The Old School House and Courtyard Nursing Home

The Old School House and Courtyard Nursing Home is a residential care home providing personal care and support for up to 36 people. The service provides support to people with dementia, older people and people with a physical disability. At the time of our inspection there were 33 people using the service.

The Old School House and Courtyard Nursing Home accommodates 36 people in one adapted building split into two areas, each of which has separate adapted facilities.

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

The service did not have a registered manager in place. A manager had been recruited, however, had not yet submitted their application to the Care Quality Commission to register.

The service requires some minor repairs and decorating; however, the provider was very responsive to this and produced action plans and time frames when the work would commence. The service and staff were clear about their responsibilities when incidents occur and understood how to raise concerns.

Some recording issues regarding medication were identified during the inspection. The manager immediately rectified this by implementing further daily audits.

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.

The service has a positive culture that is person centred, open and empowering and delivers compassionate care. Managers and staff were clear about their roles and responsibilities and had an understanding of the risks and issues facing the service.

The service has an effective governance system in place. Information from governance meetings and action plans support to drive improvement and improve outcomes for people.

The service involves people, their families in a meaningful way. It engages and involves staff and ensures their views are acted on to shape the culture of the service.

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 16 April 2021) 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.

Why we inspected

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.

We carried out an unannounced inspection of this service on 19 July 2022. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and well led.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe 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. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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 and Courtyard Nursing Home is a residential care home which was providing personal care and support to 30 people aged 65 and over at the time of the inspection. The service can support up to 42 people.

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

The provider had failed to ensure fire safety risks were resolved in a timely manner. Risks to people’s safety and wellbeing were not always identified, managed and effectively monitored. These shortfalls placed people at risk of harm.

Robust quality assurance systems were not always in place or effectively operated. Shortfalls had not been identified or promptly addressed which placed people at risk of receiving a poor-quality service. The management team was inconsistent and there was a lack of oversight from the provider.

Regular changes in the management team had led to low staff morale. Staff were kind and caring and had a positive attitude when supporting people. Relevant professionals were contacted to ensure people’s healthcare needs were met.

Staff ensured people lived in a clean and tidy environment. Infection prevention and control measures followed government guidance. However, on one occasion isolation processes were not fully followed.

People’s medicines were administered safely. Staff were trained in safeguarding adults and concerns had been appropriately reported. Action was taken following accidents and incidents to reduce the risk of them happening again. There were enough staff to meet people’s needs safely and in a timely manner.

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.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 February 2020).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We found there was a concern with governance systems, so we widened the scope of the inspection to become a focused inspection, which included the key questions of Safe and Well-led. No areas of concern were identified in the other key questions, therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old School House and Courtyard Nursing Home 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 monitor the service.

We have identified breaches in relation to risk monitoring, record keeping and addressing quality shortfalls at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Old School House and Courtyard Nursing Home is a residential care home providing personal care and support to 26 people aged 65 and over at the time of the inspection. The service can support up to 42 people.

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

People told us they felt safe and they received their medicines on time and as prescribed. Staff followed good infection control processes and lessons were learnt when things went wrong.

People’s needs were thoroughly assessed, and care plans were regularly reviewed to ensure information remained up to date. People had access to plenty to eat and drink and those who required assistance received additional support.

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.

The home was welcoming, and staff were friendly. Everyone we spoke with told us staff were kind and treated people with respect.

Staff knew people well and tailored support to meet people’s different needs. They engaged people in meaningful activity and people’s friends and families were free to visit the home at any time.

People told us the home was well-run and were confident any concerns would be addressed.

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 26 February 2019) and there were multiple 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.

Why we inspected

This was a planned inspection based on the previous rating.

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 inspection took place on the 10, 11 and 14 January 2019. The first day of inspection was unannounced.

At the time of inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 16 November 2017 we rated this service 'requires improvement'. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was Regulation 18 (staffing). During this inspection we have identified a continued breach of Regulation 18. We also identified a breach of Regulation 17. You can see what action we told the provider to take at the back of the full version of the report.

This is the second consecutive inspection this service has been rated requires improvement.

Staff induction records were not fully completed. Some staff had out of date training. Staff were not receiving regular supervision and appraisal.

Some concerns found at the last inspection were identified again at this inspection. The provider had failed to ensure appropriate action was taken to develop the service. Audits had failed to identify and address some of the concerns we found at inspection. When actions required had been identified by the provider these had not always taken place.

