The Old School House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

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 was exceptional at making sure people were at the centre of their care and treatment choices, and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People consistently received highly personalised care that was designed, delivered and reviewed around their individual needs, preferences, strengths, aspirations and life experiences. Staff demonstrated an exceptional understanding of the people they supported and continually adapted care to reflect what mattered most to them.

Care planning was exceptionally person-centred and reflected a detailed understanding of people's physical, emotional, social and psychological needs. Records contained comprehensive information about people's preferences, routines, relationships, communication needs, cultural backgrounds and desired outcomes. Care plans were regularly reviewed and updated to ensure support remained responsive to people's changing circumstances and wishes.

Staff consistently demonstrated that care plans were actively used in practice rather than existing as static documents. During discussions, staff provided detailed examples of how support had been tailored to individual preferences and changing needs. Staff understood people's routines, recognised what was important to them and adapted support accordingly. Relatives told us, “Staff know [name of person] exceptionally well” and “They [staff] deliver care in a way that reflects people’s individuality.”

People and those important to them were actively involved in planning and reviewing care. Families consistently told us they were consulted about changing needs, healthcare interventions and daily support arrangements. One relative explained staff regularly contacted them to discuss ideas, review care and ensure support reflected their family member's needs and preferences. Care records evidenced ongoing review discussions involving people, relatives and professionals where appropriate.

The service demonstrated an exceptional ability to adapt care for people with complex needs. Staff regularly reviewed support arrangements analysed what was working well and modified approaches when necessary. For people who had previously experienced placement difficulties elsewhere, plans were continually refined using staff observations, family feedback and professional advice. This ensured care became increasingly personalised as staff developed a deeper understanding of the person.

Staff worked creatively to ensure people experienced meaningful opportunities which reflected their personalities and preferences. Individual activity plans were developed around people's interests, strengths and goals. Activity keyworkers worked closely with people and families to continually review interests and ensure opportunities remained meaningful and relevant. This resulted in people participating in experiences that promoted enjoyment, confidence and wellbeing rather than generic activities.

Relatives consistently praised the personalised nature of care. One relative told us,"They don't treat anyone the same. They know what works for each person and adapt how they support them."Others described staff taking time to understand people's preferences and adapting care accordingly, particularly as dementia progressed and needs changed.

The service culture placed considerable emphasis on seeing the person beyond their diagnosis or care needs. Staff consistently focused on understanding what gave people's lives meaning and used this knowledge to shape care and support. As a result, people experienced care that was highly individualised, responsive and focused on achieving outcomes that mattered to them.

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People experienced exceptionally well-coordinated, joined-up care because staff worked proactively with families, healthcare professionals and partner organisations to ensure support was seamless, responsive and centred around people's individual needs. Care was planned and delivered in a way that promoted continuity, reduced disruption and achieved positive outcomes for people, including those with highly complex needs and previous placement breakdowns.

Staff remained flexible, adapting support as they learned more about individuals and ensuring continuity was maintained throughout periods of significant change. As a result, people who had struggled elsewhere were able to develop stable, long-term placements and experience improved wellbeing and quality of life.

Continuity extended beyond healthcare and support needs. Staff actively worked to preserve relationships that were important to people and ensured relatives remained involved in care wherever possible. Families consistently told us communication was excellent and that they were kept informed about changes, healthcare interventions and review outcomes. One relative explained they felt like part of the team supporting their family member because staff consistently involved them in planning and decision-making.

Communication systems across the service supported highly effective care integration. Staff had access to comprehensive, up-to-date care records and participated in structured handovers which ensured important information was shared consistently. Leaders had also introduced improvements to handover processes, encouraging staff to discuss emerging concerns and identify people who may require additional support. This supported early intervention and ensured continuity across shifts and teams.

Healthcare professionals recognised the quality of the service's partnership working. A professional described staff as knowledgeable, responsive and proactive, explaining that information requested was always available and that staff acted quickly when changes in people's needs were identified. Professionals consistently told us the service listened to advice, implemented recommendations and demonstrated a shared commitment to achieving the best outcomes for people. People experienced care that was seamless, coordinated and consistently focused on their individual needs. Effective integration between staff, families and external professionals helped people maintain stable placements, avoid unnecessary disruption and receive support that remained responsive as their needs changed.

