The Old School House

We found the following examples of good practice.

The provider ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the spread of infection. This included comprehensive checks for visitors on arrival.

The service had prominent and clear infection prevention control (IPC) signs with helpful information and best practice guidance. Staff were adhering to Personal Protective Equipment (PPE) guidelines and improvements were planned in relation to PPE storage arrangements.

The environment supported people to remain safe and socially distanced. Furniture in communal areas had been arranged to ensure people were able to sit socially distanced. Areas of the service were being refurbished and were closed off to people and staff wherever possible to reduce contact with visiting contractors.

We found the following examples of good practice:

• The home was clean and well-maintained. Changes had been made to the environment during the pandemic to assist with maintaining good hygiene practices. Improvements were planned in relation to personal protective equipment (PPE) storage arrangements.

• A separate area of the home had been created, so that anyone who may need to self-isolate could do so safely.

• There were robust visiting arrangements in place. This included having a bookings system and a visitors room with a clear screen to prevent potential cross infection.

• Staff maintained social distancing and were regularly tested in line with the government's current testing programme.

The Old School House is a residential care home providing personal care to 33 older people. People who live at this home receive support with complex needs associated with their diagnosis of dementia. The service can support up to 40 people.

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

The environment at the Old School House was exceptional. Further improvements had been made to enhance the facilities for people to meet their daily life needs. The service was particularly suited to people with dementia. Staff training, support and innovative working followed, and challenged best practice to help people overcome fears and anxieties. The provider had active links, sharing information and best practice with leading experts in dementia care.

Care and support was delivered following legislation and national guidance. Where people showed behaviours that challenged or were resistant to assistance they were supported using low-level distractions which enabled staff to maintain their dignity and personal cares.

Staff were very well trained and experienced in identifying and responding to any changes in behaviour. People were supported according to their own expectations and abilities. This encouraged and supported their independence and freedoms. Many positive outcomes were evidenced for people and staff told us they were motivated by the positive impact the service had on people’s lives.

All feedback received about the support provided to people was extremely positive. People received high-quality, personalised support from regular and committed staff. Recruitment checks were in place. Staff had received training and support to enable them to carry out their role. Further staff training encouraged promotional prospects and included champion roles to guide and support other staff to follow best practice. Healthcare professionals felt staff were excellently trained.

The provider had a positive ‘can do’ attitude to support known risks where people accessed the community. People enjoyed time with supporting partners who encouraged dementia friendly visits. This included local cinemas, cafes and garden centres. Staff were led by an activities team and completed fund raising events which were supported by people at the home. People were engaged with a range of innovative activities which lead to many positive outcomes.

Staff clearly understood the importance of supporting people to live in a dignified manner. We observed many positive interactions where staff provided people with gentle reassurance, guidance and where required, a comforting hug.

People received a detailed assessment to ensure the service was suitable for them and able to meet their needs. Care planning was robustly recorded on an electronic i-care system, and information was instantly accessible for staff which led to person centred care and support. A range of initiatives were in place to celebrate people’s ‘life-stories’. Staff used associated information to hold meaningful discussions with people which led to effective supporting relationships.

The provider completed regular checks to assure the quality of the service. Input and feedback were sought in a variety of ways and used to encourage further innovative practice.

The service completed a range of checks to certify and maintain the safety of the service, equipment and the environment. Staff received appropriate training to safeguard people from avoidable abuse. Systems and processes encouraged the reporting of any incidents for further investigations. Outcomes were routinely used to improve the service for the benefit of everyone.

People received their medicines safely as prescribed. Systems, processes and oversight ensured medicine management and administration followed best practice guidance and staff had the required skills and knowledge to provide this support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Passionate and forward-thinking managers led and provided an inclusive service that engaged proactively with people, their relatives and the staff team.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at http://www.cqc.org.uk

Rating at last inspection

The last rating for this service was Outstanding (published 18 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Old School House is a care home that specialises in the care of older people who are living with dementia. Most people who live at this home have complex needs associated with their diagnosis of dementia. The home is registered to provide care for up to 40 people. People are accommodated in individual bedrooms located on two floors of the building. There are communal lounges and dining areas on each floor and the floors are connected by stairs and passenger lifts. There is an enclosed garden, and some parking at the front of the building. At the time of our inspection there were 32 people living in the home. The Old School House is one of eight services run by the East Riding of Yorkshire Council.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Care was planned in partnership with people and their families, and people received the care and support they needed to meet their individual needs. Relatives spoke exceptionally highly of the quality of care they and their loved ones received, and said they were kept well informed about the person's wellbeing. The managers and staff were committed to working in a person-centred way and treating people with kind-heartedness and consideration. People, including those who had difficulties communicating or who could become upset, responded positively to the way in which staff approached them. Staff told us they enjoyed working at the Old School House and we saw staff treated people professionally but also showed people they were valued and important. Staff did this through the way they spoke to people, offering reassurance with comforting words and a gentle tone of voice and holding people's hand if appropriate.