The building required some improvements with the maintenance. Action had not always been taken in a timely manner when faults had been reported. The home had recently had a food hygiene inspection and was rated two, which means improvement is necessary. Work was ongoing at the time of inspection to resolve the issues.

Risk assessments had not always been implemented to mitigate the risk in regards to the health and safety of some people.

People were offered food and drinks throughout the day; however, people were not always offered a choice of drinks. We observed the meal time experience and found this could be improved.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Best interest decisions were carried out when required.

People told us staff were kind and caring. During the inspection we observed interactions were often task focused but staff were caring in their approach. People’s independence was encouraged.

Care plans did not always contain person centred information. The registered manager had taken steps to start improving these, by putting person centred profiles in place. Complaints were responded to appropriately.

The service had an activities coordinator, however we observed limited activities during the inspection.

The registered manager and deputy manager were open and transparent throughout the inspection.

At a focused inspection of the service in June 2017 we identified a breach of regulation in respect of the management of medicines. Storage and recording of controlled drugs was not satisfactory and some of the recommendations made in medicines audits undertaken by health care professionals had not been actioned. At this inspection we found that improvements had been made and the provider was no longer in breach of this regulation.

At our previous comprehensive inspection in October 2015 we judged the service to be Requires Improvement in Safe and Good in all other areas. There was no breach of regulation at this time but we made a recommendation about the need for service and maintenance certificates to be up to date. At this inspection we found improvements had been made.

The Old School House and Courtyard Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide accommodation and care for up to 42 older people, some of whom may be living with dementia. There were 36 people living at the home on the day of the inspection. The home is divided into three areas: The Old School House, The Courtyard and The Bungalow and each is staffed separately. All of the accommodation is on one level.

The manager had submitted their application for registration to CQC and it is currently being processed. They were previously the registered manager of another service belonging to the same provider. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that staff lacked knowledge of the Mental Capacity Act 2005 (MCA). The manager had identified this as a training need and was in the process of sourcing detailed training in this subject. In the interim, training workbooks and a specific module of training on the MCA had commenced to address the immediate need.

Induction training was not in-depth and there were shortfalls in other staff training such as moving and handling, infection control, fire safety and dementia awareness. This had been recognised by the manager and plans put in place to bring training up to date. However, in the interim period there was a risk that people were being supported by staff who lacked the knowledge they needed to carry out their roles effectively.

People had care plans in place but these did not always contain up to date information, and associated monitoring charts had been completed inconsistently. This meant that staff did not always have current information available to them so they could support people appropriately. This had been identified and care plans were in the process of being improved.

Quality monitoring of the service had been strengthened and areas that required improvement had been identified. The manager completed regular audits to check the quality and safety of the service.

Staff had not been recruited following the organisation's policies and procedures and we made a recommendation about this in the report.

There were sufficient numbers of staff employed to meet the needs of people who currently lived at the home.

People told us they were happy with the choice of meals provided at the home. Nutritional needs had been assessed, people's special diets were catered for and food and fluid intake was being monitored when this was an area of concern. However, these records were seen to be inconsistent.

Staff received training on safeguarding adults from abuse. They were able to describe different types of abuse they may become aware of and the action they would take to protect people from harm. People told us they felt safe living at the home.

Accidents and incidents were recorded appropriately and had been analysed to identify any patterns or trends, and any areas that required improvement.

Staff were kind, caring and patient. They encouraged people to be as independent as possible and respected their privacy and dignity. It was clear that staff knew people well and this helped them to provide person-centred care.

People understood how to express any concerns or complaints and any complaints made had been investigated appropriately. People were able to give feedback on the service they received, although meetings for people who lived at the home or relatives were minimal.

Supervision meetings and staff meetings had been infrequent. However, these had been reinstated and staff told us they were well supported by the new manager.

You can see what action we told the provider to take at the back of the full version of the report.

This report only covers our findings in relation to the Safe and Well-led domains. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Old School House and Courtyard Nursing Home on our website at www.cqc.org.uk

The Old School House and Courtyard Nursing Home is registered to provide care and accommodation for up to 42 older people. The home was previously registered to provide nursing care and residential care but now only provides residential care. The home is divided into three areas; The Courtyard, The Old School House and The Bungalow. The home is situated on the main road in Gilberdyke, a village in East Yorkshire. All of the accommodation is on one level. On the day of the inspection there were 36 people living at the home, including three people who were having respite care.

There was a manager in post who had been registered with the Care Quality Commission since 5 May 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. We will refer to the registered manager as ‘the manager’ throughout this report.

