This unannounced inspection took place on the 21 and 22 March 2017. At the last inspection on 7 and 14 January 2015, the home was found to be meeting all of the regulations we inspected.The Old School House is a care home that specialises in the care of older people who are living with dementia. Most people who live at this home have complex needs associated with their diagnosis of dementia. The home is registered to provide care for up to 40 people. People are accommodated in individual bedrooms located on two floors of the building. There are communal lounges and dining areas on each floor and the floors are connected by stairs and passenger lifts. There is an enclosed garden, and some parking at the front of the building. At the time of our inspection there were 32 people living in the home. The Old School House is one of eight services run by the East Riding of Yorkshire Council.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
Care was planned in partnership with people and their families, and people received the care and support they needed to meet their individual needs. Relatives spoke exceptionally highly of the quality of care they and their loved ones received, and said they were kept well informed about the person's wellbeing. The managers and staff were committed to working in a person-centred way and treating people with kind-heartedness and consideration. People, including those who had difficulties communicating or who could become upset, responded positively to the way in which staff approached them. Staff told us they enjoyed working at the Old School House and we saw staff treated people professionally but also showed people they were valued and important. Staff did this through the way they spoke to people, offering reassurance with comforting words and a gentle tone of voice and holding people's hand if appropriate.
People were relaxed with staff. Visitors and relatives told us they felt the Old School House was a safe environment for people to live in. People were protected from abuse because staff could identify the different types of abuse and knew what actions to take to report abuse.
Whilst people received excellent care, there was a strong emphasis on continually striving to improve the service. Improvements were identified through consultation with people, relatives and health care professionals involved with the Old School House through informal chats, meetings, reviews, family forums and surveys. For example, the registered provider had recently provided a dedicated area for relatives to use so that they could be close to their loved ones when they were unwell. This showed that the registered provider placed a high value on meeting the needs of people and their relatives.
As well as consulting with people, the Old School House strove for excellence through reflective practice at all levels, from care staff to senior management. There were systems in place to monitor the quality and safety of the home and bring about any improvements that were needed. The home worked in partnership with other organisations to make sure they were following current best practice and providing a high quality service.
There was a truly open atmosphere upon entering the Old School House. The home had a clear management structure, with an established service manager, registered manager and senior care officers. They worked closely with staff, frequently observing and providing care. Relatives, staff, health care professionals and volunteers were confident in the leadership of the service. They were encouraged to raise any areas of concern, which were taken seriously and the appropriate action taken.
Staff demonstrated excellent interpersonal communication with people and supported them to express their views. They had clear strategies in place where people had difficulties with communication. The staff were familiar with the needs of people living with dementia. The registered manager and senior staff kept up to date with best practice in dementia care and ensured this was adopted by the staff. The environment had been designed to promote the independence and wellbeing of people who lived with dementia. There was plenty of communal space, lounges, and dining areas were available to people, as were quiet areas where people could sit in peace.
Risks to people were monitored and staff minimised the risk of injury whilst enabling people to maintain a safe level of independence. Staff supported people in a positive way and were able to recognise when people may require additional support. They had received bespoke training to intervene when people were at risk from behaviour that may challenge others and they intervened calmly and confidently when they noticed anything that could cause a person to become distressed. We saw that people were cared for and supported by qualified and competent staff who were regularly supervised and appraised regarding their personal performance. Staff told us they felt extremely well supported by the registered manager and provider through training, seminars and meetings where their views were listened to.
People were placed at the heart of the home, which was organised to suit their individual needs. They were supported by staff that were compassionate and treated them with dignity and respect. Without exception, people’s visitors and relatives we talked with were highly complementary and positive about the staff that supported them. Relationships with families and friends were highly valued and developed so that people living at the home were able to maintain and develop their bonds with people who were important to them. We saw friends and families had built relationships with other people living at the Old School House and often continued to visit them after their own family members had died. This provided people living in the home with continued friendships and connections with people that were interested in them as individuals and that enriched their quality of life.
The mealtime we observed was relaxed and organised. People were supported to eat in a supportive and calm setting that provided opportunity to socialise as well as eat. The staff were attentive and provided the support people needed to be able to enjoy a meal. Food was attractively presented and people were able to choose what they wanted to eat. Special dietary requirements were understood and provided for. Food and drink was available at the Old School House whenever people needed it, not just at regular mealtimes.
People's ability to make decisions was assessed and where people lacked the mental capacity to consent to their care and welfare actions were taken in their best interests. There was evidence of communications with other health care professionals and people’s relatives ensuring that all the significant individuals were involved in meeting people's needs. The registered manager had taken appropriate action when people did not have the capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests.
The premises were safely maintained with maintenance certificates, contracts and records to show this. The registered provider's recruitment processes ensured suitable staff were recruited and during this inspection we saw there was sufficient staff available to provide support to people when needed.