People were relaxed with staff. Visitors and relatives told us they felt the Old School House was a safe environment for people to live in. People were protected from abuse because staff could identify the different types of abuse and knew what actions to take to report abuse.

Whilst people received excellent care, there was a strong emphasis on continually striving to improve the service. Improvements were identified through consultation with people, relatives and health care professionals involved with the Old School House through informal chats, meetings, reviews, family forums and surveys. For example, the registered provider had recently provided a dedicated area for relatives to use so that they could be close to their loved ones when they were unwell. This showed that the registered provider placed a high value on meeting the needs of people and their relatives.

As well as consulting with people, the Old School House strove for excellence through reflective practice at all levels, from care staff to senior management. There were systems in place to monitor the quality and safety of the home and bring about any improvements that were needed. The home worked in partnership with other organisations to make sure they were following current best practice and providing a high quality service.

There was a truly open atmosphere upon entering the Old School House. The home had a clear management structure, with an established service manager, registered manager and senior care officers. They worked closely with staff, frequently observing and providing care. Relatives, staff, health care professionals and volunteers were confident in the leadership of the service. They were encouraged to raise any areas of concern, which were taken seriously and the appropriate action taken.

Staff demonstrated excellent interpersonal communication with people and supported them to express their views. They had clear strategies in place where people had difficulties with communication. The staff were familiar with the needs of people living with dementia. The registered manager and senior staff kept up to date with best practice in dementia care and ensured this was adopted by the staff. The environment had been designed to promote the independence and wellbeing of people who lived with dementia. There was plenty of communal space, lounges, and dining areas were available to people, as were quiet areas where people could sit in peace.

Risks to people were monitored and staff minimised the risk of injury whilst enabling people to maintain a safe level of independence. Staff supported people in a positive way and were able to recognise when people may require additional support. They had received bespoke training to intervene when people were at risk from behaviour that may challenge others and they intervened calmly and confidently when they noticed anything that could cause a person to become distressed. We saw that people were cared for and supported by qualified and competent staff who were regularly supervised and appraised regarding their personal performance. Staff told us they felt extremely well supported by the registered manager and provider through training, seminars and meetings where their views were listened to.

People were placed at the heart of the home, which was organised to suit their individual needs. They were supported by staff that were compassionate and treated them with dignity and respect. Without exception, people’s visitors and relatives we talked with were highly complementary and positive about the staff that supported them. Relationships with families and friends were highly valued and developed so that people living at the home were able to maintain and develop their bonds with people who were important to them. We saw friends and families had built relationships with other people living at the Old School House and often continued to visit them after their own family members had died. This provided people living in the home with continued friendships and connections with people that were interested in them as individuals and that enriched their quality of life.

The mealtime we observed was relaxed and organised. People were supported to eat in a supportive and calm setting that provided opportunity to socialise as well as eat. The staff were attentive and provided the support people needed to be able to enjoy a meal. Food was attractively presented and people were able to choose what they wanted to eat. Special dietary requirements were understood and provided for. Food and drink was available at the Old School House whenever people needed it, not just at regular mealtimes.

People's ability to make decisions was assessed and where people lacked the mental capacity to consent to their care and welfare actions were taken in their best interests. There was evidence of communications with other health care professionals and people’s relatives ensuring that all the significant individuals were involved in meeting people's needs. The registered manager had taken appropriate action when people did not have the capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests.

The premises were safely maintained with maintenance certificates, contracts and records to show this. The registered provider's recruitment processes ensured suitable staff were recruited and during this inspection we saw there was sufficient staff available to provide support to people when needed.

During the day we sat with people who used the service and observed their daily activities including lunchtime and their interactions with staff. We spoke with relatives, a visiting health professional and ten staff. We reviewed documentation including five care plans.

We saw that care needs were discussed with people and/or their relatives and before people received care their consent was asked for. Two relatives said they were involved in every aspect of the care offered to their own family member.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Food and drinks were specially prepared to ensure that people had a nutritious and balanced diet.

There were enough qualified, skilled and experienced staff to meet people's needs. A relative said 'The home 'is great. I like it here and X is happy and so am I'. A visiting health professional said the staff are 'Prepared to try things to improve care and are always prepared to ask for advice'.

The home looked clean and tidy and there were infection control procedures in place. There were appropriate systems in place to monitor and improve the quality of the service. Records were found to be accurate, detailed and regularly reviewed.

From what people told us, what we observed and noted as part of the review staff cared for the people who use the service appropriately. The staff told us that the manager was supportive of them and ensured that they had regular supervision. Staff could tell us what they would do if they saw abuse happening or someone reported abuse to them. Staff also told us they tried to ensure that people's dignity and human rights were respected and we saw evidence of this during our inspection. There were appropriate systems in place to monitor and improve the quality of the service.

The relatives we spoke to said that the staff were 'kind and patient', and 'well trained with good knowledge'. The visiting health professional said 'the care here is excellent, I enjoy visiting here'.