Prior to the inspection concerns had been shared with us about the management of medicines. Audits had been carried out by the pharmacy used by the home and by an NHS pharmacy technician. Numerous recommendations had been made following these audits, including the storage and recording of controlled drugs (CDs). Some of these recommendations had already been actioned but others were outstanding. On the day of this inspection we identified concerns about the storage and recording of controlled drugs. The record of the number of pain relief patches in stock for one person did not match the actual number of patches stored in the CD cupboard.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

Although we found that there were sufficient numbers of staff on duty, we observed that there was a lack of presence in two units at certain times of the day. This was discussed with the manager who told us they would re-consider the deployment of staff to ensure there was a staff presence in each area of the home.

Service user risks were well managed and recorded. The manager was following the local authority guidance on safeguarding adults from abuse.

Accident and incidents were recorded and were audited to check for any patterns that might be emerging or any improvements that might be required.

On the day of the inspection we found the home to be clean and hygienic. There was sufficient personal protective equipment (PPE) available for staff and there were sufficient numbers of domestic staff on duty. Infection control audits had been carried out. However, we found that the laundry room did not have distinct ‘clean’ and ‘dirty’ zones. The manager told us on the day following our site visit that signs had been placed in the laundry room to make sure staff could easily identify the separate zones.

More evidence was needed to show that any shortfalls identified in audits had been addressed to ensure the necessary improvements had been made. Although satisfaction surveys had been carried out, we noted that there was a lack of analysis of the feedback. This feedback could have been used to make improvements to the service.

Our inspector visited the service and the information they collected helped answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that they felt safe living at the home and we found that there were sufficient numbers of staff on duty to ensure that people's needs were met. Staff demonstrated an understanding of the different types of abuse and the action they needed to take if they became aware of an incident or allegation of abuse. They said that they would not hesitate to take action if they observed poor practice.

Is the service effective?

We were concerned that there was a lack of written information available to staff about people's specific needs and that this could have impacted on the care people received. There was also no assessment of people's capacity to make their own decisions or the help they would need with decision making. This could have resulted in people not being consulted about their care.

Is the service caring?

We saw that staff were caring and compassionate, and that there was good interaction between people who lived at the home and staff. One person told us, 'Staff are wonderful ' I feel that they care about me. They have been really lovely.' We observed that people who needed assistance with eating their meals received appropriate support from staff.

Is the service responsive?

There was a lack of opportunity for people who lived at the home to express their views about how the care they received. A relative told us that they felt communication at the home was poor and that they would appreciate a regular update so that they were clear about their relative's current state of health and well-being. There was a complaints procedure in place. Although some people told us they were not aware of it, staff told us that they would support people who lived at the home to make a complaint if needed.

Is the service well-led?

There had been some improvements in the use of quality assurance systems since the previous inspection. However, although quality audits were being carried out, these were inconsistent and did not record the action taken to make the identified improvements. Record keeping had also improved but continued to be inconsistent; there were numerous examples of blank documents in care plans. There was no registered manager in post.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the issues of consent and the care and welfare of people who used the service.

We received an action plan from the registered provider stating that they would be compliant with these outcomes by the end of February 2014.

This inspection was to check that the provider was now compliant with the required regulations. In addition to this, we had received information of concern about staffing levels at the home and decided to add the related outcome to the inspection.

We chatted to people who lived at the home but did not ask them specific questions. We spoke with all of the staff on duty on the day of the inspection.

Although some progress had been made towards achieving compliance with outcomes 2, 4, 16 and 22, further work needed to be carried out to ensure that full compliance was achieved. We will be asking the provider to take further action.

We also had concerns about staffing levels at the home as we observed that people did not always receive assistance in a timely manner. Staff recorded as being present on the rota were not always on duty.

Staff treated people who used the service with respect and only provided care and support to people with their consent. However staff had not had training to aid their understanding of the Mental Capacity Act (MCA) 2005 and were not aware of how to ensure their practice was in accordance with the Act.

People told us they were satisfied with their care. One person told us 'They are a beautiful staff, you couldn't wish for better ' they would do anything for you.' Another person said 'The girls do help you and you can ask for anything'. However, we raised concerns regarding the moving and handling practices within the service that we asked the provider to address.

Staff were employed in sufficient numbers to ensure the needs of people who used the service were met. A relative of a person who used the service told us 'There is always somebody about'.

Records were not always accurate and fit for purpose but were stored securely.