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 for older people and people with dementia. The care home accommodates up to 42 people in one building. At the time of inspection 31 people were using the service.

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 Some staff had out of date training.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.

This inspection took place on 16 and 21 November 2017. The first inspection day was unannounced and we told the manager we would be returning to the home on 21 November 2017 to conclude 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

We carried out an unannounced focused inspection of this service on 29 June 2017. This was because we had received information of concern about the management of medicines and inadequate staffing levels. At the last inspection on 28 October 2015 the service was rated as Good.

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.

The inspection of The Old School House & Courtyard Nursing Home took place on 28 October 2015 and was unannounced. At the last inspection on 9 October 2014 the service was in breach of regulations 22 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These regulations were superseded on 1 April 2015 by regulations 18: staffing and 17: good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

On 16 April 2015 we carried out a ‘focussed’ inspection to check the progress of the service in meeting these regulations. We found there was an improvement in the numbers of staff on duty and that the newly appointed manager had begun to improve the quality monitoring and assurance systems that were in operation. On that visit the service was meeting regulations 18 and 17.

The Old School House and Courtyard Nursing Home is a residential care home that provides accommodation and support to a maximum of 42 older people, some of whom may be living with dementia. The service is a detached property situated on the main road in the village of Gilberdyke, in East Yorkshire. The service is on a bus route and there are ample car parking spaces for visitors and staff.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who had submitted an application to the Care Quality Commission (CQC) to become the registered manager. They had attended an interview and were awaiting the outcome of it from CQC. 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.

People we spoke with told us they felt safe living at The Old School House & Courtyard Nursing Home. They said, “I am quite satisfied here. I am treated very well. The staff are friendly” and “Staff look after us well here.” There were systems in place to prevent and address safeguarding incidents and staff had completed appropriate training to manage these issues, which meant that people were protected from the risk of abuse.

We found that the premises were satisfactorily maintained and provided a safe environment for people that used the service, but we made a recommendation that the provider ensured all maintenance safety certificates were renewed upon the anniversary of their expiration date, to ensure the premises were safe at all times and there was up-to-date evidence to support this.

We saw that incidents regarding people’s safety were appropriately addressed when they arose, that staff understood and exercised their responsibilities to report such incidents and that there were sufficient staff on duty to meet people’s needs.

We found that staff had been safely recruited using systems to ensure they were ‘fit’ to care for vulnerable people. We found that although management of medicines was safe there could have been a more efficient system for storing unused medicines to be returned to the pharmacist and we have made a recommendation to the provider about this in the report. We found that the premises were clean and comfortable.

We saw that staff were appropriately inducted, trained and checked regarding their skills and competences to be able to carry out their roles. Staff received support and supervision from the manager and one person said of them, “The staff know what they should be doing and they are guided by the manager. They do a good job of it.”

Staff communication was satisfactory, they followed the principles of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 in respect of people that were unable to represent themselves, so that people’s rights were upheld.

We found that staff were kind, caring, understanding and patient. Staff sometimes used fun to include people so they felt part of the group. Staff spoke politely to people and respected their wishes and preferences. Staff encouraged independence and protected people’s privacy and dignity. and they supported people to eat well and to stay as healthy as possible.

We saw that staff responded to people’s needs regarding their personal care, activities, individuality and any concerns or complaints they may express. Choices were encouraged and respected wherever possible. All of this was based on the on person-centred care plans in place to assist staff on how best to support people. Confidential information was protected and wellbeing was monitored.

We found that the culture of the service was improving under the new manager who had been in post for approximately nine months. It was described by staff as “Happy, friendly and based on teamwork” and the manager was described by visitors as “Open, honest and transparent.”

We found that audits of the service were carried out and satisfaction surveys were issued to people that used the service, relatives, staff and healthcare professionals, but not all of the information gathered was consistently analysed, coordinated and fed back to people. We found details of action that had been taken as a result of information obtained, needed to be fed back to people, relatives, staff and healthcare professionals in a more definitive way at the end of a cycle of quality monitoring and not only via memos and the newsletter.  This was something the manager had yet to achieve at the end of their first year in post.

We carried out an announced comprehensive inspection of this service on 9 October 2014. Breaches of legal requirements were found. We took enforcement action in the form of compliance actions regarding the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and we made compliance actions for regulations 22: staffing and 10: assessing and monitoring the quality of service provision. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to regulations 22 and 10.

