Old School House

Old School House is a residential care home providing personal care up to 12 older adults. At the time of the inspection 11 people lived at the home. The care home is located in a period property over two floors, the original building had an extension some years ago. People had access to a lounge, dining area and could freely access a secure garden.

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

People and their relatives told us they were looked after by staff who were kind and caring. Comments included, “My mother's general hygiene and appearance has always been of a high standard and meals are good, wholesome and freshly made” and “My mother has been happy and very well cared for.”

People and their relatives told us the service was well-led. However, we found the registered manager did not always notify us of events they were legally required to. Relatives told us the registered manager was approachable. Comments included I find the staff and management very open and straightforward.” One relative told us “If someone was to ask my recommendations for the old school house, I would not hesitate to recommend it.”

People were supported with the prescribed medicine by staff who had received training to complete this safely. However, we found some records relating to medicine were not in line with national guidelines. Some medicine did not have opening dates recorded and some medicine were returned to the pharmacy when still prescribed. We have made a recommendation about these in the report.

People were supported to have maximum choice and control of their lives. However, staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not routinely support this practice. The service completed mental capacity assessments on people. However, they were not always based on a specific decision. Two people were subject to restrictive measures and did not have a specific capacity assessment completed for this. We have made a recommendation about this in the report.

People had care plans in place. Care plan provided guidance for staff on how a person would like to be supported. However, although care plans were reviewed on a monthly basis. We found they did not routinely reflect people’s current needs. We have made a recommendation about this in the report.

People told us “I could not be looked after better,” “They [Staff] are all pleasant” and “I like it here anyhow, friendly place, food is good.” People’s relatives told us “The staff are always welcoming and friendly and have a genuine care for the residents.”

People were protected from avoidable harm. Risk assessments were in place for risk of falls, fire and pressure damage.

People were supported to engage in activities which they enjoyed. The service had forged links with the local community and people looked forward to visits from school children.

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 2 July October 2018).

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 some improvement had been made. However, we found the provider was still in breach of regulations.

This is the second consecutive time the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

Enforcement

We have identified a breach of regulation in relation to information the provider is legally required to inform us about.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

We previously inspected the service on the 19 and 20 October 2016. The service was rated Good at the time. However, the provider was failing to support people in line with the Deprivation of Liberty safeguards (DoLS). We found a breach of the Regulations of the Health and Social Care Act 2008. We asked the provider to complete an action plan to show what they would do and by when to improve the key question, Effective to at least good. At this inspection we found improvements had been made.

Old School House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection ten older adults lived at the home.

The service had 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.

Providers have responsibilities to ensure buildings and premises are safe for people to reside in. We found gaps in some of the required checks to manage and control the risk of Legionella. On the day of the inspection we found some remedial actions were required to ensure bathroom and toilet areas could be cleaned effectively. At the time of our inspection no call bell system was working. One person had been distressed by the delay in staff attending to their needs as a result.

Care providers should ensure medicines are stored within manufactures guidelines. Medicines which require refrigeration need to be kept between a specific temperature range. The records maintained about fridge temperatures did not always demonstrate this was the case. We have made a recommendation about this in the report.

Throughout the inspection we asked to look at documents which could support compliance with the Regulations of the Health and Social Care Act. We found some documents were not available on the day and gaps in record keeping. A number of issues had been highlighted to the registered manager; however, they were unable to provide us with evidence of remedial action taken. For instance, an electrician had issued an unsatisfactory report in November 2017 and no action had been taken.

We found the Old School House presented a homely environment to people. We received lots of positive feedback from people living at the home and their relatives. Comments included “It’s fantastic,” “The staff are very caring and I could not ask for better,” “We are so lucky here,” “Everyone [Care workers] are so good here.”

People were looked after by staff who knew how to support them in a dignified manner. Staff had good knowledge of people, their likes and dislikes. A relative told us “The staff treat the residents with dignity and there is a lot of warmth and laughter between residents and staff.”

People had access to meaningful activities. When day trips were organised family members were always invited. There was a wide range of activities for people to join in with. People who choose to stay in their room had one to one sessions with activity staff.

People and their relatives were involved in decisions about the care. Staff knew how to support people made decisions and encouraged independence.

Staff felt supported by the registered manager and relatives told us “The team is well led.” A relative told us “The home is superbly run by [Name of registered manager] and her team, nothing is too much trouble and I am always made immediately aware if any member of the team have any concerns relating to my Mum.”

You can see what action we told the provider to take at the back of the full version of the report.

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 was last inspected in December 2013 where it was found to be fully compliant with the regulations. This is the first inspection and rating of the location under the Health and social Care Act 200 (Regulated Activities) Regulations 2014.

People’s feedback regarding the home was complimentary. One person told us, “I like the whole atmosphere, I would rather be here than anywhere else”. We saw people were treated with compassion and respect. The registered manager provided effective leadership to the service and held regular residents’ meetings to ensure people were involved in the running of the home. Staff we spoke with told us the manager was fair and supportive.

People were safeguarded from abuse and neglect. Staff had received training in safeguarding and told us they would not hesitate to report any concerns regarding people’s care.

Risk assessments were in place, where risks were identified these were followed through in people’s care plans. One person we spoke with could not remember being involved in their care plan reviews. Whereas another person said ‘very occasionally I have seen it’. One family member said she had been consulted about their relative’s care plan when they were first admitted to the home. However, they had not had any reviews since then.

Activities were planned and people were encouraged to participate either in groups or on a one to one basis. One person told us that they preferred reading and sometimes the activity coordinator read to them. We found care was person-centred; people were involved in activities or spending time on a task as they wished. We observed one person busy knitting in their room. One person commented in the residents’ meeting how they had made many new friends and they enjoyed the activities especially playing cards and bingo.

The atmosphere in the home was homely and welcoming. One person we spoke with told us, “I looked at other homes but they were so big, this one is small which suits me.”

There were systems in place for monitoring and auditing to enable improvements in the quality of care. For example audits were carried out for care planning, catering, medicines, infection control and accidents.

The service had not complied with the Mental Capacity Act 2005. This was evidenced by lack of completed mental capacity assessments and records of best interest decision making and deprivation of liberty. Where people lacked mental capacity to make informed decisions, or give consent, the service did not act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice. Discussions about consent were not held in a way that met people’s communication needs. We discussed this with the registered manager and they told us they would endeavour to address this.

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

We heard that people understood the care and treatment available to them, and had their views and experiences taken into account. Residents were encouraged to make decisions about their lives, and that was demonstrated by information in the care plans we read.

We saw many social interactions between the staff and the people who lived there. It was a friendly and calm environment where people were encouraged to do as much or as little as they chose.

People felt that they were looked after by staff who had received appropriate training and guidance to enable them to deliver a high standard of care.

All records we requested were immediately available, filed neatly and accurately. Records were dated and signed as required. People could be assured that necessary information could be found quickly if necessary.

We were told meals were excellent, portions were sufficient, and other food choices were available if they did not the want the meal offered.

People said their bedrooms and bathrooms were well-furnished and cleaned daily.

We heard from people and their relatives that they knew and understood the complaints procedure. They said they were confident their concern or complaint would be dealt with appropriately and quickly.

People told us they were looked after kindly and with respect.