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs. People, relatives and those acting on their behalf consistently received information in ways they could understand and use. The service demonstrated an exceptional commitment to ensuring information was accessible, personalised and responsive to individual communication needs, enabling people to remain involved in their care and make informed decisions wherever possible.

Communication needs were clearly identified, assessed and reflected throughout people's care records. Staff understood how each person preferred to receive information and adapted their communication approaches accordingly. Staff consistently demonstrated patience and flexibility, taking time to ensure information was presented in a way people could understand.

Staff familiarised themselves with people’s care records and used this information routinely to tailor conversations, explain choices and engage people in meaningful discussions. A relative told us, “Staff make considerable efforts to understand how [name of person] communicates and adapt support as their needs change.”

People benefited from information being presented in ways that promoted familiarity, recognition and confidence. Personalised memory displays, life history information and individual room displays acted as communication tools, helping people orientate themselves and supporting meaningful interactions with staff, visitors and healthcare professionals. These resources enabled staff to start conversations, reduce anxiety and support engagement for people living with dementia and memory loss.

Families consistently reported they were kept informed about changes in care, healthcare appointments, reviews and significant events. Staff maintained open and transparent communication and worked flexibly to ensure relatives could access information in ways that suited them. Families described staff as approachable and responsive and told us information was communicated promptly and sensitively. One relative explained they always felt informed about developments affecting their family member and knew staff would contact them if anything changed.

The service actively promoted information sharing through multiple communication channels. Relatives had opportunities to receive updates through meetings, reviews, newsletters, telephone calls and direct conversations with staff and managers. Leaders recognised that effective communication required flexibility and ensured information was accessible to relatives who could not always attend the service in person.

Professionals consistently found staff knowledgeable and responsive when information was requested. Healthcare professionals told us staff could provide accurate and up-to-date information about people's needs and progress and worked openly to ensure relevant information was shared appropriately. This contributed to joined-up care and improved continuity for people. People experienced communication that was personalised, accessible and meaningful. Information was provided in ways that reflected individual needs and enabled people and those important to them to remain involved, informed and connected to decisions about their care and support.

People, relatives and those important to them were exceptionally well involved in decisions about care, support and the ongoing development of the service. Leaders had created a culture where people's voices genuinely influenced decision-making, improvements and outcomes. Feedback was actively sought, valued and consistently used to shape both individual care and wider service development.

People and their relatives were encouraged and supported to share their views in ways that suited them. Leaders recognised that meaningful involvement required more than gathering feedback and had developed a range of opportunities for people and families to influence decisions.

The provider demonstrated a strong commitment to co-production. Families were actively involved in care planning, reviews, recruitment activities and service development. Relatives described being consulted about important decisions and told us staff valued their knowledge and understanding of their loved ones. One relative explained, "They always ask what we think and genuinely listen." Another told us, "We aren't just informed about decisions, we're involved in making them." This created a collaborative culture where people and families helped shape the support provided.

Feedback was not only gathered but resulted in meaningful change. Leaders maintained clear action plans and regularly demonstrated how suggestions from people and families had been used to improve the service. Changes to activities, communication processes, environmental improvements and family engagement arrangements had all been influenced by feedback. Families consistently told us they could see that their views made a difference and described a culture where leaders actively welcomed challenge and new ideas.

The service also ensured people who found verbal communication difficult remained involved in decisions about their lives. Staff used a range of approaches to understand people's experiences, including observation, life history information, behavioural cues, communication plans and discussions with those who knew the person well. Staff demonstrated a detailed understanding of people's non-verbal communication and routinely adapted support based on people's responses, preferences and emotional wellbeing. This ensured people remained at the centre of decisions regardless of communication ability.

Families consistently praised the openness and responsiveness of leaders. One relative described the registered manager as, "Approachable and always willing to listen." Another told us, "If we raise something, it gets sorted." Relatives explained they felt comfortable discussing concerns, knowing they would be taken seriously and addressed appropriately. This transparency strengthened trust between families and the service.

The provider treated complaints, concerns and feedback as opportunities to improve. Records showed concerns were investigated openly and thoroughly, outcomes were shared with families, and learning was embedded into practice. Families told us they felt informed throughout investigations and were reassured by the openness demonstrated by leaders and staff. This approach reinforced a culture where people felt heard and respected.

