About the service: The Old School House is registered to provide accommodation for up to 36 older people who require personal care. The majority of people living at the home were living with dementia. Some people require nursing support and this is provided by the local community nursing team. At the time of the inspection, 18 people were living at the home.

People’s experience of using this service:

• There had been changes to the management structure of the home since the previous inspection. A new manager had been appointed and the senior management team had been strengthened with the appointment of a general manager supporting the provider. The provider had employed a management consultant and was working with the local authority and other organisations to improve the management of the home. People and staff told us the home had improved. We also received positive feedback from the local authority and the community nursing team.

• Comprehensive quality assurance audits had been put in place. A variety of audit tools ensured all aspects of service provision and health and safety were reviewed in detail by the management team each month.

• People told us they felt safe living at the home. Protocols and training provided staff with the information and guidance they required to identify and report suspected abuse.

• Some people told us they felt anxious about a person entering their rooms. The manager stated action was being taken to reduce the risk of this person entering people’s rooms. Following the inspection, the manager told us some people’s bedroom door locks had been changed to ones they found acceptable.

• Staff recruitment processes were safe and staff were employed in sufficient numbers to meet people’s care needs.

• People told us staff were kind, caring and respectful. Our observations showed staff were kind, caring, friendly and attentive. The increase in staffing levels allowed staff more time to spend with people, and not feel rushed. Staff enjoyed working at the home and confirmed improvements had been made since the previous inspection.

• The computerised care record system was being used to record people’s care needs and associated risk and provide staff with the guidance they required to meet people’s needs and reduce risks. However, where people were resistive to receiving support with their personal care, this needed to be better recorded, and flexible and responsive support detailed. Further attention was also needed to monitoring forms as we found these had not always been fully completed, or had inconsistencies.

• People’s healthcare needs were being met. We received positive feedback from the community nursing team about the care people received.

• The home was acting within the principles of the MCA. Staff sought people’s consent and where necessary with authorisation, restricted people’s liberty to maintain their safety.

• Medicines systems were organised and managed safely. Where the manager had identified supply and support issues with the pharmacist, action had been taken.

• Training in relation to people’s care needs required some further improvement and the manager had plans in place to address this.

• The provider and manager planned further improvements to the social and leisure activities provided for people and recognised the importance of meaningful engagement to people’s well-being.

• People told us they had no complaints and said they knew who to talk to if they had any concerns. Where complaints had been received, these were recorded and actions identified to resolve the issue.

• The home was clean, tidy and well maintained.

The home met the characteristics of a rating of “Good” for two key question and “Requires Improvement” for three key questions. Our overall rating for the home after this inspection was “Requires Improvement”.

We made four recommendations for improvement in relation to staffing levels, training, personal care and social engagement.

Rating at last i

This inspection took place on 17, 21 and 26 September 2018 and was unannounced on the first day. The Old School House is registered to provide accommodation for up to 36 people who require personal care, most people live with some degree of dementia. Some people require nursing support and this is provided by the local district nurses. At the time we visited, 26 people were living at the home.

There was a registered manager employed at the home. 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 and associated Regulations about how the service is run.

The last inspection in September 2017 rated the service as Good overall, and across all key questions. This inspection was brought forward because of a high number of safeguarding concerns being raised and being investigated by the local authority, which had resulted in the service becoming part of an organisational safeguarding process. This meant the local authority safeguarding team, commissioners, CQC inspectors, police and other professionals had met to discuss the safety and well-being of the people living at the service. The provider, their operations team and the registered manager had been part of these discussions. The findings of our inspection have also been shared with the local authority, so that it can form part of the safeguarding process.

At this inspection in September 2018 we found there were failings across all key questions. People were not safe at The Old School House. There were not enough staff to ensure people's needs were met in a timely way or by staff who had the information they needed to meet people's needs. Many people at The Old School House were living with some degree of dementia with complex needs, requiring support and supervision to keep them safe. The staffing levels did not ensure they received the care they needed.

The organisation and leadership of the service was poor. This meant the registered manager and provider had not recognised that the staffing levels did not reflect people's individual needs. The service was based on completing tasks for people with a routine focussing on staff rather than people's needs. The provider and managers had not listened to staff, who said they had raised the issue of inadequate staffing levels many times but had been told the numbers of people at the home was low so staffing levels had been reduced. This meant that although staff were caring and worked hard to meet people's basic needs, they were physically unable to ensure people received person centred care in a timely way. This had led to very low staff morale.

