Selly Park

Selly Park is a care home providing nursing and personal care for 29 people aged 65 and over at the time of the inspection. The service can support up to 50 people.

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

The provider’s governance systems to monitor the delivery and quality of the service provided for people were not consistently robust and required further improvement. For example, ensuring risk assessments and care plans were reflective of all medical conditions such as epilepsy/seizures and clear consistent protocols in place to support staff on what they need to do to support people effectively.

Most of the people, relatives, and staff we spoke with said the staff provided good quality care.

People were safe using the service. Staff knew how to protect people from harm and reduce the risk of accidents and incidents. At the time of our site visit, we found there were enough suitably recruited staff on duty to meet people’s needs and to keep people safe. People were supported by staff who knew their needs well. Staff supported people with their medicines and this was done safely. Staff understood how to prevent and control the spread of infection.

People had been assessed before being accepted to the service to ensure the provider could meet their needs. Assessments addressed people's physical and health needs, their cultural and language needs, and what was important to them. Staff received training which helped them to deliver personalised care. People were happy with the choice of food available and where appropriate, received additional support with their dietary needs. The provider worked well with external health and social care professionals and people were supported to access these services when they needed them to ensure their health was maintained.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests; the policies and systems in the service required some improvement to ensure the provider continued to support this practice.

Staff were knowledgeable about people’s care and support needs. Most of the people and relatives told us how friendly and caring the staff were. Staff enjoyed their work and got on well with the people they supported. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

Some of the people using the service at the time of the inspection could not always tell us about their experiences. However, whilst on site, we saw positive interactions between people and staff and people looked comfortable with the way they were being supported. Relatives we spoke with gave us positive feedback on the service and the way the staff supported their family members to remain safe. Staff provided responsive care to people in line with their preferences and choices. If people communicated non-verbally staff knew how to engage with them.

People were supported by staff who knew their preferences. Complaints made since the last inspection had been investigated and families knew who to contact if they had any concerns. Relatives and staff were happy with the way the service was being led and there was a culture amongst the staff team in providing person-centred care.

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

Rating at last inspection: The last rating for this service was inadequate (published 29 May 2019) and there were multiple breaches of regulation. This service has been in Special Measures since 29 May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

People’s experience of using this service:

Not all risks to people were being managed effectively to ensure people’s safety. Safe moving and handling practice was not always followed. Not all people received their medicines as prescribed.

There was not always enough staff on shift to care for people. People did not always receive the support they needed at meal times.

People were not supported by staff whose training was consistently effective and always gave them the skills and knowledge required.

People were not supported in a consistently caring way. While some interactions were kind and caring and positive examples were seen, we saw staff were not always consistent with this support.

People had access to some leisure opportunities and activities. Improvements could be made to the opportunities available.

The registered manager understood her responsibility under the Mental Capacity Act 2005 (MCA). Staff were recruited safely and understood their responsibility to protect people from the risk of harm and report their concerns.

The provider had quality assurance and governance systems. These were not effective in identifying the areas of improvement required within the service.

We found the provider was not meeting the regulations around safe care and treatment, staffing and good governance.

Rating at last inspection: At our last inspection in January 2017 (report published in April 2017) we rated Selly Park Nursing Home as Requires Improvement.

Why we inspected: This was a planned inspection which took place on 30 and 31 January 2019

Enforcement : Full information about CQC’s regulatory response to the more serious concerns found and appeals is added to report after any representations and appeals have been concluded.

Follow up: As we have rated the service as inadequate, the service will be placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not, enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We conducted a comprehensive unannounced inspection of this service over two days on 12 and 13 January 2017. On the first day the inspection team consisted of two inspectors and a specialist advisor who had clinical knowledge of the needs of the people who used this type of service. We were also accompanied by an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. On the second day the inspection team consisted of one inspector.

Before the inspection we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.