People and families influenced not only individual care but the future direction of the service. Leaders actively involved relatives in service development work, quality assurance initiatives and recruitment activity. This level of involvement exceeded traditional consultation approaches and demonstrated a genuine commitment to partnership working and co-production. Healthcare professionals and families consistently recognised the provider's willingness to listen, learn and adapt.

As a result, people experienced a service that was shaped around their views, preferences and experiences. People and families were not passive recipients of care but active partners in decisions and improvements. This inclusive approach strengthened relationships, improved trust and contributed directly to the outstanding outcomes experienced throughout the service.

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it. People experienced equitable access to care, treatment, activities and community opportunities because staff and leaders worked proactively to identify and remove barriers that may otherwise have prevented people from achieving positive outcomes.

Staff adapted activities, environments and support approaches to make community participation possible. Rather than excluding people because of risk, communication difficulties or cognitive impairment, staff developed individual solutions which enabled people to participate safely and meaningfully. This included adapting activity programmes, providing additional support, reviewing risks and collaborating with families and professionals to maximise opportunities.

Staff worked hard to consider potential barriers people might experience to ensure equitable access. Some people experienced difficulty engaging with standard mealtime routines and preferred to eat at different times from other people living at the service. Rather than expecting the person to fit into established routines, staff adapted meal provision around their individual needs and preferences. Staff recognised this barrier and the kitchen team ensured food was available when the person wished to eat and provided additional snacks and nutritional support when required. This removed barriers to maintaining adequate nutrition and enabled the person to receive support in a way that reflected their preferences and promoted their wellbeing.

Staff recognised that some people living with advanced dementia could no longer communicate their needs, wishes or preferences verbally. Staff explored personalised communication approaches, utilising life history information, observations, familiar objects, photographs and knowledge provided by families to understand people's preferences and responses. This enabled people to remain involved in decisions about their daily lives and ensured care continued to reflect what was important to them.

Staff acknowledged that behaviours of distress alongside complex presentations, had become barriers to accessing stable care and building positive relationships. Staff worked closely with one person's family, their community psychiatric nurse, GP and wider multidisciplinary team to understand the underlying causes of their distress, life history, triggers and preferred methods of support. Staff adapted their approach over time, developed personalised support strategies and ensured care was delivered consistently by staff who knew the person well. As a result, the person became more settled, incidents of distress reduced and they were able to develop positive relationships with staff and other people living at the home. The placement remained stable and the person's quality of life significantly improved.

Families consistently told us staff made significant efforts to overcome barriers and ensure people received the support they required. One relative described, “Staff continually look for solutions rather than reasons why something cannot happen.” Healthcare professionals also praised the service's willingness to work collaboratively and provide equitable access to specialist services and interventions. People experienced a service that actively promoted equality of access and opportunity. Staff consistently removed barriers, adapted support and advocated for people to ensure they could access healthcare, relationships, community opportunities and meaningful experiences regardless of their individual circumstances.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff recognised that one person's emotional wellbeing and quality of life were being affected by medicines prescribed to manage distress. Rather than accepting this as unavoidable, staff worked closely with the person's family and healthcare professionals to review the effectiveness of the treatment and explore alternative approaches. Following a series of reviews, the person's medicines were significantly reduced, and support strategies were adapted around their individual needs. A relative told us there had been around a 50% reduction in the medicines their family member was receiving and described a noticeable improvement in their wellbeing and engagement. This ensured the person achieved improved outcomes through a personalised approach rather than being supported in the same way as everyone else.

The provider demonstrated a strong commitment to equality through its family partnership approach. Leaders actively sought feedback from relatives to understand whether people were experiencing positive outcomes and used this information to identify where improvements could be made. Family members consistently reported improvements in wellbeing, confidence, health, engagement and emotional security following admission to the service. Several relatives described outcomes, “Exceeded their expectations” and stated that, “Staff have achieved improvements I have not experienced elsewhere.” Care records, observations and feedback consistently showed staff adapting support to meet people's differing needs, helping them achieve outcomes that were meaningful to them as individuals.

