About the service: The Old School House is a residential care home providing personal and nursing care to eight people with a learning disability at the time of the inspection.

Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The home was not fully meeting the principles of this policy.

People’s experience of using this service:

People did not consistently receive safe care. Peoples risk assessments were not always followed and risks associated to the environment had not been mitigated.

People were not consistently receiving responsive care and support.

The systems in place to monitor the quality of care were not always effective and actions were not consistently driving improvements.

People felt safe and they were protected from the risk of abuse. There were sufficient safely recruited staff. Staff were trained and able to support people’s needs.

People were treated with kindness by staff who knew them well. People’s privacy and dignity was respected and their independence was encouraged. People could choose for themselves.

People were listened to and had their views sought about the care they received. There was a positive culture and learning and partnership working were encouraged.

The service met the characteristics of Requires Improvement in most areas. We have made recommendations about assessment and care planning and understanding current guidance.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and governance. Details of action we have asked the provider to take can be found at the end of this report.

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

Rating at last inspection: At the last inspection the service was rated Good (report published 22 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found the service had deteriorated to Requires Improvement.

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

Our inspection took place on 20 July 2016 and was unannounced. When we last inspected the service on 9 June 2016 we rated the service as requires improvement. We found the provider was meeting all requirements of the law. We did however, identify improvements were required.

The Old School House provides accommodation and personal care for up to 10 adults with a learning disability. At the time of our inspection 9 people were living at the service.

At the last inspection we found further improvements were required to increase staff understanding of how to keep people safe and quality assurance processes required further development. During this inspection we found improvements had been made. At the last inspection we found staff lacked understanding of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLs). During this inspection we found the provider had made improvements.

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.

People felt safe. There were sufficient numbers of staff to respond to people’s needs and support people safely. People were supported by staff who had been recruited safely and had the skills and knowledge to meet people’s care and support needs. People were supported by staff who knew how to recognise and report potential abuse. Risks to the health, safety and well-being of people were identified and managed. Staff had a good understanding of how care and support should be provided in order to keep people safe. People’s medicines were stored and managed safely and people received their medicines as prescribed.

People’s nutritional and hydration needs were met and people were involved in the planning and preparation of meals. People were given choices of food and drink and specialist diets were catered for. People had good access to a range of healthcare professionals when required.

People and their relatives felt they were supported by staff who were friendly and caring. People’s individual needs were understood and met by staff and people and their relatives were involved in making decisions about how their care and support was provided. Staff supported people in a way that maintained their privacy and dignity and promoted their independence. People were supported to maintain relationships that were important to them.

People felt involved in the assessment, planning and review of their care. Staff had a good understanding of people’s, personal needs and preferences. People were encouraged and supported to follow their individual interests and take part in activities they enjoyed. People and their relatives knew how to complain and expressed confidence that concerns would be dealt with efficiently by the registered manager.

People, relatives and staff were encouraged to give feedback and felt involved in the development of the service. The registered manager had effective systems in place to monitor the quality and consistency of the care provided and was committed to driving continuous improvement.

The inspection was unannounced and took place on 9 June 2015. At the last inspection in August 2013, we found the provider was meeting the regulations we inspected.

The Old School House provides care and accommodation for up to 10 people with a learning disability. There were nine people living in the home on the day of the 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.

People told us they or their relative was kept safe. Staff and managers had received training in safeguarding people and demonstrated an understanding of abuse. However, they were not aware of their responsibility to refer incidents of potential abuse to keep people safe from harm. There were enough staff to meet people’s needs and to support them in leading the lives they chose. People were given their medicines when they needed them by staff who had received training.

People were supported by staff that had the skills to meet their needs. Staff had received training and felt supported in their roles. People were supported to make decisions and choices but staff did not understand the requirements of the law to support people who lacked mental capacity to ensure their human rights were fully protected. People’s healthcare needs were regularly monitored and reviewed.

Staff were kind towards the people they supported and interacted with people calmly and positively. We saw staff had developed positive and trusting working relationships with people. People were listened to and respected by staff who knew them well and their privacy and dignity was respected.

People's care plans and risk assessments were personalised. Staff were able to tell us how people preferred their care and support to be delivered. People took part in a range of activities and staff knew how to raise concerns on behalf of the people they supported. The management team had responded to a complaint received since the last inspection.

The management team were approachable and supportive. People considered the home was well-led and felt listened to. People’s views were sought about the quality of the service they or their relative received at the home. The provider had some systems to monitor quality but acknowledged this was an area for development to drive continuous improvement.

When we visited the Old School House, we met eight people who lived at home. Everyone was busy helping with the house work or getting ready to start their activities for the day. Some of the people had verbal skills and they told us what they were doing that day and the next. One of the people showed us their craft activities and pictures of their holidays on a photo board.