We checked any notifications the registered provider had sent us. These contain details of events and incidents they are required to notify us about by law, including unexpected deaths and injuries occurring to people receiving care. As part of planning our inspection, we also reviewed the actions the registered provider told us they would take in response to the findings of our last inspection. We also spoke with a person who commissions packages of care from the service and a health professional who regularly supports people who use the service. We used this information to plan what areas we were going to focus on during our inspection visit.

During our inspection visit we spoke with nine people who used the service and two relatives of people who used the service. We also spoke with the nominated individual for the service, the registered manager, two nurses, one senior carer, five care assistants, two housekeepers and two members of the catering team. We sampled the records, including seven people’s care plans, three staffing records, medicines management and quality monitoring. We also spoke with a community health care nurse who was visited the service during our inspection. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

At our last comprehensive inspection in October 2015 we found that the care and support provided to the people who used the service required improvement. We identified concerns with the provider’s recruitment process and the management of risks which meant people could receive unsafe or inappropriate care. We were concerned with the provider’s quality review processes and how people were supported to express their views of the service. Staff appeared busy and unable to support people promptly with personal care or help them to pursue their personal interests. Following the inspection in October 2015 we met with the registered provider to discuss our concerns. The registered provider gave us reassurances and sent us plans about how they would improve to ensure they met the needs of the people they were supporting and their legal requirements.

Selly Park is a residential home which provides nursing care to older people most of who are living with dementia. The service is registered with the Commission to provide accommodation and personal care with nursing for up to 50 people and at the time of our inspection there were 35 people using the service. There was a registered manager at this location. 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 and associated Regulations about how the service is run.

At this inspection we found many things had improved. We observed staff responding promptly to people’s requests for support. All the people we spoke with expressed confidence in the new manager and staff told us they enjoyed working at the service. Although we noted some improvements in the number of care staff available to support people and noted attempts to recruit to nursing vacancies there was not the required staff levels identified as necessary by the provider to support the registered manager to deliver the provider’s improvement plan. This meant the registered manager had not completed all the actions identified as necessary to improve the service and to meet people’s specific needs by the time they told us they would. Although the provider had recruited additional care staff they had not replaced an activities coordinator who left a month ago. There had been a reduction in the number of activities staff which meant that people continued to be at risk of not receiving sufficient support to pursue their personal interests and/or avoid social isolation. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager had conducted assessments to identify if people were at risk of harm and started a programme to review records to ensure they were up to date.

People told us staff responded promptly to requests for support however several members of staff said they needed to spend more time with people in order to promote social interaction and interests.

Staff we spoke with could recognise the signs of abuse. The registered manager and staff understood the process of notifying other authorities when they were concerned a person was at risk of harm. The provider did not ensure the premises were managed appropriately to keep people safe. Medicines were being given as prescribed and stored safely but improvements were needed to ensure medicinal creams were used as prescribed and recorded well.

Staff were knowledgeable about the need to obtain consent. The registered manager had reviewed and updated the providers’ policy to ensure people were supported in line with the Mental Capacity Act (2005). The registered manager had approached the appropriate authority when it was felt there was a risk people were being supported in a way which could restrict their freedom.

Staff were supported to maintain their skills and knowledge through regular training and people were supported to access additional health care services when they needed them.

Menus reflected people’s preferences and drinks and snacks were available throughout the day.

Although the culture of the home had become more person centred since our last visit care staff were still focused on completing tasks instead of considering people’s individual interests and preferences. There was a lack of resources and clear guidance about how to support people to engage in their individual interests. You can see what action we told the provider to take at the back of the full version of the report.

The provider had a complaints process which was displayed around the home. The registered manager reviewed complaints and comments to identify any trends. People said the registered manager had taken action when they raised concerns.

The provider’s processes for monitoring and improving the quality of the service had improved, however it did not always ensure a prompt response by the provider when concerns were identified. The provider did not have a robust system to respond to all the concerns in our latest report. You can see what action we told the provider to take at the back of the full version of the report.