The Old School House Care Home

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 remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulation in relation to premises and equipment. Improvements were not found at this assessment, and the provider remained in breach of this regulation. In addition, the provider was in breach of the legal regulation relating to safe care and treatment.

This service scored 44 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Records showed incidents were recorded, however not all incidents and accidents had evidence of being signed off or reviewed by the management team. This was the case for a number of incident records throughout April, including an incident where a person was entering another person’s bedroom, causing them distress. This meant the provider could not always be assured incidents and accidents were being escalated and monitored appropriately to minimise reoccurrence.

Professionals told us that while some improvements had been made at the service, these were not always sustained. One professional told us, “The same patterns of concern have continued over a prolonged period, despite ongoing support.”

Concerns raised by people and relatives were not consistently acted on, and learning was not always embedded. A person told us, “I would like the sofa to be replaced… I have asked three times” which demonstrated issues were not resolved.

Staff described improvements in communication through daily meetings and reported a more open approach to discussing concerns.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Feedback from relatives was mixed regarding communication about hospital admissions and care changes.

Relatives told us staff were kind and compassionate, and some staff described good teamwork. However, others raised concerns about inconsistent leadership, staff turnover, and the impact this had on continuity and quality of care.

Some people reported positive experiences of admission, with one person stating, “I moved here from hospital… I really liked it.” However, evidence identified gaps in communication and coordination meant relatives where not always included when people moved between services.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from abuse, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Some professionals told us there were repeated safety concerns. Comments included, “Individuals were moved out of the home, as concerns were raised that they [the service] were not able to meet their needs safely” and “There are repeated examples where risks identified have not been addressed promptly or sustained.” The professional provided examples, including concerns relating to personal care, hydration and risk management.

The Nominated Individual showed us some records of concerns being escalated to the local authority safeguarding team. They were aware some staff had not completed their safeguarding training and told us this was being “managed via performance management.”

Although people told us, “I feel safe here”, poor care practices put people at risk of harm. The consultant working with the service told us, “There is more training to be done on staff being able to identify and then report on appropriate safeguarding concerns.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. When people receive care and treatment in their own homes, an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The service had applied for DoLS through the legal authority and had a tracker monitoring these applications.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks related to falls and mobility were not always managed appropriately. One person described being discouraged from moving and not having access to mobility equipment. We observed a piece of equipment being out of reach for a person, putting them at increased risk of falls.

Observations identified unsafe moving and handling practices and inadequate management of risks such as choking.

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 provider did not provide a consistently safe or well-maintained environment. For example, some fire doors did not close properly and routine internal checks for fire safety, legionella, and equipment maintenance were missing or could not be evidenced in line with the providers processes. A staff member told us, “The only thing (which needed to improve) is the plumbing we have ongoing issues with the hot water.” However, we saw records of routine external 6 monthly LOLER (Lifting Operations and Lifting Equipment Regulations) checks and fire risk assessment.

We discussed these concerns with the Nominated Individual, who told us they had now put these checks in place and had contacted a professional to complete work on ensuring the fire doors close appropriately and were safe.

We received mixed feedback from relatives in relation to the service being well maintained. Comments included, “They have new furniture and a new washbasin”, but others expressed concerns about windows not closing properly and the TV remote control not working.

The provider did not always have enough suitably trained and supported staff to meet people’s needs.

People often adapted their expectations because they recognised there were not enough staff. One person said, they “wait for staff” rather than requesting support, indicating care was not always delivered when needed.

Staff and relatives told us there was a high staff turnover which affected continuity of care. Comments included, “Staff are doing their best in a very difficult situation because there is no continuity of management”, and “To be honest I think they could do with a couple more staff. Carers have been having to do the cleaning and work in the kitchen as well. There’s a lack of consistency in the carers.”

There were no records to demonstrate new staff were safely inducted to the service. One staff member told us, “I do my shadow shifts and they showed me around, but I have not been sent any induction paperwork.” Many staff told us they had not had a formal supervision. The Nominated Individual told us they knew formal supervisions had not taken place, however, they were completing spot checks and working on the floor with staff.

Safe recruitment practices were being followed. Staff had references and Disclosure and Barring service (DBS) checks, as required. DBS checks provide information, including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

We observed unclean areas, including the bathroom and kitchen spaces. In one bathroom, there was a missing tile behind the toilet, and the bathroom fabric light switch was visibility dirty. These concerns prevented surfaces from being effectively cleaned to minimise the risk of cross-contamination. There was a strong unpleasant odour within the dining room. Cleaning schedules were not fully completed, and monitoring systems were not embedded. Environmental cleanliness issues and lack of oversight increased the risk of infection and did not ensure people were protected.

Cleaning products were left accessible in communal areas, and unclean areas were observed, increasing risks to people’s safety and wellbeing. These issues demonstrated significant and ongoing risks within the environment.

The Nominated Individual told us that, following concerns raised about the kitchen, this area had been deep cleaned. However the same concerns had been identified at our previous assessment, and the provider had not implemented effective systems to monitor and maintain the cleanliness of the kitchen. As a result, these shortfalls continued to be evident at this assessment.

We received mixed feedback from relatives in relation to the cleanliness of the service. Comments included, “[Their] room always smells clean”, and “I have found congealed food under [their] bed, on the walls and on table legs which had been there for a long time. I’ve dug some off with wet wipes. I’ve spoken to the manager about this, and they said that [Person’s name’s] room needs a deep clean but that’s not happened yet.”

The provider did not always manage medicines safely and effectively, although some appropriate systems were in place.

We found records did not always include PRN (When required medicines) protocols and PRN records were incomplete. While leaders were aware of these issues and had begun to act, systems were not yet fully effective in reducing risk.

Most relatives told us they were not contacted or involved with changes in people’s medication. Comments included, “No they don’t (contact me)”, and “No, and I did have to remind the home that I have Power of Attorney Health Welfare when they didn’t inform me that (Person’s name) had been hospitalised.”

People told us, “They support me to take my meds, that’s fine”, and we found medicines were stored securely.