Background to this inspection
Updated
7 March 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team was made up of two inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Old School House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Old School House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
During the inspection
We spoke with 8 people who used the service and 4 relatives about their experience of the care provided and two visiting healthcare professionals. We spoke with 5 members of staff including the provider, compliance manager, two managers and care workers. We reviewed a range of records. This included 10 people's care records and multiple medication records. We looked at recruitment and a variety of records relating to the management of the service, including policies and procedures.
Updated
7 March 2023
About the service
About the service The Old School House is a residential care home providing accommodation in one adapted building for up to 36 older people who require personal care. The service specialises in supporting people living with dementia. At the time of the inspection 26 people were living at the home.
Since our last inspection improvements had been made in how risks to people were assessed, monitored and managed. There were sufficient staff deployed to meet people's needs and staff recruitment was on-going. Medicines were managed safely, and people received their medicines as prescribed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; although there were policies in place the systems in the service did not always support this practice because records relating to decision making were not always in place.
The provider, manager and staff were clear about their roles and responsibilities. Quality assurance checks were in place to monitor the quality of the service provided, however improvements were still being embedded.
People living at The Old School House told us they received safe care from staff who knew how to identify and report any concerns. People told us and we observed staff treated people with kindness, dignity and respect.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 13 September 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended that the provider consider, The National Institute for Health and Care Excellence's (NICE): Giving medicines covertly: A quick guide for care home managers and home care managers providing medicines support and take action to update their practice accordingly. At this inspection we found the provider had acted on this recommendation and the provider was able to explain how people would receive their medicines covertly and in line with NICE guidelines.
Why we inspected.
The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.
Further to this we carried out an inspection of this service on 11 July 2022 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve risk management, medicines management and governance arrangements.
We also undertook this focused inspection to check they had followed their action plan and to confirm they met legal requirements. This report only covers our findings in relation to the Key Questions safe, caring and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will meet with the provider following this report being published to discuss how they will fully embed and sustain changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.