. We served four more warning notices and the home was placed in to Special Measures and rated Inadequate.

At our last comprehensive inspection in July 2017 we found the provider had made significant improvements since our last inspection and had complied with three of the four warning notices we had served. The service was taken out of special measures. There had been improvements in safe care and treatment, meeting nutritional and hydration needs, and good governance. However, a warning notice regarding person centred care was not met due to a lack of activities on offer for people and lack of choice in having baths and showers. We rated the service as Requires Improvement.

The provider sent us a service improvement plan detailing how they would make the necessary improvements to the service.

At this inspection we found that the provider had made some improvements, however, this was not enough for them to be rated overall ‘Good.’ This is the third consecutive time the service has been rated Requires Improvement or Inadequate.

There is a 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 using the service had complex needs and were not able to tell us their experience of using the service. Relatives told us that people using the service were safe. People were protected from the risk of abuse. Staff knew what constituted abuse and understood their responsibility to report abuse. Staff were aware of the whistleblowing procedure and reporting any concerns to external authorities.

Risk assessments documented areas of individual risks, however, how to mitigate these risks was not always documented. Nevertheless, staff understood about risk management and how to manage risks posed by people using the service. The provider followed safe recruitment practices. There were sufficient staff on duty to meet people’s needs.

Systems were in place to manage and administer medicines, including individual ‘as and when required’ protocols. However, we found medicine administration record charts were not always completed accurately. People were not always protected from the risk of the spread of infection. Infection control procedures were in place and staff were provided with the necessary personal protective equipment. However, we found staff did not always follow appropriate. infection control procedures.

There were systems in place for reporting and recording incidents and accidents and learning from incidents took place. Safety checks were carried out to ensure the building and equipment used to carry out care was safe for people using the service.

Staff received regular supervision and an appraisal, which included a review of their performance and training needs and setting of objectives for the coming year. Staff received training relevant to their role.

People’s nutrition and

The last comprehensive inspection of this service was on 6 and 7 December 2016. At that time, we found breaches of seven legal requirements. We served four enforcement warning notices on the provider, London Borough of Haringey. These were in respect of safe care and treatment, meeting nutritional and hydration needs, person centred care and good governance. We gave three requirement notices for the other breaches which were regarding consent, staffing and making notifications to us. We then carried out a focused inspection on 22 and 30 March 2017 to check whether the provider was compliant with the four warning notices. We found not enough improvements had been made and none of the warning notices had been fully met. We served four more warning notices and placed the home in Special Measures.

This inspection was an unannounced comprehensive inspection and took place on 26 and 27 July 2017. Osborne Grove Nursing Home is registered to provide accommodation and personal and nursing care for up to 32 people. The home is run by the London Borough of Haringey. There were 17 people living at the home at the time of this inspection. No further admissions were planned at the time of the inspection.

There was 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.

At this inspection, we found the provider had made significant improvements since our last inspection and had complied with three of the four warning notices we had served. There had been improvements in safe care and treatment, meeting nutritional and hydration needs, and good governance. A warning notice regarding person centred care was not met due to a lack of activities on offer for people and lack of choice in having baths and showers. We found some improvements had been made in these areas but the warning notice was not fully complied with. More people were now supported to have a bath or shower and the provider had bought specialist equipment to enable others to use the shower safely which they planned would happen soon after our inspection. The range of activities in the home was limited but the activities coordinators spent time with individual people each day reading, giving hand massages or chatting to them which was positive for people’s wellbeing. The manager had introduced trips out at the weekend which people said they appreciated. Small groups had been out to places such as Epping Forest, local parks and the Princess Diana memorial.

The standard of care had improved and the oversight of care by the management team had also improved. They had introduced care records in people’s rooms so staff could record the care they had given a person (for example, supporting them to wash, have a drink, change position) at the time they gave the care. Nurses and the management team checked the care records daily. This meant that record keeping was better and the management team could pick up any problems promptly. This reduced the risk of people becoming constipated, dehydrated or sustaining a pressure ulcer as those aspects of care were monitored daily.

There had been improvements in the management of medicines. We made two recommendations about storing medicines at a safe temperature and reviewing written guidelines for medicines that were taken as and when required, to ensure staff knew exactly when a person needed the medicine and what dose.

The provider had bought new equipment to help them provide safer care. People who were at risk of pressure ulcers had the appropriate beds and pressure relieving mattresses and personalised chairs to help support them to sit safely.

