The Old School House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Improvements were made to the service when shortfalls were found. For example, the provider’s medicines audits identified errors when people had not received all their medicines. To address this, managers were introducing a new ‘monitored dose’ medicines system to make it easier for staff to ensure people received all the medicines they were prescribed.

This demonstrated that risks were dealt with and not left. Errors were seen as an opportunity to put things right, learn and improve.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People who were thinking of coming to the service had the opportunity to visit first to see if it suited them. Staff completed a pre-admission assessment which considered their views, the views of relatives/representatives, and information about the person’s needs from health and social care professionals. This collaborative approach ensured people’s safety and well-being was prioritised when they moved into the service.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Relatives said they had no concerns about people’s safety at the service. They told us staff always contacted them and the local authority if there was an incident or accident at the service. A relative said, “Yes, it’s been very good. We’re kept informed about anything and everything now.”

The provider had risk management policies and procedures that minimised restrictions on people’s freedom, choice and control. Managers and staff followed these to ensure people made decisions about their life, care and treatment in line with the Mental Capacity Act 2005.

At our last inspection some people’s choices as to where they spent their time was restricted as they were encouraged to stay in communal areas where staff were present. At this inspection improved staffing levels and deployment, and a better understanding of people’s needs, abilities, and wishes, meant people had the freedom to spend time in their rooms, in communal areas, and out in the community.

Staff were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people using the service. A staff member told us, “We all know what to do if someone is at risk. We would tell the [interim] manager or whoever was in charge, or we’d go to [the provider], and if nothing was done, we’d tell the local authority and CQC.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a balanced and proportionate approach to risk that supported people and respected the choices they make about their care.Where appropriate, people were encouraged to take positive risks in order to live fulfilling lives. For example, since our last inspection some people were being supported to use community facilities (transport/shops) more independently.

Staff had received further training to manage specific risks. At our last inspection, staff were not always following a specific emergency health protocol which outlined the measures to take in response to a person's health condition. The provider agreed to immediately address this. At this inspection, most staff had completed the necessary training, and only trained staff accompanied the person when they went out into the community.

Staff managed distressed behaviours well, following detailed care plans and risk assessments. Since our last inspection, they had had safety intervention training at de-escalation and breakaway level. We observed a staff member successfully using these skills to redirect a person from another person. This was done tactfully and calmly with a good outcome for both people involved. The provider had applied to register with the restraint reduction network with a view to further improving staff practice in this area.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The service’s call bell system was not working effectively and was potentially unsafe. This system was used by staff if they needed urgent assistance. Managers and staff were unsure whether it worked in all parts of the premises. People were accommodated on three floors and at times staff were alone with people on one of these floors. There was also an activities hub in the courtyard where staff might also be alone with people.

We discussed the call bell system with managers who took immediate action to address the risk. Following our inspection, and as a temporary measure, staff were given hand-held radios which they could use to call for assistance. The provider agreed to have the call bell system replaced and was in the process of getting quotes for this work to be carried out.

Other risks in the environment had been identified and addressed. The stairs were steep, so people used the lift instead, supported by staff where necessary. Window restrictors were fitted and water temperatures controlled. The gardens were secure and the front door kept locked with a safety button to unlock it.

Some refurbishment, including new bath and shower rooms, and redecoration was taking place to improve and upgrade the premises. This had resulted in minor disruption to the premises and the temporary removal of some user-friendly signage. The interim manager said this would be put back in place once the improvements had been completed.

The safety of the premises, including communal and personal spaces (such as bedrooms), and the living environment were checked and managed to support people to stay safe. The provider’s health and safety manager and the service’s maintenance person carried out regular audits to ensure the premises were safe and well-maintained. The fire risk assessment had been reviewed and was up to date. Records showed equipment had been checked and serviced in line with national requirements.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Relatives were satisfied with staffing levels at the service. A relative said they visited the service regularly at different times and it was never short-staffed. All the relatives we spoke with made many positive comments about the staff. A relative told us, “The staff know the residents well and they meet their needs. [People] are busy and do lots of things.”

The service had an established staff team who were knowledgeable about the people they supported. Some new, permanent staff had been recruited and were being inducted and trained. They were enthusiastic about working at the service and keen to learn about and understand people’s needs. The service still used a small group of agency staff who were familiar with the service and its values. These staffing arrangements meant people received continuity of care and support.

Staff were safely recruited and had the necessary checks to help ensure they were suitable to work with people using care services. They completed a comprehensive induction followed by ongoing training and development throughout their employment. Where necessary the provider’s training department sourced specialist training courses so staff could meet the range of needs of the people using the service.

The provider and interim manager continuously reviewed staffing levels to ensure people’s needs were consistently met. Staffing decisions considered dependency levels, individual needs, funding provisions, and service occupancy so people received safe and responsive care at all times. Additionally, 24/7 on-call management support was in place to provide guidance and respond to any urgent staffing or care concerns.
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The premises were clean and tidy throughout. Relatives said the premises were always clean. A relative told us, “Yes it seems nice and clean, no issues. [Person’s] room and bed is clean, seems fine, I’m pleased with cleanliness.” Another relative commented, “When I go there the lounge, corridor and kitchen are well-managed and clean. It smells nice - of good food cooking.”

Improvements had been made to cleanliness and infection prevention and control (IPC) at the premises following a local authority IPC visit in 2025 when shortfalls were found. In response the provider created an action plan setting out what needed to be done. When we inspected all the recommended actions were competed and the service was fully compliant. In addition, the service had been awarded a 5-star rating (the highest achievable) for food hygiene.

Staff were trained in IPC and understood, their roles and responsibilities for maintaining high standards of cleanliness and hygiene. Hand hygiene and general IPC competency assessments were conducted regularly to ensure staff training was effective. Accessible policies covering IPC, health and safety, food hygiene, and COSHH were kept in the office so managers and staff could refer to them at any time.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people and their representatives in planning, including when changes happened.

At our last inspection medicines were not always managed safely. There was a lack of guidance for safe administration, and best practice was not always followed. At this inspection medicines management had improved, and people’s medicines were ordered, administered, recorded, stored, and disposed of safely.

The service had a new, secure medicines room and secure trolleys to transport medicines throughout the service. When people had medicines on an ‘as required’ (PRN) basis, written instructions were in place to inform staff of how and when it was appropriate to administer these medicines. This reduced the risk of people being over-medicated.

Where people needed to have their medicines administered directly into their stomach through a tube, there were clinical protocols in place to inform staff on how to prepare and administer these medicines safely. Staff had certificated training in enteral feeding/medicines administration and the NHS team who oversaw this specialism visited the service to check administration was being done safely.

The service worked with GPs and psychiatrists to reduce, where appropriate, the amount of medicines people took. This was in line with Stopping over medication of people with a learning disability and autistic people (STOMP),an NHS England initiative to prevent the inappropriate prescribing of psychotropic medications.

Relatives were involved in decisions about people’s medicines. A relative said staff arranged a conference call when it was proposed a person’s medicines were changed. They said, “We had a conversation with the staff rather than just being told. They went through the new medication and explained what it is and what it’s for. They explained this to us in detail and sent an email too. It was good."