The Old School House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 100 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider consistently ensured people's needs were comprehensively assessed, reviewed and understood in partnership with people, relatives, advocates and healthcare professionals. Assessment processes were holistic, personalised and continually reviewed, enabling people to achieve exceptionally positive outcomes and experience care tailored to their individual needs, preferences and aspirations.

People received highly personalised care because their needs were assessed thoroughly before admission and continually reviewed thereafter. Assessments considered people's physical health, emotional wellbeing, mental health, communication needs, life histories, relationships, personal preferences, risks and what was most important to them. People, relatives and professionals were actively involved in assessment processes to ensure staff developed a comprehensive understanding of each individual and their desired outcomes.

The provider demonstrated exceptional practice in assessing and supporting people with complex needs, including individuals who had experienced previous placement breakdowns or periods of instability. Leaders and staff invested significant time in gathering information from families, healthcare professionals and previous services before admission. New admissions were supported through structured transition arrangements, enhanced observation and regular reviews to ensure care remained responsive as staff developed a deeper understanding of the person. This approach helped people settle successfully and achieve positive outcomes.

Staff demonstrated an excellent understanding of people's assessed needs and were able to describe how assessments influenced daily care and support. One member of staff told us, “Everybody is different. We spend time getting to know people, their routines, what they like and don't like, what can upset them and what helps them feel reassured. The care plans give us a good starting point, but we continually learn more about people and update support as their needs change.” Another member of staff explained, “We don't just assess people when they arrive and leave it at that. People's needs change all the time, especially with dementia, so we're always observing, reviewing and adapting support.” This demonstrated a culture where assessment was viewed as an ongoing process rather than a one-off event.

Assessment processes were strengthened through effective multidisciplinary working. Staff worked closely with a range of health professionals to ensure assessments remained accurate, current and informed by best practice. A healthcare professional described staff support and outcomes as ‘amazing’ and praised their ability to understand people's needs and respond effectively when circumstances changed. Professionals consistently highlighted the provider's detailed understanding of people and its ability to achieve positive outcomes for individuals with highly complex needs.

Assessment information was regularly reviewed through care reviews, professional input, family engagement, incident analysis and ongoing observation. Families consistently reported feeling involved in decision-making and told us their knowledge and understanding of their relatives was valued. One relative explained, “Staff regularly contact me to discuss any change in [name of person] needs and reviews of support.” This helped ensure care remained relevant and personalised.

The impact of this approach was significant. People who had previously experienced challenges within other services became more settled, experienced reduced distress, improved wellbeing and greater stability. Families consistently described positive changes following admission and told us staff had achieved outcomes they had not experienced elsewhere. Assessments were used not only to identify needs, but to understand strengths, aspirations and opportunities, enabling people to achieve meaningful outcomes and an enhanced quality of life.

People consistently received exceptionally personalised care and treatment that was informed by current evidence, recognised best practice and specialist professional guidance. Staff worked proactively with healthcare professionals to ensure care reflected people's changing needs and preferences, resulting in positive health, wellbeing and quality of life outcomes.

Care and treatment were delivered in line with nationally recognised guidance, evidence-based practice and individual clinical recommendations. Staff demonstrated a detailed understanding of people's needs and ensured professional advice was translated into day-to-day care. Care records evidenced regular involvement from GPs and other specialist professionals, with recommendations promptly incorporated into care plans and support arrangements.

People with complex nutritional, hydration and swallowing needs benefited from particularly effective evidence-based care. Staff followed specialist SALT and dietetic guidance relating to food textures, thickened fluids, positioning, pacing of meals and nutritional supplementation. Nutritional plans were regularly reviewed and adapted in response to changing needs. Monitoring records showed staff consistently followed professional recommendations and escalated concerns appropriately.

Healthcare professionals consistently described the service as highly responsive to professional advice and committed to delivering evidence-based practice. One professional told us staff were, "Very proactive and always seek advice when needed." Another described communication as, "excellent" and explained that recommendations were implemented quickly and consistently. Professionals repeatedly highlighted staff's detailed knowledge of people's healthcare needs and their ability to translate specialist guidance into meaningful support.

Families told us, “Staff understand people's conditions, act quickly when concerns are reported and work extremely well with healthcare professionals.” One relative explained, “I feel reassured because staff always seek specialist advice when needed and communicate well to ensure any recommendations are followed.”

The provider demonstrated a strong commitment to ensuring staff possessed the knowledge and skills necessary to deliver evidence-based care. Staff received comprehensive training relevant to the needs of people using the service, including dementia care, dysphagia awareness, medicines management, safeguarding, nutrition and end-of-life care. Training was supported through supervision, competency assessments, reflective discussions and observations of practice. Leaders continually reviewed training needs and provided additional learning opportunities when people's needs changed.