The lack of effective staff deployment meant three people were not able to get up and go to bed when they wanted or have their needs met in a person centred or timely way. Staff said personal care support continued into late morning on a regular basis as during our inspection on the first day, based on how much time staff had. Many people required one or two care staff for personal care and mobility support, and most people needed prompting or assistance with eating and drinking. All the people living at the home required their food and fluid intake to be monitored, to help ensure adequate nutrition and hydration. There was not enough time for staff to meet these needs effectively or keep people safe. Staff had recorded people's weights and food and fluid input was recorded but they had not recognised that in reality people may not be receiving adequate nutrition, including those people identified as being at high risk. This meant people remained at risk of losing weight and not receiving enough food and fluids throughout the day and night.

Falls risk assessments showed that most people at The Old School House were at high risk of falls which was increased due to l

The Old School House is a residential care home which provides care for up tp 36 people who are elderly, may suffer with mild mental health conditions, dementia and/or have restricted mobility. On the day of the inspection 33 people were living in the home.

At the last inspection in August 2015, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

People and a relative commented, “I like it here. They are all nice” and “I can’t fault them. All the carers are lovely and approachable. I help them do the gardening with people. They are really good to mum.”

People remained safe at the service. There were sufficient staff available to meet people's needs. Risk assessments had been completed and actions taken to minimise harm. This was particularly

important for people who may challenge others due to living with dementia, for example. People received their medicines safely.

The service had 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.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff were competent and well trained. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals according to their individual needs.

Staff were caring and people had built good relationships with the staff. We observed staff being patient and kind, understanding how people liked to be cared for. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People were able to make choices as much as possible in their day to day lives. There had been no formal complaints since the last inspection and the complaint process ensured any complaints would be fully investigated and responded to. Complaints were also discussed in regular staff meetings to ensure all staff knew where care could improve.

People were supported to take part in a range of activities. However, there was no dedicated activity co-ordinator employed during our inspection but there was an advertisement publicised. Therefore, organised activities were mainly through external entertainers at present. The registered manager was pro-actively looking at ways to improve the opportunities for more meaningful stimulation, especially for people living with dementia. We saw staff engaging with people throughout the day including those people who spent more time in their rooms. The registered manager had introduced ‘dementia friendly’ sensory stimulation to further engage people. The registered manager was introducing more individualised activity records to ensure people received engagement and stimulation, especially whilst the home sought a new activity co-ordinator.

The service continued to be well led. People and staff told us the registered manager and current deputy manager were approachable and there was always a manager available for support. The provider lived close by and the managers also felt well supported. The registered manager/provider sought people's views to make sure people were at the heart of any changes within the home and regularly enabled them to have time to discuss any issues.

The registered manager/provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Further information is in the detailed findings below.

People we spoke to told us they enjoyed living at the home and they felt well cared for. They told us, “…can’t fault the staff.” We saw people had detailed, personalised care plans to help staff meet people’s varied needs. Where possible people were involved in all aspects of care planning and the staff we met knew people well.

We found there were sufficient staff on duty to meet people’s care and treatment needs. Staff told us they felt supported and had regular access to supervision, training and development. This enabled them to provide high quality care to the people they supported. The staff we met and observed caring for people were kind and patient and often acted as their advocate when needed to ensure their best interests were considered.

We found the home was clean and there were good systems in place to help reduce and prevent infections.

The home had robust systems in place to monitor all aspects of quality within the home and acted on areas where there were concerns. People who lived in the home and staff were involved in improving aspects of care provision where possible.

We spoke with two of the twenty three people who used the service. We visited late at night following information we had received. Most people were asleep as the visit occurred out of hours at 11pm. We spoke with the two care staff on duty. The following day we spoke with members of the care home management team and a health professional from a mental health team.

The people we spoke with told us they were happy with the care and treatment they received. People told us they felt able to raise any complaints they might have with staff. Staff told us they felt supported by the management team and felt able to raise concerns.

On the night of our visit that people were well cared for and treated with respect and dignity. The staff on duty responded to meet people's needs. We saw staff engaging with people and meeting their needs. We observed staff respecting people's choice to be awake late, watch the television programme they chose to and choose where they wished to relax.

We visited the service as a part of our scheduled programme and to follow up on some information we had received about staff training and appraisals. On our visit we found that considerable work had been carried out at the home in the last year on assessing and improving the quality of the service people experienced and strengthening the leadership in the management team.

