CQC report explained · a residential care home
What the CQC found at Old School House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2019
Rated Requires Improvement; inspectors found kind, safe care, but consent, records and management needed improvement.
This was an unannounced inspection by two inspectors on 11 July 2019. They spoke with people, relatives, staff and healthcare professionals. They reviewed care records, staff records, medicines, incident records and management systems.
People and relatives described staff as kind and caring. The home was clean, people were protected from avoidable harm, food was well regarded and activities included visits from local school children. The safe rating improved to Good.
Inspectors found problems with mental capacity assessments and best-interest decisions. Care plans did not always reflect people's current needs. Some medicines records were not accurate or in line with guidance.
The overall rating was Requires Improvement. Caring and Responsive were Good, while Effective and Well-led were Requires Improvement. This was the second consecutive Requires Improvement rating.
Kind and respectful care
People and relatives consistently described staff as kind, friendly and caring. Inspectors also observed people being treated with compassion and dignity.
“We observed people were treated by staff who demonstrated they were kind and compassionate.” from the report
Safety improvements
The home had improved its approach to environmental risks since the previous inspection. Risk assessments, fire checks and equipment maintenance were in place.
“At this inspection we found significant improvements had been made.” from the report
Food and nutrition
Staff knew people's food preferences and dietary needs. People appeared to enjoy meals, and support was provided when someone needed help eating.
“People's nutritional needs, likes and dislikes were well known by the cook and kitchen staff.” from the report
Activities and community links
People were supported to join activities and maintain relationships. Inspectors saw that a visit from local school children had a positive effect on people's engagement and mood.
“It was clear the visit had a positive impact on people's emotional well-being.” from the report
Mental capacity and restrictions
seriousCapacity assessments were not linked to specific decisions. Two people using bed rails did not have recorded best-interest decisions, meaning the home was not routinely following the Mental Capacity Act code of practice.
“The service did not routinely comply with the code of practice of the Mental Capacity Act 2005.” from the report
Care records did not reflect current needs
needs fixingSome care plans and dependency assessments were out of date. This included records about mobility, foot care and memory, although staff knew how to support people in some cases.
“We noted care plans were not routinely reflective of people's current needs.” from the report
Medicines records and stock control
needs fixingSome medicines records were handwritten or amended without the required second check. Opening dates were missing from some medicines, and prescribed medicines were sometimes returned to the pharmacy unused.
“At the end of each medicine cycle unused medicines were returned to the pharmacy for destroying, even if they were still prescribed.” from the report
Required notifications were missed
seriousThe provider did not always tell CQC about events it was legally required to report. This was a breach of regulation.
“The provider and registered manager failed to notify us of all the events it was legally required to do so.” from the report
Audits did not identify problems
needs fixingThe home carried out audits, but they did not always lead to improvement because they failed to identify issues found by inspectors.
“However, the audits did not always drive improvement.” from the report
- 01How have you changed mental capacity assessments and recorded best-interest decisions, especially for people using bed rails?
- 02How do you make sure care plans and dependency assessments are updated when a person's needs change?
- 03What checks now ensure handwritten medicines records, opening dates and medicine returns are managed correctly?
- 04Which events must be reported to CQC, and how do you make sure notifications are sent on time?
- 05How do your audits now identify and fix problems that inspectors previously found?
This was an unannounced inspection of the care, premises and management of the home, covering all five CQC questions; the report also compares the findings with the previous inspection. This explanation was written from the published report of 22 August 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2018
Old School House was rated Requires Improvement; inspectors found kind, personalised care but important safety and record-keeping problems.
The inspection was unannounced and took place on 14 May 2018. Inspectors spoke with six people living at the home, two relatives, the manager and three staff. They reviewed care plans, staff files and other records, and contacted health and social care professionals.
The home was rated Good for Effective, Caring and Responsive. People were treated with warmth and dignity, received personalised support and had access to activities. Improvements had been made since the previous inspection in 2016, when the home did not follow the rules about restrictions on people's liberty.
The home was rated Requires Improvement for Safe and Well-led. Inspectors found gaps in checks for Legionella, unsafe or poorly maintained areas, a broken call bell system and incomplete records. Medicines were generally managed safely, but fridge temperature records were not complete.
Kind and respectful staff
Inspectors found that staff knew people well and treated them with dignity. Relatives also described warmth and kindness.
“We observed staff communication with all residents was warm and friendly, showing caring attitudes.” from the report
Personalised support
Staff understood people's preferences and adapted support to their communication needs, routines and interests.
“This showed creativity in communication and that staff had a desire to provide person centred approach to working with people.” from the report
Activities and inclusion
People could take part in activities inside and outside the home. People who stayed in their rooms were offered one-to-one sessions.
“People had access to a wide range of meaningful activities both within the home and in the local area.” from the report
Improved decision-making support
The home had improved its processes for assessing capacity, making best-interest decisions and applying for the required safeguards.
“We have been satisfied the provider is no longer in breach of this regulation.” from the report
Generally safe medicine administration
Inspectors saw medicines being given calmly and found administration records were complete. There was a separate problem with recording medicine fridge temperatures.
“People's medicines were managed and administered safely. People received their medicines as prescribed.” from the report
Broken call bell
seriousNo call bell system was working during the inspection. One person had to wait for help and was left in an undignified situation. The report says a new system was fitted on 22 May 2018.
“The person we spoke with had been left in an undignified state longer than was acceptable due to no call bell being available.” from the report
Gaps in building safety checks
seriousThe home had not recorded required water temperature checks to manage Legionella risks. Some flooring was not secured, some windows could fully open without a recorded risk assessment, and an unsatisfactory electrical report had not been followed up with evidence.
“However, they failed to adequately control the risk as water temperatures were not routinely checked.” from the report
Incomplete records
needs fixingRecords about safety checks, cleaning, call bells and other remedial actions were incomplete. The manager could not always show what had been done to resolve known problems.
“Other records within the home contained gaps, or where issues had been highlighted it was not always clear what remedial action had been taken.” from the report
Medicine fridge records
needs fixingFridge temperatures were not recorded for part of the inspection period, and the records did not show all the temperatures needed to confirm medicines were stored safely.
“There were no temperatures recorded between 9 April 2018 and 14 May 2018.” from the report
- 01Has the call bell system fitted on 22 May 2018 remained working, and how is it tested now?
- 02What regular checks are now completed for Legionella, including water temperatures and shower-head descaling?
- 03What action was taken after the unsatisfactory electrical report dated 24 November 2017?
- 04How are safety problems recorded, assigned and checked until they are fully resolved?
- 05How are medicine fridge temperatures recorded, and what happens if a temperature is outside the safe range?
This was an unannounced inspection of the whole service and all five key questions; the report also checked improvements required after the previous 2016 inspection. This explanation was written from the published report of 17 July 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Old School House
3 rated inspections over 3 years: the service has slipped, from Good to Requires improvement.
- August 2019Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2018Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 17 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
89 live-in carers within about an hour of Buckinghamshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,300 a week. 79 can care for a couple. 13 years' experience on average.
“We can all fully relax around Nyarai and she feels like part of our family, which is no mean feat!”
“She was v competent and confident and we felt our mum was safe in her care. She supported us through a difficult time.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.