Staff consistently spoke positively about the quality of training and its impact on care delivery. One member of staff told us, "The managers are always looking at what training we need based on the people we support. If something new comes up, they make sure we understand it and know what to do." Staff described learning as practical, relevant and directly linked to improving outcomes for people.

The impact of this approach was evident in people's outcomes. People received timely access to healthcare support, experienced well-coordinated care and benefited from interventions that reflected current professional guidance and evidence-based practice. Staff were knowledgeable, confident and skilled and consistently used their learning to improve people's health, wellbeing and quality of life.

The provider ensured people benefitted from exceptionally well-coordinated care because staff, teams and partner organisations worked together seamlessly to achieve positive outcomes. Communication systems were highly effective and ensured staff consistently had access to accurate, up-to-date information to support people safely and in line with their individual needs, preferences and goals.

Staff demonstrated an in-depth understanding of people's needs and worked collaboratively across all departments to provide joined-up support. Information about people's care and treatment was shared effectively through comprehensive care plans, electronic care records, structured handovers and regular multidisciplinary discussions. Staff told us communication within the service was, ‘excellent’ and that they felt confident raising concerns or sharing information to ensure people received consistent care.

Information gathered was used to develop increasingly personalised care plans and ensure people settled safely into their new home and were able to remain living closer to those important to them. Staff explained how temporary one-to-one support was initially implemented to enable them to understand people's preferences, behaviours, communication styles and support needs.

Communication processes were continually reviewed and improved. Leaders had introduced quality improvement work to strengthen handovers and ensure staff consistently identified emerging risks and concerns. Staff were encouraged to discuss anything they were worried about and share information proactively to enable early intervention. The service applied formal quality improvement methodologies to evaluate and strengthen communication systems and continuously improve care delivery.

There was a strong culture of partnership working throughout the service. Staff described positive relationships with healthcare professionals and reported that advice and guidance were readily accessible when required. Leaders actively encouraged collaborative working and recognised the value of different professional perspectives in achieving the best possible outcomes for people. Healthcare professionals told us, “Staff are responsive to recommendations and demonstrate a commitment to working together to improve people's health, safety and wellbeing.” Relative’s and professionals consistently described a service where communication was open, effective and focused on achieving the best possible outcomes for people.

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People were supported to achieve exceptionally positive health and wellbeing outcomes because staff consistently recognised changes in their health needs, responded proactively and worked closely with healthcare professionals to promote healthier lives. Staff knew people exceptionally well and took timely action to reduce the risk of deterioration and improve people's overall wellbeing.

People benefited from highly personalised support which promoted both their physical and emotional wellbeing. Staff understood people's individual healthcare needs, life histories, preferences and routines and used this knowledge to support healthier lives. Care records demonstrated people received regular access to healthcare services including GPs, dentists, speech and language therapists, dietitians, occupational therapists, physiotherapists, chiropodists and specialist clinicians when required.

Staff were proactive in identifying changes in people's health and seeking professional input at the earliest opportunity. Healthcare professionals consistently told us staff knew people well and promptly escalated concerns about changes in health and wellbeing. One healthcare professional told us, “Staff recognise health concerns early and contact the appropriate services without delay, ensuring people receive timely support to prevent deterioration wherever possible.”

People experienced improved health outcomes because of the service's proactive approach to monitoring and supporting their wellbeing. Relatives described significant improvements following people’s admissions into the service. One relative told us, “[Name of person] had frequent infections prior to moving into The Old School House but has not experienced further infections since staff have taken the time to understand and support them.” Another relative explained, “[Name of person’s] health deteriorated significantly in a previous placement. I believe it’s down to the staff at The Old School House; they are highly skilled and achieve much better outcomes for people.

People's emotional wellbeing was promoted through meaningful activity, social engagement and maintaining relationships important to them. Staff recognised the links between physical health, emotional wellbeing and overall quality of life. Relatives described how staff supported people to remain involved in activities they enjoyed, access the local community and maintain social connections. One person was supported to visit local archives linked to their lifelong interests, while others were supported to enjoy music, community events, therapy animals and meaningful social opportunities which promoted wellbeing and reduced feelings of isolation.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

People experienced exceptionally positive outcomes because staff consistently monitored their health, wellbeing and quality of life and used this information to adapt care and support when people's needs changed. Monitoring systems were highly effective and enabled staff to identify changes early, work proactively with healthcare professionals and continually improve outcomes for people.

