Background: Patient safety culture (PSC) is a cornerstone of ensuring care without harm, most notably in nursing homes whose residents are the most fragile because of old age, chronic conditions, and temporality. In rural districts such as Osmanabad, PSC encounters a variety of challenges, including resource scarcity, lack of adequate staff, and diverse sociocultural norms that may determine the way care is provided. Objectives: This study aims to describe the perceptions and practices of staff in nursing homes in Osmanabad concerning PSC, to determine systemic, infrastructure, and interpersonal factors that impact safety, and the extent to which cultural competence and family involvement impact communication and reporting. Method: A qualitative, phenomenological design was employed in four nursing homes in Osmanabad. A purposive sample of 70 respondents, who consisted of registered nurses, nursing aides, and administrators, was recruited. The collection of data involved three methods: semi-structured interviews, non-participant observations, and document review. Analysis was based on open and axial coding using NVivo to thematise coding. A member checking process was used to verify the accuracy and authenticity of emerging themes. Results: Four overarching themes were identified: (1) deficiencies in safety awareness and training, with staff heavily reliant on peer-led learning; (2) infrastructure constraints including shortages of equipment and poor maintenance; (3) communication barriers, including fear of blame and limited incident reporting; and (4) cultural challenges, where language and traditional beliefs impacted on provision of standardized care. The role of the family as an informal caregiver had a mixed effect, influencing safety outcomes positively and negatively. Conclusions: Enhancing PSC in the nursing homes of Osmanabad would require a multi-pronged strategy – robust safety education, effective infrastructure, non-punitive reporting systems, and culturally sensitive care methods. Such interventions are essential to closing the gap between formal procedures and human elements in rural LTC, and to safeguard older adults in rural, underserved settings.