The provider had increased staffing levels and support and supervision given to

Prior to this inspection, we carried out an unannounced comprehensive inspection of this service on 6 and 7 December 2016. At that time, we found breaches of seven legal requirements. We rated the service as ‘Requires Improvement’ and we served four enforcement warning notices on the provider, London Borough of Haringey. These were in respect of safe care and treatment, meeting nutritional and hydration needs, person centred care and good governance. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We carried out this focused inspection on 22 and 30 March 2017 to check that the provider had followed their action plan and to confirm that they now met the legal requirements relating to the four warning notices.

This report only covers our findings in relation to the four warning notices. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Osborne Grove Nursing Home on our website at www.cqc.org.uk.

Osborne Grove Nursing Home is registered to provide accommodation and personal and nursing care for up to 32 people. The home is run by the London Borough of Haringey. There were 19 people using the service at the time of this inspection. Commissioners had imposed an embargo on new people moving into the home due to concerns about the quality of care provided until improvements were made. No further admissions were planned at the time of the inspection.

There was a registered manager but they had been on extended leave since 1 December 2016. 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 temporary manager at our last inspection on 6 and 7 December 2016 had left as had their line manager. A new management team had been in place for a few weeks at the time of this inspection. The new manager had been in post since January 2017 and was applying for registration. A deputy manager had been in post since December 2016 and a nurse consultant to oversee the management of the home since February 2017.

At this inspection, we found that the provider remained in breach of legal requirements relating to safe care and treatment, meeting nutritional and hydration needs, person centred care and good governance, despite some evidence of addressing matters relating to our warning notices. None of the warning notices were fully complied with.

We found care plans had improved but records of care provided showed that care was not always provided in accordance with the person’s care plan. One example of this was “turning charts”. Where a person’s care plan stated that they were at high risk of pressure ulcers and should be supported to change position or “turn” every two or four hours, charts showed this was not always carried out. There was insufficient evidence that some people at high risk of developing pressure ulcers were supported to change position regularly, especially at night, in accordance with their plan of care.

Two people had care plans stating that they needed to take prescribed food supplements and be offered snacks between meals as there were concerns about weight loss. The food/fluid records showed that they were not always offered these.

Moving and handling equipment to help staff move people who were unable to get up by themselves had improved since the last inspection as staff had attended further training in using the hoists safely and each person had their own named sling for use with the hoist which improved safety and reduced infection control risk. However pressure relieving mattresses to reduce the risks of people sustaining pressure ulcers were not in good condition. There were no records of staff checking th

This inspection took place on 6 and 7 December 2016 and was unannounced. The inspection was prompted in part by notification of an incident where a person sustained an injury and information that moving and handling equipment had been out of use for twenty days. The information about the incident indicated potential concerns about the management of the risk of falls from moving and handling equipment. This inspection examined those risks.

The previous inspection was in November 2015 and at that time all legal requirements were met. We made recommendations at the previous inspection to improve care plans, activities and

stimulation for people living at the home to ensure that people’s needs were met proactively and

responsively. There had been some improvement since that inspection but not enough to ensure people’s needs were always met.

Osborne Grove Nursing Home is registered to provide accommodation and nursing care for up to 32 older people. The home had a registered manager in place however they were on extended leave 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. An interim manager started the day before the inspection. This person had worked at the home for several weeks in a different capacity so had some knowledge of it. There was also a “supporting manager” who was working at the home temporarily to assist with a plan of improvements.

At the time of this inspection there were 24 people living at Osborne Grove in three eight-bedded units. The fourth eight-bed unit was closed and no further admissions were planned at the time of the inspection.

People living in the home told us they were happy with the care and had good relationships with the staff. The visitors we met were generally happy with the care too.

People said staff were friendly and polite and they felt well looked after. There was mixed feedback about the food; some said it was good and others said it lacked variety. We also found a lack of choice, and people who were supposed to have fortified meals and extra snacks were not always receiving these.

Most people said they had nothing to occupy them during the day though some were happy to stay in their rooms. We found there was a lack of activities and opportunity to go out for people. There was a full-time activities coordinator but the provider had used them for other duties. They were returning to their full-time role at the time of the inspection.

The moving and handling equipment (hoists) had been out of action for twenty days just prior to the inspection. The equipment had been checked for safety and was working and in use at the time of the inspection but most people had to stay in bed for twenty days which contributed to one person developing a pressure ulcer. Appropriate action had been taken relating to the accident using a hoist to prevent a similar accident happening.