Since 1 April 2015 the 2010 Regulations have been replaced by The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore regulation 22 is now regulation 18: staffing and regulation 10 is now regulation 17: good governance.

We undertook this focussed inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old School House & Courtyard on our website at www.cqc.org.uk

The service was registered to provider support and accommodation for 42 older people, some of whom may have a dementia related condition. On the day of the inspection there were 20 people using the service.

The provider is required to have a registered manager in post and on the day of the inspection there was a newly appointed, but unregistered, manager managing the service. 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. The newly appointed manager told us they would be submitting an application to become the ‘registered manager’ within the next two weeks.

At our focussed inspection on the 16 April 2015 we found that the provider had followed their plan, which they had told us would be completed by March 2015, and that legal requirements had been met.

During our inspection on 16 April 2015 we found that there had been some staff changes. The service had a new manager in post. Some care staff had left and new ones had been recruited. We saw that there were sufficient care staff deployed to ensure that they had time in their day to provide the care people required and to coordinate some activities. We spoke with the staff about the staffing levels that the service was operating with and staff told us they thought there were sufficient at the moment to meet people’s needs. They said that they had been covering each other’s absences and the staff team had settled down following some changes in employees.

We found that there had been some changes to quality assurance and monitoring systems (audits and satisfaction surveys) so that people and stakeholders had been consulted about the service. We saw evidence in the form of audits and satisfaction surveys that people, their relatives and other stakeholders had been consulted about the service of care provided.

We were told by staff that the atmosphere/culture of the service was changing for the better. They said, “Staff are more settled now and while there are still some issues to resolve morale has got much better. We work together more, have more time, and people are doing more activities.”

The inspection was unannounced. We previously visited the home on 2 July 2014. We found that the provider did not meet the regulations that we assessed and we asked them to take action. At this inspection we found that appropriate action had been taken to make the identified improvements.

The service was previously registered to provide nursing care but is now registered to provider support and accommodation for 42 older people, some of whom may have a dementia related condition. On the day of the inspection there were 27 people living at the home. The home previously had three units, but the unit known as ‘The Bungalow’ was closed for refurbishment on the day of the inspection.

The provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC).  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.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm. However, there were insufficient numbers of staff to ensure that people’s needs could be consistently and safely met.

Staff had been employed following robust recruitment and selection processes and this ensured that only people who were considered suitable to work with vulnerable people had been employed.

People’s nutritional needs had been assessed and people told us that they were satisfied with the meals provided by the home.

We observed good interactions between people who lived at the home and staff on the day of the inspection.  People told us that staff were caring and this was supported by most of the relatives we spoke with.

Staff received a range of training opportunities although there were gaps in training that needed to be addressed. Staff did not have effective supervision meetings that gave them the opportunity to discuss concerns with a manager.

We received comments from people who lived at the home, relatives, staff and health care professionals about the lack of social activities. However, we observed that this was due to the home being short staffed and not the willingness of staff to spend time with people.

People’s comments and complaints were responded to appropriately, but there were insufficient systems in place to seek the feedback of people and their relatives about the service provided, either through surveys or meetings.

The home lacked consistent leadership and this had affected the atmosphere of the home and led to dissatisfaction amongst the staff group.

This inspection was carried out to check on improvements made since the last inspections in October 2013 and March 2014, when we had identified areas of non-compliance.

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.

At the last inspection of the home in October 2013 we made compliance actions for outcomes 2, 4, 16 and 21. We found that care plans did not include appropriate information about a person's capacity to make decisions and that they were not personalised. There was a lack of quality assurance systems in place to monitor that the service provided by the home met people's individual needs and that the home was a safe place for people to live and work. Recording in care plans was not thorough.

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.

We visited The Old School House and Courtyard Nursing Home on 9 October 2013 as part of a scheduled annual inspection. Since our last visit the provider has stopped providing nursing care but has not yet formally changed the name of the service with the CQC. At the time of our visit there were 28 people residing at the service. There had been a very recent change in management arrangements and the new manager had been in post for three days at the time of our visit.

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.

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity and kept personal information confidential.

People said that they had good access to outside healthcare professionals and they were satisfied with the level of medical support given to them. They said staff were good at giving them their medication on time and when they needed it.

People understood about safeguarding of adults and told us that they felt safe within the service. They told us there was an open door policy within the service which worked well and they were confident of using the complaints system if they needed to.