Staff routinely challenged barriers that may have prevented people from experiencing positive outcomes. People moving into the service experienced significant anxiety, confusion and distress during periods of transition. Management and staff carefully considered and assessed how they could support in different ways to achieve positive outcomes. For example, staff implemented enhanced observation, additional one-to-one support and frequent reviews following one person’s admission. They worked closely with family members and professionals to understand the person's routines, triggers, preferences and communication style. As the person's needs became better understood, support was adapted and increasingly personalised. This included a conscious effort to do everything promised and communicate where any issues arose, so the person could understand and not feel disadvantaged. This enabled the person to settle successfully into the home, develop trusting relationships with staff and achieving positive outcomes that may not otherwise have been possible through a standard admission process.

Healthcare professionals consistently praised the service's person-centred approach and described positive improvements in people's wellbeing, engagement and quality of life. Professionals recognised staff's ability to adapt care, respond to changing needs and achieve outcomes for people whose circumstances were particularly complex. This external feedback reinforced evidence that the service delivered equitable and positive outcomes for people with differing needs and backgrounds. People experienced improvements in wellbeing, stability, independence, engagement and quality of life regardless of the challenges they experienced. The service demonstrated a clear commitment to ensuring every person had the opportunity to achieve outcomes that mattered to them, with staff consistently adapting support to overcome inequalities and promote inclusion.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

Staff worked proactively with people, families and healthcare professionals to ensure future wishes, preferences and goals were understood, respected and reviewed. Planning was highly personalised and enabled people to maintain choice, dignity and control over important decisions affecting their lives.

The service demonstrated an exceptional commitment to understanding what mattered most to people both now and in the future. Care records evidenced detailed discussions with people, relatives and those acting on their behalf regarding future preferences, healthcare decisions and personal wishes. Staff recognised that future planning extended beyond clinical decisions and included maintaining relationships, achieving meaningful goals, preserving identity and ensuring people continued to experience the best possible quality of life.

People benefitted from highly individualised end of life planning which reflected their wishes, values and priorities. Staff worked closely with healthcare professionals, families and advocates to ensure plans remained current and responsive to changing needs. Families consistently described being actively involved in discussions and decision-making. End of life care was recognised externally as an area of exceptional practice, with professionals commending the service's compassionate, person-centred approach and commitment to achieving positive experiences for people and those important to them.

The service had developed innovative approaches to supporting future planning and end of life care. End of Life Comfort Boxes were available to support people and families during the final stages of life. These contained comfort items, mouth care products, sensory resources, information and practical guidance aimed at supporting dignity, comfort and emotional wellbeing. Families told us these resources provided reassurance and practical support during difficult times and helped ensure people remained comfortable and cared for.

Leaders and staff demonstrated an exceptional understanding of the importance of involving families in future planning. Relatives were encouraged to contribute to discussions regarding future wishes, healthcare decisions and care preferences. Families described feeling listened to and supported throughout the process. One relative told us they felt fully included in planning and that staff took time to ensure decisions reflected their family member's values and personality.

People's future healthcare wishes were considered through ongoing reviews, best-interest processes and multidisciplinary discussions where appropriate. Where significant healthcare decisions were in place, records showed these were discussed appropriately, reviewed regularly and understood by staff. Staff demonstrated a good understanding of people's wishes and the importance of ensuring care remained aligned with their preferences.

The service supported people to continue achieving meaningful personal goals, regardless of age, diagnosis or changing health needs. Staff continually reviewed what was important to people and worked creatively to support aspirations, interests and valued experiences. This included maintaining community links, supporting important relationships and ensuring people had opportunities to continue participating in meaningful activities for as long as possible.

Families who had experienced bereavement consistently praised the service's compassionate and personalised support. Relatives described staff going above and beyond to support both people and families before, during and after death. Innovative approaches including remembrance initiatives, such as purple hearts placed on people’s room doors so others wereaware to respect the relative’s privacy, sentimental belongings collated to pass to relatives and personalised bereavement support to ensure families felt valued, supported and included throughout the process. People experienced care that respected their wishes, protected their dignity and promoted control over important decisions about their future. Future planning was highly personalised and embedded throughout the culture of the service, ensuring people and families remained at the centre of decisions during all stages of life.