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Inspection carried out on 18 September 2017

During a routine inspection

This unannounced comprehensive inspection took place on 18 and 19 September 2017. The last inspection took place on 19 May 2015. Selkirk House was meeting the requirements of the legislation at this time and was given an overall rating of Good.

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 interes

Inspection carried out on 19th & 20th May

During a routine inspection

The inspection took place on the 19 & 20 May 2015 and was unannounced.

At our last inspection on the 1 February 2014 we found breaches of legal requirements in relation to the care and welfare of people who used services. We also found breaches in legal requirements relating to the management of medicines, staffing levels, staff support and the notification of incidents. At this inspection we found that improvements had been made in all these areas.

Selkirk House provides care and accommodation for up to 42 people. On the day of our inspection 40 people were living in the home. Selkirk House provides care for older people with physical and mental health needs, which could include people living with dementia.

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, their relatives and other agencies spoke highly about the care delivered at Selkirk House. Comments included, “It’s a lovely environment; I would be happy for my parents to be here. The atmosphere is home from home”, and “The care is excellent”.

People told us the staff were caring and they felt they mattered. They said staff listened to them and respected their wishes. Staff we spoke with were very clear about the importance of respecting people. They consistently spoke about people being individuals and treating people as they would like to be treated.

People felt safe in the home. The staff recognised people’s rights to make choices about their lifestyles, and risks were managed well. ”The registered manager said, “We use risk assessments to promote opportunities rather than use them as barriers”. Recruitment practices were robust and staff were employed in sufficient number to meet people’s needs and to keep them safe.

People were protected by staff who knew how to recognise signs of possible abuse. Staff felt reported signs of suspected abuse would be taken seriously and investigated thoroughly. Staff were able to talk confidently about the action they would take if they identified potential abuse had taken place.

People had their medicines managed safely. People received their medicines on time and in a way they chose and preferred. People’s health and well being was paramount, and systems were in place so staff could recognise changes in people’s health and take prompt action when required. The food in the home was of a good quality and catered for people’s specific dietary needs and preferences.

Care and support focused on each person’s individual needs, their likes, dislikes and routines important to them. When people were unable to consent to their care or support discussion took place to ensure decisions were made in their best interests. When people’s needs changed staff reacted promptly involving other social and healthcare professionals if needed.

A range of activities were available to meet people’s needs and particular interests. Family and friends were welcomed to join in mealtimes and activities and links with the local community were considered important by people and the service.

Staff told us they were supported and encouraged to question practice. Comments included, “We are listened to and feel valued members of the team”. Staff said they were aware of the values of the service and these were regularly discussed and promoted. Staff were inspired and motivated to provide a good quality service and had a clear understanding of their role and what was expected of them.

Since the last inspection a new registered manager had started work in the home and had worked hard to address issues raised at the previous inspection and to further improve the quality of the service. People, staff and relatives spoke highly of the management. Comments included, “Moral has improved over the past year, we give 100% we wouldn’t want any people not to receive the care they need”, and “The team and team leaders are very strong. We have a duty of care to ensure people are safe and happy”.

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised had been used to help drive continuous improvement across the service.

Inspection carried out on 1 February 2014

During a routine inspection

We met or spoke to most of the 41 people who used the service. We spoke to four visitors, talked with the staff on duty, and checked the provider's records. One person who used the service said, �The staff are lovely� and �They are kind.�

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.

Inspection carried out on 14 October 2012

During a routine inspection

We met 18 people who used services, talked with staff and checked the provider's records. We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs which meant they were not all able to tell us their experiences.

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.

Reports under our old system of regulation (including those from before CQC was created)