The people told us about their trips to the shops and fishing. All the people seemed happy and relaxed and keen to show us their home.

The staff we saw supporting people with their activities understood what each person wanted. Everyone seemed very comfortable in each other’s company. The arrival of the registered manager was eagerly greeted by the people who seemed very pleased to see her and the facilities manager when they joined us in the dining room.

We asked people if we could have a look around the building and go into their bedrooms. We were shown around by the registered manager and joined by a senior care worker. The building had been extended to provide new bedrooms with bathrooms, a new lounge area and administration office. The new facilities were very well designed and furnished to a high standard. We were shown round the older accommodation and told about the plans in hand to modernise and upgrade the rooms.

We saw all the occupied bedrooms, which were furnished and decorated to suit the individual needs of each person. All the bedroom doors had alarms connected to the monitor board for night time support.

The lounge areas were very spacious and well furnished. The kitchen had recently been refitted to a high standard and all the bathroom and toilet areas had up to date facilities and were well maintained.

We spoke to two of the four staff members on duty. They told us that they felt very well supported by the management and their colleagues. They were listened to and consulted before decisions were made. They had access to any training they needed to support them to do their work and that their current training was up to date. They told us about the work they undertook to support the people to have active and full lives. They told us how they supported the people to see their families. They knew how to report any concerns regarding safeguarding issues and would not hesitate to report any concerns. They both said the staffing levels were good and they could provide the support the people needed.

We met with four people who received a service at The Old School House. One person told us that they were, "Happy" with the care and support that they received. People who could not share their views with us were observed to be relaxed and comfortable.

People who received a service enjoyed a range of leisure and social activities, both at home and in the local community.

People’s likes, dislikes, preferences and goals were considered in relation to the care and support they received. People were involved and consulted in how their care was delivered. Independent living skills were promoted.

Staff met people’s care and support needs in ways that they preferred. We saw that detailed records gave staff the information that they required to do this. People’s health needs were closely monitored. Assessments of risk supported practice.

People were supported by a knowledgeable and well trained staff team who knew their care and support needs well. Staff said that they felt well supported. Most staff had worked at the home for a number of years enabling them to provide consistent care and support.

The environment was well maintained. We saw changes had been made to the home in order to keep people safe. We asked the manager to check that these changes were not restricting others living at the home.

We saw that the home had a complaints procedure in place. We were told that there had been no recent complaints.

There are currently eight people living at The Old School House. The home has two vacancies. Six of the eight people were able to share their views and experiences with us and were fully involved in supporting this review. We spent time observing the care and support given to the two people who could not speak with us. We spoke with all of the staff on duty, with the facility manager and with the registered manager. We also spoke with a visiting social care professional and with three relatives.

People told us that they were very happy living at the home. One person told us, “I am really happy living here. I want to live here forever”.

The majority of the people living at The Old School House had lived there for a very long time. The home had recently admitted two new people and everyone we spoke with told us that the move had gone very well. People had known the new people that had moved in and were happy that they had come to live with them. One person told us, “I like the new people who live here”.

People lived very active lives with varying levels of support. People took part in a range of leisure and social activities, both at home and in the local community.

People were involved in developing independent living skills as far as they were able. People told us that they liked doing their washing and cleaning.

People said that they enjoyed the meals that they had at The Old School House and people said that they got together as a group to plan the menus. Everyone told us that they liked their food. Staff told us that people were encouraged and supported to eat healthy and nutritious meals in order to maintain their good health. A relative confirmed this.

People were supported to manage their money and effective records and regular checks ensured that people’s money was always accounted for.

People were supported to attend regular health care appointments and when people’s needs increased or changed there was evidence that the home worked with health and social care professionals to support them to feel better. Relatives and staff gave us examples of how they did this and of the positive changes that they had seen in relation to people’s health and wellbeing.

All care records were seen to be very well organised and reviewed regularly. People were involved in the review of their care and support plans and these were seen to be very detailed. Care plans described people’s likes and dislikes, needs and preferences. These plans were important because they were used to ensure that people had all of their needs met safely but also they minimised behaviours that caused people upset and distress. The home worked with outside health and social care professionals to ensure risk assessments and support plans were effective and kept people safe. People also had person centred plans that contained pictures of people that were important to them and of activities and events that they had enjoyed. People also had photos of the staff team that supported them.

People were supported by a knowledgeable and well trained staff team who knew people’s care and support needs well. People told us that they liked the staff who looked after them. All of the staff had worked at the home for a long period of time. Staff and relatives regular described the home as being like “one big family”. Relatives felt very involved and part of that family.

People were involved in the running of the home as far as they were able and also consulted in relation to how they lived their lives. Plans were in place to support people to enjoy their lives and staff were aware of risks, people’s rights and their responsibilities in order to enable people to do this.

The home effectively ensured that people’s views were considered and listened to in relation to the running of the home.