The Old School House

The Old School House is a care home providing personal care and accommodation. The service can support up to 7 people. People living in the home had their own bedrooms and there were shared communal spaces, including lounges, a kitchen, and a garden area. At the time of this inspection 3 people were receiving a regulated activity.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People's experience of using this service and what we found

The service had made improvements required following our last inspection and could demonstrate how they met most of the principles of right support, right care, right culture. However, further improvements were needed regarding the providers quality monitoring systems, activities and some aspects of care planning.

Right care

Improvements were needed to be made regarding the identification and recording of peoples wishes and preferences as they approached the end of life. People were safeguarded from the risk of abuse as staff had refreshed their safeguarding training and knew how to respond to allegations of concern. People’s individual care and support plans reflected their needs, wants and wishes.

Right Support

People needed to be further engaged in developing activities which were functional, enjoyable and built on their existing skills whilst promoting new ones. People were involved in the development and reviews of their care and support plans which reflected their needs and wishes. 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; the policies and systems in the service supported this practice.

Right culture

People received effective care and support which met their individual needs. The provider completed quality checks to identify and improve people’s experiences of care. However, these checks needed to be embedded into practice and demonstrated as effective over time. These included checks to the physical environment where people lived to ensure it was safe.

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 inadequate (published 21 December 2023) and there were breaches of regulations regarding safety, protection from abuse, consent, person centred care and how the service was managed. Following the last inspection, the provider was issued with a warning notice giving them a specific date by which to be compliant with the law. Improvements were noted at this inspection and the provider was no longer in breach of regulations. However, improvements were still required. Please see the responsive and well-led sections of this report.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Old School House is a care home providing personal care to 3 people at the time of the inspection. The service can support up to 7 people. People living in the home have their own bedrooms and there are shared communal spaces, including lounges, a kitchen and a garden area. At the time of this inspection 3 people were receiving a regulated activity.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People's experience of using this service and what we found

The service could not show how they met some of the principles of right support, right care, right culture

Right Support

Although The Old School House is a smaller building, part of a local community, people still did not always have the opportunity to gain new skills or experience new things. The provider did not promote independence or the development of social or vocational skills.

People were not supported by staff to have the maximum possible choice, control and independence. The completion of mental capacity assessments was inconsistent and did not follow best practice. There was a lack of understanding and application of the mental capacity act or the decision-making process when people were unable to make decisions for themselves.

Although people were supported by enough staff there was little direction on how to effectively engage and stimulate people. There was limited information on people’s individual communication skills or how to identify and promote individuals’ goals and aspirations.

People were not involved in the development of their care and support plans and the plans in place did not accurately reflect their current needs and wishes. Care plan reviews were ineffective and did not involve the person or those close to them.

Right care

People did not receive appropriate care and support as staff did not have the right information, guidance or assessments. People were at the risk of abuse as the management could not evidence they had effectively monitored incidents or situations or pass on information of concern to others when needed.

People’s individual care and support plans did not reflect their needs, wants and wishes.

The principles of STOMP (stop over medicating people with learning difficulties) had been considered and referenced when people were prescribed ‘as required’ medicines. However, when people received medicines disguised in food there were no care and support plans to support this safely or in accordance with the person’s wishes.

The management team failed to promote equality and diversity as this was not recorded in people’s care and support plans. People did not receive privacy as the introduction of CCTV had not evidenced people’s involvement, consent or best interests.

Right culture

People did not receive effective or responsive care and support which met their individual needs. People were not empowered by a staff team to live a fulfilled life that included taking positive risks. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible or in their best interests; the policies and systems in the service did not support good practice. There was a lack of understanding around how people should be involved with the service delivery.

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 4 May 2022) and there were breaches of regulations regarding consent, person centered care and how the service was managed. 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 the provider remained in breach of regulations and we found additional concerns and breaches including safety and protecting people from the risk of abuse.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support right care right culture and to follow up on action we told the provider to take following the last inspection.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old School House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s individual care and support, consent, keeping safe, protecting from abuse and how the service is managed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information, we may inspect sooner.

About the service

The Old School House is a care home providing personal care to five people at the time of the inspection. The service can support up to seven people. People living in the home have their own bedrooms and there are shared communal spaces, including lounges, a kitchen and a garden area. The building is over two floors.

People's experience of using this service and what we found

The service could not show how they met some of the principles of right support, right care, right culture

Right Support

Although The Old School House is a smaller building, part of a local community, people still did not always have the opportunity to gain new skills or experience new things. People were going out more and there were plans in place to further develop this in the future.

People were not supported by staff to have the maximum possible choice, control and independence, as people’s capacity had not been considered or best interests decisions made. There was a lack of understanding around this and staff provided us with inconstant views of how people should be supported.

People were supported by enough staff, further improvements were needed to ensure staff fully understood the needs, wishes and aspirations of the people they supported. When people chose not to verbally communicate, more development and understanding was needed to ensure they were involved in the home equally as the other people who lived there.

People were supported to make day to day choices however they needed to be empowered to ensure they were involved with making bigger decisions. Improvements were needed to ensure people were involved with their care and reviews and to ensure information was presented to them in a format they understood.

The home environment had improved it was homely and clean.

Right care

Staff did not always have the relevant skills or experience to ensure they received

the appropriate care. Although training had increased since our last inspection, we could not always see how staff had implemented this and how this had impacted on people.

