About the service: Selly Park is a care home that is registered for 50 people and was providing personal and nursing care to 38 people at the time of our inspection.

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 carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

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.

This inspection took place on 27 and 28 April 2016 and was unannounced. There were 35 people using the service. On the first day the inspection team consisted of four inspectors and 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 team consisted of two inspectors and a specialist advisor. The specialist advisor had experience of providing nursing care to people who use this type of service. The inspection was to review how the provider had responded to concerns raised at our last inspection.

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 peopl

This inspection took place on 22 and 23 October 2015 and was unannounced. We had not inspected this service since there had been a change of legal provider in August 2014.

Selly Park is a residential home which provides nursing care to older people most of whom 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 36 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.

The registered manager had conducted assessments to identify if people were at risk of harm but people’s care records had not always been updated as their conditions changed. The lack of current and accurate records about support that was to be provided placed people at risk of receiving incorrect support. You can see what action we told the provider to take at the back of the full version of the report.

Several people said they were bored because staff were too busy to sit and help promote their interests. The registered manager had failed to identify that current staffing arrangements and deployment had a detrimental impact on the safety and well-being of people using the service. You can see what action we told the provider to take at the back of the full version of the report.

Staff we spoke with could recognise the signs of abuse and could explain the process they would take if they felt a person was at risk of abuse. The provider and registered manager did not always take action when they received information of concern.

The registered manager did not ensure the premises were managed appropriately to keep people safe. Medicines were mostly managed safely.

Staff were knowledgeable about the requirements of seeking consent however The registered manager had not considered each person’s individual support needs or assessed if any less restrictive alternatives were available. You can see what action we told the provider to take at the back of the full version of the report.

Staff were supported to maintain their skills and knowledge through regular training. However staff did not always follow directions left by visiting health care professionals.

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

People gave us mixed feedback about how they were supported to access additional health care services when they needed them.

The provider did not promote a positive culture which was person centred. Many people told us that staff were focused on completing tasks instead of responding to people’s requests for support and promoting a homely atmosphere. The care and support provided to meet people’s health care needs failed to consider their individual welfare and preferences. 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. A complaints log was not always completed sufficiently to identify how incidences could be prevented from happening again.

The provider’s processes for monitoring and improving the quality of the service were not robust and had not identified several failings at the service. You can see what action we told the provider to take at the back of the full version of the report.