The Old School House Care Home

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• 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 good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to dignity and respect, safe care and treatment and good governance.

This service scored 42 (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 did not always make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People and relatives told us they were not involved in care planning, with one person saying, “I don’t know anything about any care plan”.

We found gaps between assessments and care delivery, including inaccurate or unreliable records, such as personal care being recorded but not delivered. Care plans and risk assessments were not always consistent, and staff did not always demonstrate a clear understanding of people’s needs. Some people reported concerns about hygiene, with one stating it had “been months since I have had a shower”, while records indicated personal care had taken place, showing inconsistencies.

We observed staff supporting a person to move around the home, however, they did not speak to the person or ask them where they would like to spend their day.

We did see records of care plans and clinically recognised tools for assessing people’s needs and monitoring outcomes, such as Waterlow and MUST (Malnutrition Universal Screening Tool) charts.

The provider did not consistently deliver care and treatment in line with evidence-based guidance, and people were exposed to avoidable risks.

People’s nutritional and clinical needs were not always met in line with best practice. For example, people assessed as needing modified diets or supervision during meals were not always supported, increasing risks such as choking. Staff were not always able to tell us who had modified diets, and records showed people were sometimes given incorrect fluid consistencies. This placed people at risk of receiving inappropriate care. These concerns were widespread and ongoing, showing a continued failure to embed effective assessment processes.

We observed moving and handling practice which was not in line with best practice guidance and increased the risk of harm and injury to a person. Repositioning to prevent pressure damage was not consistently recorded or completed.

A professional told us, “Based on our observations, we do not feel staff consistently demonstrate a strong understanding of resident’s needs or risks. Inaccurate understanding of resident’s functional abilities, for example, a resident identified as independent despite requiring supervision.” However, another professional told us, “Residents were given food on their laps, and they were not supported with eating their meals. We have encouraged staff, raised concerns and action was taken.”

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Feedback from people and relatives was mixed, with some not being kept informed about changes in care or hospital admissions.

A relative told us, “There needs to be consistency in the manager and there should be a supportive network for staff as currently they are not able to work to the best of their abilities with all the comings and goings across the board from management, staff and cleaners. Someone needs to look at the dynamics and kick them into gear.”

A professional told us, “We aimed to work collaboratively to enable the service to reflect, learn and develop without immediate escalation. However, there has been limited evidence of meaningful or sustained improvements.”

Staff described daily meetings and handovers where key information was shared, and some reported improved communication and teamwork. Professionals commented about the effectiveness of the handovers, saying, “Handover quality is generally poor and inconsistent” and “We noted handovers to be very basic and brief about concerns overnight, but no detail.”

At the time of our assessment the provider was working alongside the local authority team and other professionals as part of a safeguarding process.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

Support for health needs was inconsistent, with examples of delays in addressing issues such as broken hearing aids and limited encouragement to mobilise. These failures showed the service was not effectively supporting people to maintain health, wellbeing and independence.

Feedback from professionals and relatives also raised concerns about whether people always received appropriate support with eating and drinking. Comments included, “[Person’s name] fluid intake is not to a standard I would expect, due probably to a lack of staff.”

Opportunities for activity and social interaction were limited. People described feeling lonely, with comments such as, “There is nothing to do here”, and “It can get lonely.”
We observed a lack of meaningful engagement, with people often left sitting without interaction. Professionals and relatives told us, “I could not observe any meaningful activities taking place. I noted that there was no organisation in terms of activities and readily available books, puzzles, magazines etc. The team have also recruited another activity coordinator, which is very positive.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

We saw records of food and fluid intake monitoring, including records of how much people had eaten. However, records were not always consistent. For example, some entries showed care interventions had taken place when people reported they had not. As a result, the provider could not be assured documentation was reliable or accurate to effectively monitor peoples care and treatment.

Professionals raised concerns in relation to escalating concerns to meet clinical expectations, comments included, “Our experience is that there are ongoing concerns regarding timely identification, escalation, and management of clinical risks” and “There have been multiple occasions where significant clinical issues had not been escalated in a timely way. This indicates that internal monitoring and escalation processes may not be consistently effective.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People reported limited choice, for example, “You get what you are given”, particularly in relation to clothing.

We observed occasions where staff did not seek consent or allow people time to respond, and records did not always demonstrate that people were involved in decisions.

One person’s care plan lacked mental capacity assessments in relation to restrictions in the persons care, for example bed rails and CCTV. Other people had mental capacity assessments completed, but they did not always reflect people’s views or how decisions were explained to them. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

These inconsistencies meant people’s rights were not always upheld, although there were some areas of appropriate practice. People told us staff often knocked and asked permission before providing care, with one person saying, “They do ask permission and they often knock”.