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 decision

This inspection took place on 31 October and 16 November 2017 and was unannounced. The service was registered to provide accommodation and nursing care for up to 80 older people. On the first day of our inspection 57 people were using the service.

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 i

We carried out an unannounced comprehensive inspection of this service on 12 October 2016. Repeated breaches of legal requirements were found in respect of Regulations 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The 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. We subsequently issued the provider with warning notices for the breaches, which told them they were required to become compliant and by when. At our comprehensive inspection we also found breaches of Regulations 11 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. 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.

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.

This inspection took place on 11 & 12 October 2016. The first day was unannounced.

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 s

This inspection was unannounced and took place on the 9 and 16 February 2016.

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

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

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.”

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

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.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

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.

This was a focused visit to check if the compliance actions made following our previous visit in June 2012 had been addressed. Therefore we did not speak to people using the service at this visit. People that we spoke with at our visit in June 2012 confirmed that they were happy with the support and services provided to them.

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.

One person we spoke with said, “I haven’t been here very long but so far the staff seem very polite and friendly.” This person confirmed that staff had asked them about their preferences regarding food and interests they had.

Another person told us,” the staff are very good, they look after me well, they all seem very nice.”

Visitors told us that the staff contacted them if there were any issues or concerns with their relative’s health. One visitor said, “staff ring me if there is anything wrong and keep me updated. I don’t need to keep coming too much, I feel that x is safe here.” Another visitor told us,” I’m very happy with the care provided, I can always speak to staff if I have any concerns, or they ring me if x is unwell.”

Comments regarding the staff team included, “I think they do a very good job.” And “staff here are excellent, I can’t fault them.”

Visitors told us, “if we had any problems we’d speak to the manager, but we don’t, we are kept up to date and informed about everything.”

Osmaston Grange is situated in Belper in Derbyshire. The service is provided within two separate buildings. The older building is used for residential care for up to 40 older people. The new building accommodates up to 24 people with nursing needs on the upper floor and up to 11 people with dementia on the lower floor. A total number of 80 people can be accommodated at this service. On the day of our inspection a total of 66 people were in receipt of care at Osmaston Grange.

A registered manager was 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.

We found that there was not always enough staff available to meet people’s needs and individual preferences.

Systems in place had not identified what staff needed to do when medicines were found to be out of stock. This meant that people were at risk of not being given specific medicines such as pain relief when they needed it.

People and their relatives told us that people were safe at Osmaston Grange and were protected from abuse. Staff had a good understanding of how to protect people.

We found safe recruitment practices were in place to protect people using the service from unsuitable staff and training was provided so that staff were able to improve their knowledge and skills to provide care for people.

People and their representatives were involved in issues of consent and for people who lacked mental capacity under the Mental Capacity Act 2005 and Deprivation of Liberty; measures were being put into place to ensure that the appropriate legal requirements were being applied. Staff demonstrated an understanding of the relevant requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. This is a law that protects people’s right to consent to care and treatment and to their freedom.

People told us that they received care provided by staff that were kind to them and knew their individual needs well. We saw that people were supported to make decisions about their care and welfare because their risks were identified, managed and reviewed. People were provided with an individual care plan which set out their care needs. We saw people and their families were involved in their care planning and when people were unwell healthcare professionals including community nurses, hearing specialists and doctors were contacted. Staff understood people’s support needs.

During the meal time we found that staff supported people according to their needs. People were provided with sufficient food and drink to meet their nutrition and hydration needs.

People told us that they knew how to raise any concerns they had and a complaints policy was in place. We saw complaints were investigated and recorded with actions taken where necessary.

The registered manager communicated with people using the service their visitors and family members. Staff received communications through staff meetings, supervisions and daily contact with the registered manager. A quality assurance system was in place to monitor the care provided at the service although staff told us that they did not always feel supported.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.