We saw people at the home were being well cared for. Many of the people at Lambspark Care Home had some degree of memory loss associated with older age. People told us they were happy there. People said: “They look after us”, “Nice people, staff great, foods good” and “I love it, everyone’s friendly, it’s my home. I have no regrets”. People we observed who could not communicate with us verbally about their experiences appeared contented and settled.

We found that care plans had been improved to better reflect people’s individuality and past history.

We saw people's rights were being protected, including the right to make decisions. Where people lacked the capacity to make decisions themselves appropriate arrangements were in place to act in their best interests.

We found that people had opportunities to engage in activities that met their needs. Although there had been a high turnover of staff in the last year we we saw positive relationships in place.

We found that staff were not receiving appraisals or supervisions. The service had identified this and had an action plan in place.

We visited Lambspark Care Home as a part of our planned programme of inspections and because we had received some concerns around the staffing levels and resulting stresses impacting on staff.

On our visit we looked at the home's staff recruitment systems, training, staff support and welfare management. We also looked at how peoples' care needs were being assessed and recorded, to ensure staff received clear information about people's needs and how they should be met.

We spent time observing care being delivered and spoke to some individuals living at the home. The people we spoke to had varying degrees of memory loss, and were not able to give us in depth views on the care they received. However people told us:

"I like it here"

"The people are nice. They sort me out"

"If I didn't like it here I wouldn't come back. I have been here for a long time".

One person smiled and nodded when we asked them if the staff were kind to them and another person told us they found things for them when they were missing.

We saw people being treated with respect and making choices about how they spent their time and with their support needs. We saw staff engaging with them and communicating positively. Staff were clear about people's needs and were confident in the interactions we saw.

We saw there were enough staff on duty to support an individual following a medical emergency and ensure they received the medical support and treatment they needed. Other staff were able to provide re-assurance to other people living at the home who had been present at the time.

People enjoyed spending social time together in the ground floor lounge and had participated in an entertainment session in the morning which was run by a specialist visiting entertainment service.

The inspection was announced and took place on 15 and 16 August 2015. We telephoned the service an hour prior to the inspection to notify them because it was a week-end. Our last inspection was on 7 June 2013 and found the service was meeting all the legal requirements.

The Old School House provides care and accommodation for up to 36 people. On the day of the inspection 32 people were living in the home. The Old School House provides care for people who are elderly, may suffer with mild mental health conditions, dementia and/or have restricted mobility.

The service had 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.

During the inspection people and staff appeared relaxed, there was a calm and pleasant atmosphere. Comments included “It just feel so homely, staff are friendly and care” and, “The staff are so kind.” We observed and people told us they had the freedom to move around freely as they chose and enjoyed living in the home.

People and relatives spoke highly about the care and support they received, one person said, “The care here is good.” Another said, “It’s lovely here and the staff are so polite, kind and caring.” Care records were personalised and gave people control where possible. Staff responded quickly to people’s change in needs. People and their family were involved in identifying their needs and how they would like to be supported. People's preferences were sought and respected for example, if they liked to stay in their bedrooms or relax in one of the lounges.

People’s risks and environmental risks were managed well and monitored. People were promoted to live full and active lives and participate in the entertainment and special days the service organised such as cream teas and fireworks night. Activities reflected people’s interest and pastimes they enjoyed.

People mostly had their medicines managed safely. However, some people at the time of the inspection did not always receive their medicines as prescribed or receive them on time. Prompt action was taken following the inspection and feedback from professionals to ensure robust checks were made to improve the management of medicines. The service was working closely with their pharmacist, people’s doctors and their staff to resolve these issues quickly and ensure procedures and checks were followed.

People were supported to maintain good health through regular access to healthcare professionals, such as GPs, mental health professionals, social workers, occupational therapist and district nurses.

People told us they felt safe. Staff understood their role with regards the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Applications were made and advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse; they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident reporting any incidents or allegations and these would be fully investigated.

Staff described the management to be very open, supportive and approachable “Very supportive, been amazing to me, it’s a pleasure to work for them”. Staff talked positively about their jobs. Staff worked together as a team to meet people’s needs for example if someone preferred a particular gender of staff to support them this was arranged.

Staff received a comprehensive induction programme. The Care Certificate had been implemented for new staff. The care certificate is a national initiative designed to ensure new staff are appropriately trained. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Audits were conducted, trends noted and action taken when needed. Feedback from people, friends, relatives and staff was encouraged.