CQC report explained · a nursing home
What the CQC found at Osmaston Grange
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found unsafe medicine management, incomplete fire evacuation records and care plans that were not always followed. Infection control had improved and there were enough staff to meet people's needs.
- Effective?
- Requires improvement
- This question was not assessed during this focused inspection. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This question was not assessed during this focused inspection. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not assessed during this focused inspection. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- Management systems and audits did not consistently identify or prevent problems. Information about incidents was not always shared, and staff had not received training on supporting people whose behaviour challenged.
What inspectors found, January 2022
Rated Requires Improvement; inspectors found caring staff and enough staff, but medicines, fire safety and management checks were not consistently safe.
This was an unannounced focused inspection on 14 December 2021. Inspectors checked the Safe and Well-led areas, spoke with people, relatives and staff, and reviewed care, medicines, staffing and management records.
The home had enough staff and relatives were generally positive about the care. Inspectors also found improvements in infection control and the environment. Staff understood how to report safeguarding concerns, and concerns raised had been investigated.
However, one person had missed pain medicine for three weeks. Some medicines lacked clear instructions, fire evacuation records were incomplete, and care plans were not always followed. Management audits had not consistently found these problems, and information about incidents was not always passed on.
The overall rating remains Requires Improvement. Safe and Well-led were both rated Requires Improvement. This was a focused inspection, so the other three question ratings were carried over from the previous comprehensive inspection.
Enough staff
Inspectors found there were enough staff for people's current needs. Recruitment checks were also completed before staff started work.
“There were enough staff to meet people's needs.” from the report
Improved infection control
The home had improved its infection prevention and control arrangements since the previous inspection. Inspectors were assured about admission procedures, PPE, testing, hygiene and visits.
“At this inspection we saw improvements had been made.” from the report
Safeguarding
Staff understood how to report safeguarding concerns. Concerns that had been raised were investigated and shared with staff.
“When safeguards had been raised these had been investigated and shared with the staff.” from the report
Kind relationships
Inspectors saw friendly interactions between people and staff. Relatives described staff as kind, caring and responsive.
“There was a relaxed friendly feel at the service, we saw people and staff reflecting their relationships with friendly greetings and understanding people's needs.” from the report
Missed and unclear medicines
seriousOne person did not receive pain medicine for three weeks. Some as-required medicines did not have clear instructions, and the process for giving medicines covertly did not consider their effect when mixed with different foods.
“We found one person had not received their pain medicine for three weeks, the person was unable to express their discomfort and could have been in pain during this period.” from the report
Fire evacuation records
seriousTwo people did not have personal emergency evacuation plans, while another plan related to someone who no longer used the service. This could affect a safe evacuation.
“We found two people living in the home did not have a personal emergency evacuation plan, and another person no longer used the service.” from the report
Weak management checks
needs fixingAudits did not always identify problems with medicines or daily environmental checks. The home did not have a reliable ongoing system to make sure lessons were learned.
“Audits had been completed; however, they had not always identified all the areas which needed addressing to ensure people safety.” from the report
Incomplete incident handovers
needs fixingHandover records did not include all falls and incidents on a specific date. This could mean people did not receive the checks or support they needed afterwards.
“We reviewed the handover documentation and found not all the required information had been shared.” from the report
Missing behaviour-support training
needs fixingSome staff said they needed training to support people whose behaviour challenged. This training had not been provided.
“We found this training had not been made available and some staff felt this training was needed to ensure the required support was being provided for some people using the service.” from the report
- 01What checks now make sure every person receives their medicines as prescribed, including pain relief and as-required medicines?
- 02Do all current residents now have up-to-date personal emergency evacuation plans?
- 03How do managers check that care plans are followed and that problems found in audits do not happen again?
- 04How are falls, incidents and follow-up checks recorded and handed over between shifts?
- 05When will staff receive training to support people whose behaviour challenges?
This was a focused inspection of Safe and Well-led, mainly checking previous concerns about infection control and the environment; the other three question ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 20 January 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2021
Rated Requires Improvement; inspectors found ongoing risks in care planning, medicines, infection control and management oversight.
This was an unannounced focused inspection on 2 March 2021. Inspectors looked at Safe and Well-led, reviewed care, medicine and management records, spoke with people and staff, and contacted relatives after the visit.
The home had not made enough improvement since the previous inspection. Care plans and risk assessments did not always reflect people's current needs. Inspectors also found medicine stock errors, gaps in cleaning and hand hygiene supplies, and staffing arrangements that did not always meet people's needs.
The home's systems for checking quality had not found or fixed several problems. The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement, while the other question ratings were carried over from the previous comprehensive inspection.
Safeguarding awareness
Staff had received safeguarding training and understood the importance of raising concerns. They said they felt confident to do so.
“Staff we spoke with were aware of the importance of raising concerns and felt confident to do so.” from the report
Working with professionals
The home maintained relationships with health and social care professionals during the COVID-19 period. Referrals were made when people needed additional support.
“Relationships with health and social care staff had been maintained throughout the COVID-19 period.” from the report
Some medicines controls
Although medicine records and stock checks remained a concern, temperatures in the medicine room and fridge were recorded.
“Temperatures had been recorded to ensure the medicine room and fridge were kept at the required temperatures to maintain medicine integrity.” from the report
Care plans and risk assessments
seriousCare plans were not always updated when people's needs changed, and some health risks had no assessment or clear actions. Inspectors said this meant people could be at increased risk of harm.
“Risk assessments were not always in place, these related to people's individual health care needs, for example pressure care or diabetes.” from the report
Medicines records
seriousMedicine stock discrepancies had continued from the previous inspection. Records did not always show clearly whether people had received their prescribed medicines.
“This meant we could not be assured that people had received their prescribed medicine as recorded in the medicine administration records.” from the report
Infection control and equipment
seriousSome pressure equipment and high-touch areas were not cleaned as required. Hand hygiene supplies were sometimes empty, and one walking aid still had dirt on it after cleaning.
“We identified pressure cushions and mattresses which had not been routinely cleaned as per the cleaning schedules.” from the report
Staffing and deployment
needs fixingThere were not always enough staff in the right places to meet people's needs. Some night shifts were not fully covered at the level identified by the home's dependency tool.
“We saw how one person was delayed in receiving the help they required.” from the report
Weak quality checks
needs fixingAudits had not found several problems, including infection control issues, equipment concerns and continuing medicine stock errors. Improvement plans did not always include timescales.
“Audits had been completed; however, they had not always identified the areas which required improvement.” from the report
Limited activities
minorInspectors saw little meaningful activity or stimulation during the visit. Several people stayed in their rooms and were mainly seen for personal care.
“We observed people had not been supported with meaningful activities during our inspection.” from the report
- 01How are you now making sure care plans and risk assessments are updated when a person's needs change?
- 02What checks now prevent medicine stock errors and confirm that prescribed medicines have been given?
- 03How do you ensure pressure equipment, high-touch areas and other equipment are cleaned and maintained?
- 04How do you cover shifts when the planned staffing level is not met, especially at night?
- 05What action has been taken in response to staff concerns about teamwork, communication and the open culture?
This was a focused inspection of Safe and Well-led only; the other ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 4 June 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Osmaston Grange
10 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- January 2022Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- October 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- February 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- September 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- February 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- July 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- April 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- June 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- February 2011
Registered with the Care Quality Commission on 3 February 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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