Staff used a range of recognised assessment and monitoring tools to evaluate people's health and wellbeing. People's nutritional status, weight, skin integrity, mobility, falls risks, continence needs, behavioural support requirements and overall wellbeing were regularly reviewed and monitored. Care records demonstrated that information was analysed and used to inform decisions about people's care and support, ensuring interventions remained effective and responsive to changing needs.

The service demonstrated an exceptional commitment to reviewing care and adapting approaches when they were no longer achieving the best outcomes. Staff explained how they reviewed support approaches, monitored their effectiveness and sought professional guidance where required. For example, people who had previously required enhanced one-to-one support were regularly reviewed to determine whether less restrictive approaches could be safely introduced. Through careful monitoring, use of equipment, environmental adaptations and ongoing risk assessment, several people had successfully reduced or ceased one-to-one support whilst maintaining their safety and wellbeing.

People experienced significant improvements in wellbeing and quality of life because staff continually evaluated outcomes and adjusted support accordingly. Leaders described examples where people had arrived following multiple unsuccessful placements and experienced positive outcomes because staff monitored their needs closely, adapted support and worked collaboratively with families and professionals. This enabled people to become more settled, engage more meaningfully in daily life and remain living within their local communities.

Monitoring systems extended beyond physical health and included emotional wellbeing, quality of life and meaningful engagement. Staff evaluated people's responses to activities, social opportunities and individual interventions and used this information to shape future support. Relatives told us, “People are encouraged to participate in activities linked to their interests and past lives.” This showed how staff supported improvements in wellbeing, confidence and engagement.

Leaders maintained strong oversight of outcomes through governance systems, performance dashboards, audits and regular review processes. Information regarding falls, incidents, behaviours of distress, restrictive practices and healthcare needs was analysed to identify themes, trends and opportunities for improvement. The registered manager described how data was used to understand changes in outcomes and proactively implement improvements where required.

The service demonstrated a strong culture of reflection and continuous improvement. Following incidents or changes in people's needs, staff held debrief discussions, reviewed outcomes and modified care approaches to improve future experiences for people. Leaders introduced quality improvement projects, including improved handover processes and structured risk discussions, to strengthen monitoring systems and ensure emerging concerns were identified and acted upon at the earliest opportunity.

Families and professionals consistently described improvements in people's wellbeing, safety and quality of life and told us staff were proactive in recognising when support needed to change to achieve better outcomes.

The provider always carefully explained to people and their relatives what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

People and their relatives were supported to make decisions about their care and treatment in ways which maximised their choice, independence and human rights. Decision-making processes were highly person-centred and consistently reflected the principles of the Mental Capacity Act 2005, ensuring people received support which was proportionate, individualised and the least restrictive possible.

Staff demonstrated a strong understanding of consent, mental capacity and best-interest decision-making. Care records showed capacity assessments and best-interest decisions were completed when people lacked the capacity to make specific decisions for themselves. These processes involved families, advocates and healthcare professionals where appropriate, ensuring decisions reflected people's wishes, values and previously expressed preferences.

People benefited from exceptionally personalised approaches to decision-making. Staff recognised capacity could fluctuate and understood the importance of supporting people to make as many decisions as possible in their day-to-day lives. Staff consistently described how they offered choices, gave people time to process information and adapted their communication approaches to maximise participation in decisions. Staff understood people had the right to make unwise decisions and explained how they balanced people's rights with their duty to keep them safe.

The service demonstrated a strong commitment to ensuring restrictions were only implemented when absolutely necessary. Leaders and staff worked proactively to reduce restrictive practices, promote independence and continuously review whether restrictions remained appropriate. Where restrictions were required, these were clearly documented, reviewed regularly and supported by appropriate legal authorisation. DoLS applications and conditions were monitored effectively, and families remained involved throughout the process.

The service worked collaboratively with families and professionals involved in people’s care to support complex decision-making. Following incidents, managers coordinated best-interest meetings involving healthcare professionals and family members to review risks, treatment options and future care arrangements. Decisions were carefully considered, reflected professional guidance and ensured the person's wishes, safety and quality of life remained central to decision-making.

Relatives consistently described being actively involved in decisions affecting their loved ones. One relative told us, “Staff always seek permission for healthcare interventions and keep us fully informed of any changes.” Others described being consulted regarding medicines, care reviews and decisions affecting treatment and wellbeing. Families told us staff listened to their views and valued their knowledge of the person. People received care and treatment which respected their rights, maximised their involvement and ensured decisions were made in their best interests when required. Consent processes were embedded within a strong person-centred culture where staff consistently promoted choice, dignity and independence.