This unannounced inspection took place on the 21 and 22 March 2017. At the last inspection on 7 and 14 January 2015, the home was found to be meeting all of the regulations we inspected.

The Old School House is a care home that specialises in the care of older people who are living with dementia. Most people who live at this home have complex needs associated with their diagnosis of dementia. The home is registered to provide care for up to 40 people. People are accommodated in individual bedrooms located on two floors of the building. There are communal lounges and dining areas on each floor and the floors are connected by stairs and passenger lifts. There is an enclosed garden, and some parking at the front of the building. At the time of our inspection there were 32 people living in the home. The Old School House is one of eight services run by the East Riding of Yorkshire Council.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

Care was planned in partnership with people and their families, and people received the care and support they needed to meet their individual needs. Relatives spoke exceptionally highly of the quality of care they and their loved ones received, and said they were kept well informed about the person's wellbeing. The managers and staff were committed to working in a person-centred way and treating people with kind-heartedness and consideration. People, including those who had difficulties communicating or who could become upset, responded positively to the way in which staff approached them. Staff told us they enjoyed working at the Old School House and we saw staff treated people professionally but also showed people they were valued and important. Staff did this through the way they spoke to people, offering reassurance with comforting words and a gentle tone of voice and holding people's hand if appropriate.

People were relaxed with staff. Visitors and relatives told us they felt the Old School House was a safe environment for people to live in. People were protected from abuse because staff could identify the different types of abuse and knew what actions to take to report abuse.

Whilst people received excellent care, there was a strong emphasis on continually striving to improve the service. Improvements were identified through consultation with people, relatives and health care professionals involved with the Old School House through informal chats, meetings, reviews, family forums and surveys. For example, the registered provider had recently provided a dedicated area for relatives to use so that they could be close to their loved ones when they were unwell. This showed that the registered provider placed a high value on meeting the needs of people and their relatives.

As well as consulting with people, the Old School House strove for excellence through reflective practice at all levels, from care staff to senior management. There were systems in place to monitor the quality and safety of the home and bring about any improvements that were needed. The home worked in partnership with other organisations to make sure they were following current best practice and providing a high quality service.

There was a truly open atmosphere upon entering the Old School House. The home had a clear management structure, with an established service manager, registered manager and senior care officers. They worked closely with staff, frequently observing and providing care. Relatives, staff, health care professionals and volunteers were confident in the leadership of the service. They were encouraged to raise any areas of concern, which were taken seriously and the appropriate action taken.

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Due to having a variety of complex needs and communication difficulties related to dementia, people who used the service were limited in what they could tell us directly about their care and treatment.

During the day we sat with people who used the service and observed their daily activities including lunchtime and their interactions with staff. We spoke with relatives, a visiting health professional and ten staff. We reviewed documentation including five care plans.

We saw that care needs were discussed with people and/or their relatives and before people received care their consent was asked for. Two relatives said they were involved in every aspect of the care offered to their own family member.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Food and drinks were specially prepared to ensure that people had a nutritious and balanced diet.

There were enough qualified, skilled and experienced staff to meet people's needs. A relative said “The home ‘is great. I like it here and X is happy and so am I’. A visiting health professional said the staff are “Prepared to try things to improve care and are always prepared to ask for advice”.

The home looked clean and tidy and there were infection control procedures in place. There were appropriate systems in place to monitor and improve the quality of the service. Records were found to be accurate, detailed and regularly reviewed.

Due to having a variety of complex needs and communication difficulties related to dementia, only one service user was able to tell us directly about their care and treatment. We used a number of different methods to help us understand the experiences of people using the service. During the day we sat with the service users and observed their daily activities including lunchtime and observed their interactions with staff. We spoke with one service user, three relatives, a visiting health professional and staff including the manager, three senior care officers and two care workers. We reviewed documentation including four care plans.

From what people told us, what we observed and noted as part of the review staff cared for the people who use the service appropriately. The staff told us that the manager was supportive of them and ensured that they had regular supervision. Staff could tell us what they would do if they saw abuse happening or someone reported abuse to them. Staff also told us they tried to ensure that people's dignity and human rights were respected and we saw evidence of this during our inspection. There were appropriate systems in place to monitor and improve the quality of the service.

The relatives we spoke to said that the staff were “kind and patient”, and “well trained with good knowledge”. The visiting health professional said “the care here is excellent, I enjoy visiting here”.

We did not speak with people as part of this follow up review.

Due to the severity of people’s dementia they were unable to provide us with many comments, however one person told us they really liked the staff and thought they were wonderful.

The inspection took place over two days; 7 and 14 January 2015. The inspection was unannounced.

The last inspection of this service was on 12 November 2013 when the service was found to be meeting all of the regulations inspected.

The Old School House is a care home without nursing. It provides services for up to 40 older people living with dementia. The bedrooms and living areas are on two floors. There were 39 people living in the home at the time of our inspection.

There was a registered manager in post at the time of the visit. 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.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. DoLS are part of the Mental Capacity Act (MCA) 2005 legislation which is in place for people who are unable to make decisions for them. The legislation is designed to make sure any decisions are made in the person’s best interest.

The manager had a good knowledge and awareness of MCA. People in the home had received good support to have their rights in relation to the MCA upheld. Best interest meetings were regularly organised to ensure people’s choices were respected. When necessary the home advocated for people to reduce agreed restrictions on people’s lives, ensuring people had the correct support for their rights to be upheld.

People were supported to be protected from harm. The service readily responded and reported any concerns.

People were supported with any risks in their lives, these were identified and plans were put in place to reduce these and help people remain safe.

People were supported by good staffing levels which were adjusted dependent upon the needs of the people living there. When necessary people were provided with one to one staffing levels. This helped to make sure their individual needs were met.

People received personalised support with their medication. Systems were in place for the ordering, storage, administration and disposal of medication, with some minor amendments required.

People were supported by a well trained staff team. The manger organised customised training help make sure staff remained up to date and were following the latest best practice guidance.

People were supported to have their choices upheld and this included with their dietary needs.

People were supported to have their general health needs met. A customised service was in place to ensure that people received quick access to professional support with the dementia care needs. This helped make sure people’s changing needs were responded to quickly and effectively.

People were supported by staff who were knowledgeable about the needs of people who lived in the home, this included their history, likes and preferences. Staff were patient and with people and spent time with them , their interactions reflected consideration for people who lived in the home and respected people’s privacy.

People were supported by a comprehensive care planning system. People’s care plans included a large amount of information which included how the person communicated with people. These care plans were up to date and regularly reviewed. This information was available to staff to help make sure staff were aware of people’s current needs.

People were supported to maintain important relationships. Friends and relatives freely visited people and took part in activities with people, for example, taking their relatives out in the community.

Different activities were available to people. These included craft and music work as well as trips out into the local community.

The manager had ensured a positive culture in the home; they provided good leadership and knowledge about the needs of the service. The manager was aware of latest best practice and shared this with staff to help practice.