Staff received training and an induction that helped them support people. Competency was checked in some area’s improvements were needed to ensure this covered all keys areas, including capacity and consent.

Improvements had been made and people were protected from harm, procedures in place supported this and staff were able to demonstrate an understanding to us.

Care plans had been updated to identify when people may be at risk and when incidents had occurred these were reviewed. The governance of the home had improved, and audits were identifying areas of improvement. These needed to be more robust to ensure the identified all concerns.

The principles of STOMP (stop over medicating people with learning difficulties) had been considered and referenced when people were prescribed ‘as required’ medicines.

Staff enabled people to access specialist health and social care support in the community. Staff promoted equality and diversity in their support for people. People received kind and compassionate care.

Staff protected and respected people's privacy and dignity.

Right culture

People continued to not always be always supported by a management team and staff who fully understood the holistic needs of supporting people with learning disability and autism. People were not empowered by a staff team to live a fulfilled life that included taking positive risks. The culture of the home restricted people as the ethos, values and attitudes of the management team and staff were not empowering. There was a lack of understanding around how people should be involved with the service delivery.

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 inadequate (published 4 May 2022) and there were breaches of regulations.

At this inspection we found the provider remained in breach of regulations. The provider had not complied with the warning notice for Regulation 11 and this remains.

This service has been in Special Measures since 11 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and to follow up on action we told the provider to take at the last inspection.

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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old School House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 11, Need for consent, Regulation 9 Person Centred Care and Regulation 17, Good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information, we may inspect sooner.

The Old School House is a care home providing personal care to five people at the time of the inspection. The service can support up to seven people. People living in the home have their own bedrooms and there are shared communal spaces, including lounges, a kitchen and a garden area. The building is over two floors.

People's experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service could not show how they met some of the principles of right support, right care, right culture

Right Support

Although The Old School House is a smaller building, part of a local community, people did not always have the opportunity to gain new skills or experience new things.

People were not supported by staff to have the maximum possible choice, control and independence, as people’s capacity had not been considered or best interests' decisions made.

People were limited with the choices they made, some areas had improved including how meals were planned however this was one aspect of people’s care and for other areas this had not been considered.

Improvements had been made to the environment to ensure it was safe, however further improvements were needed to create a homely environment for people to live in.

Right care

Staff did not understand, and people were not protected from abuse. Staff had training on how to recognise and report abuse, however, we could not be assured this was effective.

People were at risk of not receiving their medicines when needed and recording systems were not always in place or guidance for as required medicines.

Staff did not always have the relevant skills or experience to ensure they received the appropriate care. Although training had increased since our last inspection, we could not always see how staff had implemented this and how this had impacted on people.

People were limited in pursuing their interests as we saw people mainly only accessed the local shop and community instead of experiencing wider environments. There was no evidence of how people were involved with their care or the people that were important to them.

The care people received was not always person centred, care plans we reviewed were not always individual to the persons needs and not presented in a format they could understand.

Staff protected and respected people's privacy and dignity.

Right culture

People were not always supported by a management team and staff who fully understood the holistic needs of supporting people with learning disability and autism. People were not empowered by a staff team to live a fulfilled life that included taking positive risks. The culture of the home restricted people as the ethos, values and attitudes of the management team and staff were not empowering.

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 inadequate. The service was inspected on 17 and 22 December 2021. (Published 14 March 2022) There were breaches of regulations.

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 the provider remained in breach of regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and to follow up on action we told the provider to take at the last inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Old School House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to regulation 11, Need for consent, regulation 12, Safe care and treatment, regulation 13, safeguarding service users from abuse and improper treatment and regulation 17, Good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information, we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service.

This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

The Old School House is a care home providing personal care to five people at the time of the inspection. The service can support up to seven people.

People’s experience of using this service and what we found

The service could not show how they met some of the principles of right support, right care, right culture.

Right Support

People were not supported by staff to have the maximum possible choice, control and independence. People did not have the opportunity to gain new experiences or learn new skills. People were not always supported by staff to pursue their interests. Staff did not support everyone to take part in activities within their local community. People were not supported to play an active role in maintaining their own health and wellbeing.

Right Care

People were supported by staff who did not have the relevant skills or experience to ensure they received the appropriate care. Staff did not always understand or respond to people’s individual needs. Staff did not understand how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse but did not apply this understanding. People did not always have the opportunity to take part in activities and pursue interests that were tailored to them. The provider did not have enough appropriately skilled staff to meet people’s needs or to keep them safe. Staff protected and respected people’s privacy and dignity.

Right Culture

People did not have an inclusive or empowered life because of the ethos, values, attitudes and behaviours of the management and staff. People were not supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and autistic people may have. This meant people did not always receive compassionate or empowering care. The care and support people received was not always person-centred. We could not be assured that people and those important to them were involved in planning their care. Not all people’s quality of life was enhanced by the service’s culture.

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

This service was registered with us on 2 July 2020 and this is the first inspection.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support right care right culture.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to regulation 9, Person-centred care, regulation 11, Need for consent, regulation 12, Safe care and treatment, regulation 14, Meeting nutritional and hydration needs, regulation 15, Premises and equipment, regulation 17, Good governance and regulation 18, Staffing at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.