Selkirk House

Selkirk House is a residential care home providing regulated activity of accommodation for persons who require nursing or personal care to up to a maximum of 42 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 38 people using the service.

People’s experience of using this service and what we found

Prior to the inspection we received concerns related to infection control practices at the service. During the inspection we saw some staff not wearing their face masks correctly. This was immediately addressed by the registered manager who arranged for all staff to re-visit their infection prevention and control training. We found no other infection control concerns and we were satisfied that the concerns we had identified had been addressed.

People told us they felt safe living at Selkirk House. One person commented, “I love living here and I'm a safe as I can be." People were supported by staff who understood their needs and knew how to protect people from the risk of abuse.

Risks relating to each person had been identified and care plans and risk assessments were in place to guide staff how to manage and reduce risks. Care plans and risk assessments included detailed information about people's skin integrity and the support they needed to minimise the risks of developing pressure sores. Where people were unable to change their position in bed to relieve pressure on their skin, staff regularly helped them to do so. Equipment such as specialist pressure relieving mattresses were in place, and daily checks were made to ensure their effectiveness.

Effective systems were in place to ensure people received their medicines as prescribed and medicines were received, stored, administered, and disposed of safely.

We observed there were enough staff to care for people safely and meet their needs. Staff were available to respond to people's requests for assistance and the atmosphere was calm and relaxed. However, some people and staff told us that at times, people had to wait for their care needs to be met. We discussed this with the registered manager who told us they were currently recruiting more staff to ensure staffing levels responded to the identified needs of people.

Recruitment practices at the service ensured that, as far as possible, only suitable staff were employed.

A positive culture was shared to ensure good outcomes for people. Incidents were investigated and improvements were made. Managers and staff were clear about their roles and regulatory requirements.

Staff we spoke with told us communication between staff and managers was good. Staff said they were able to share feedback during regular supervision meetings and staff meetings. Daily handover meetings took place between shifts and where possible the managers attended.

The registered manager and provider had systems in place to monitor the quality and safety of the home. This included audits, improvement plans and gaining feedback from people and staff.

The service worked in partnership with other organisations to make sure they were following current practice, providing a quality service and to ensure the people in their care were safe.

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

Rating at last inspection and update

The last rating for this service was good (6 November 2017).

Why we inspected

The inspection was prompted due to concerns received about infection control, skin care, medicines management and lack of support for staff. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Selkirk House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Selkirk House Residential Home is a care home which offers care and support for up to 42 predominantly older people. At the time of the inspection there were 39 people living at the service. Some of these people were living with dementia.

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.

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks. We found these were being managed well.

We found the risks surrounding this incident were actioned immediately to help keep people safe, this involved changing how fire doors were accessed by people using the service.

At this inspection we found the service remained Good in all areas.

Why the service is rated good.

One person said; “I feel safe and very well cared for here”, “I can’t complain about the care - it’s exceptional” and “The staff are lovely and last week […] (naming the registered manager) brought me flowers”. Another said; “It’s a very caring place, with lovely carers.” One person said; “I need help only with dressing and undressing and the times this happen each day are set to suit me – it’s wonderful”.

People remained safe at the service because they received their medicines safely. People, relatives, professionals and staff told us there were sufficient staff to meet people’s needs. Risk assessments were completed to enable people to retain their independence and receive care with minimum risk to themselves or others. People were protected from the spread of infections as staff were aware of infection control procedures. Safe recruitment procedures were followed before new staff began working in the service.

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

People said the staff were kind and very caring. One person said; “I find all the staff very caring, they all seem to know me so well” and “I am very well cared for, the staff here are exceptionally kind and caring.” There was a busy but calm atmosphere in the service. People's privacy was respected. People where possible, or their representatives, were involved in decisions about the care and support people received. People had their end of life wishes documented and staff had received end of life care training to support people.

The service remained responsive to people's individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Complaints were fully investigated and responded to. A relative said; “I know any concerns I have are sorted straight away.”

People were assisted to take part in a wide range of activities according to their individual interests. Entertainers visited the service and trips out were also planned for people.

The service continued to be well led. People, relatives, professionals and staff told us the registered manager and management team were very approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Further information is in the detailed findings below.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. One person said, 'I don't like the food they offered and asked for something else and they made it for me.'

Staff we spoke with were clear about the actions they would take should they have any concerns about people's welfare.

We looked at care records for four people. We spoke to staff about the care given, looked at the records relating to them, met with them and observed staff working with them. We saw that people's care records described their needs and how those needs were met. This meant that people's care and welfare needs were being met.

We saw that medication was administered by suitably trained staff. People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to administer and record medication.

During our visit to the home we saw that the home did not have sufficient staff on duty to meet the needs of people living in the home. We spoke with most of the staff working during our visit and all agreed that the home did not have sufficient staff.

The staff did not feel sufficiently supported to ensure that people within the service were protected.

We found that the home was not letting the Care Quality Commission know of incidents such as people being injured as a result of falling in the home.

Records were sufficient to protect people against the risks of unsafe or inappropriate care.

We saw people's privacy and dignity were respected and staff were helpful. Comments from people who lived in the care home included "Absolutely no cause for complaint" and 'The staff team really get on together and they are all lovely'.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We looked in detail at the care four people received. We spoke to staff about the care given, looked at records related to them, met with them, and observed staff working with them.

We observed that people were supported to make decisions about their lives and be as independent as possible. Some relatives said that their relatives living in the home were not always presented well, this included people wearing inappropriate clothing.

We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse.

A visiting paramedic said when they visit the home, the home is always clean and the staff are kind and helpful.