There were breaches of seven regulations at this inspection. This was because we found improvements were needed in the areas of medicines, equipment, food, assessing mental capacity, support for staff, governance of the service, person-centred care, and making notifications to us. You can see what action we told the provider to take at the back of the full version of the report.

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective.

On the day of the inspection there were thirty people living at the home (two vacancies). We spoke to twelve people using the service, five relatives visiting the home, the manager and nine staff members, and looked at five people’s care records. We spent time in each of the home’s four units, which each included eight single en suite bedrooms, a kitchenette lounge and diner, and adapted bathrooms and toilets.

All of the people we spoke to told us that they were happy living there, and that they were treated with respect by staff. People told us “It’s the best home for miles,” and “they get very good care here.” They advised that they were “treated with respect,” and given choices about their care. Visitors said that they were kept informed about their relatives’ health, and that any issues of concern were dealt with appropriately.

We observed many examples of staff supporting people in a friendly and professional way that respected their dignity. People were happy with the food provided to them at the home. Detailed records were kept regarding people’s needs, and support provided to address nutritional requirements. These were stored securely as appropriate.

On the morning of our visit, the home had been unusually short staffed due to short notice sickness, however additional staff arrived before lunchtime. Despite the shortage, we saw staff supporting people calmly and patiently. Staff and people living at the home indicated that there were usually sufficient appropriately trained staff to meet people’s needs effectively.

People told us that they felt safe at the home, and the home had effective systems in place to ensure that people were protected from abuse.

We talked to people living in the home and spent time observing the care and lifestyle that people experience. Overall the feedback was that people are provided with the care that they need, and are well settled in the home. They are given choices and have formed good and supportive relationships with staff.

People were very positive about the support provided by staff at the home, with comments including ‘it’s really good - marvellous,’ ‘I never get bored,’ ‘there are always enough staff,’ and ‘I love the food.’ Most people liked the food, however some would benefit from access to a pictorial menu when making meal choices.

The home has a good track record of preventing and treating pressure sores, but people would benefit from more rigorous recording of progress made with treatments. People said that staff asked them what their needs and wishes were, and met these as far as possible. They confirmed that they received their medication at the prescribed times, and that they saw healthcare professionals when needed.

A variety of activities were available both within and outside of the home, and people were satisfied with these. They were clear about who they could speak to if they had a complaint or felt at risk of harm. Appropriate quality control procedures are in place for the home so that people know that their views are taken into account.

This inspection took place on 4 and 25 November 2015 and was unannounced which meant that nobody at the home knew about the visit in advance.

Osborne Grove Nursing Home is registered to provide accommodation and nursing care for up to 32 older people. The home had a registered manager in place however they were on extended leave. 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. An interim manager starting in August 2015 was in place at the home to cover the registered manager position.

The future of the home was uncertain during the first day of our inspection, as a decision was awaited about whether the provider would continue to run the service, and whether it might take on a more rehabilitative role. It was therefore a difficult time for people living at the home, their relatives and staff. Despite this we found a pleasant and relaxed atmosphere in the home, with staff providing a high standard of care.

We found that there were some shortfalls in how up to date people’s care plans were and the recording of care provided to them. There was also room for improvement in the activities provided to people and encouragement for people to get out of bed during the day.

Staff were available to meet people's health and care needs. People spoke highly of the care and treatment that they or their relatives received, and we observed that people’s privacy and dignity was protected effectively. Their consent was sought before care or treatment was provided, and they were consulted about the way the service was run. Where people were unable to go out without supervision and could not consent to this, appropriate legal procedures were followed. We observed patient and caring interactions from staff working with people during our visit.

People were satisfied with the food provided at the home and the support they received in this area. Medicines were stored and administered safely by trained staff. Risks to people were assessed, with plans in place to keep them safe from identified risks including the risk of abuse. The home was kept clean and tidy with infection control procedures followed.

Staff understood people’s likes and dislikes regarding their care and treatment. People using the service, relatives and staff said the interim manager was approachable and supportive. Systems were in place to monitor the quality of the service .People and their relatives felt confident to express any concerns, so these could be addressed. There were areas requiring refurbishment in the home including some bathrooms and kitchenettes.

Staff said that they received good support from the home’s management, and they had regular supervision and appraisal sessions and attended regular team meetings. They spoke highly of the training provided by the provider organisation. Safe recruitment systems were in place to ensure that fit and proper staff were employed within the home.