We carried out this unannounced inspection on the 07and 08 March 2017. Selly Wood House Nursing Home provides nursing care and support for up to 44 older people who may also live with dementia. At the time of our inspection 39 people were residing at the home.

We undertook a comprehensive inspection of this home in October 2015. We found that the home had continued to provide a good service, although we identified some concerns with medicines management and issued a requirement notice. A specialist pharmacy inspector re-visited the home in December 2015 and found the issues had all been fully addressed. The home was compliant with the requirements of the law and meeting people’s needs well in the other four of the five key questions we looked at.

The home has a registered manager. 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 told us that they felt safe. People’s relatives, staff and health professionals supported this view. Staff had been trained in adult safeguarding and when we spoke with them they showed a good level of knowledge about possible signs of abuse and the action they would take in reporting any concerns.

People received their medicines safely and there were effective systems in place to monitor medicines administration.

The feedback we received about staffing was mixed. Some people reported that they had the support they required and did not have to wait an unreasonable amount of time for support or for a response to their call bell. Other people told us, and some of our observations supported that people were left for long periods without staff support, and some people had to wait a long time for help when they needed the toilet, to change positions or when they called their call bell.

Staff told us they had received induction, sufficient training and on-going support. There were handovers between staff at each shift change. During our inspection we observed that the handovers were not always effective at ensuring temporary staff had the information they needed to support people safely.

Staff had some knowledge of the Mental Capacity Act (MCA) (2005) and described how they supported people with making choices. Restrictions to people's liberty had been identified. When necessary the relevant applications had been made and kept under review.

People had access to regular healthcare and specialist healthcare advice. The nursing care provided was good and followed published good practice guidelines.

People’s feedback about the food provided was generally positive. Some people really enjoyed the food. People were able to eat communally in the dining room, or in their bedroom. The staff supported people in a dignified and respectful way when they required help to eat and drink.

We received consistent feedback that the quality of care provided by individual staff was good and people told us that staff were kind and caring. Many of the staff we met had been in post for a long time and they demonstrated that they knew the people they supported well. During our observations we saw good staff practice that ensured people were treated with dignity and respect.

People told us that they were able to be involved in planning their care. This ensured it would meet their individual needs and preferences. Reviews of care happened regularly and records showed the involvement of people or their relatives to ensure people were still happy with the care they were receiving.

People and their relatives were supported to think about the care they would like to receive at the end of their life. The nursing and management staff had developed positive networks with specialist end of life practitioners, to ensure peopl

We carried out an unannounced comprehensive inspection of this service in May 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Selly Wood House Nursing Home) on our website at www.cqc.org.uk

We looked at the management of medicines. People could be confident they would get their tablets and medicines at the correct time. People told us they were happy with the way medicines were being managed.

Some people needed nursing staff to apply a medicated patch to their body to help relieve pain. These were not always being used as they should. People told us they had not experienced any pain or discomfort related to this, and we were satisfied with the additional action the registered provider told us they would take to improve this further.     

We found that people were treated with kindness and compassion, and had opportunities to make decisions about things which were important to them.

People told us that the standard of care was generally very good, and comments from people included, “I am very happy with my care and support (my carer) is very respectful. I can do most things if I want to, there is nothing I would change, there’s nothing that needs changing, I’m quite happy.”

We had previously raised concerns about the food and drinks provided to people who were at risk of malnutrition or dehydration. At this inspection we found significant work had been undertaken to improve on the quality of food offered to people, and the recording of the amount taken. We found that people who were able to choose their food, and eat independently were offered a good choice of interesting and nutritious meals.

People told us they felt safe. One person said, “They are very good. I have never been mistreated.” We found that systems were in place to reduce the risk of people being at risk of abuse.

The systems in place to check that the home was operating safely and to a good standard had been improved since our last inspection. We found a robust schedule of checks and audits were in place. These were undertaken by staff with different roles within the organisation and by external consultants. This ensured people lived in a well organised environment and received good quality care.

We used a number of different methods to help us understand the experiences of people using this service. Some people were able to talk to us about their care and support, and we met five relatives who gave feedback from their perspective for people who were unable to share their experiences with us. We invited an Expert by Experience (Exbyex) to join our inspection team. They spoke individually with seven people, and observed some of the support and activities available to people in the lounge. We observed the lunch time meal for people in the dining room and two people in their room, to see how support was provided with eating and drinking.

We observed staff interactions with people to be kind and friendly. People we spoke with all told us how staff were mindful to protect their dignity when helping them with care, and we saw staff knock or call out to people before entering a person's room. One person said, "I am very pleased with how they treat me here." It was one person's birthday on the day of our visit, and we saw staff surprise them with a cake and bouquet of flower's.

We looked at the care being delivered on Maple and Sycamore- two of the units within Selly Wood House. We found that personal care was being delivered to a very high standard. We saw people being cared for in bed, who had been supported with oral care, skin care, and to dress in an attractive way, that suited their age, culture and style. One person told us, "I'm very happy with my care, my chief carer is wonderful." We found that people were supported to see the health professionals they needed to, and where possible people could keep the practitioner's they had when living at home. We were told," I asked if I could keep the same dentist, they sorted that out for me." One health professional told us, " They always respond straight away. They are very pro-active." The majority of feedback we received during our visit showed people were very happy with the service provided at Sellywood house.

We did not find that all the health care needs people had were well documented or that we could through records see they were being met. Despite this, our discussions with the nursing and care worker team showed that staff had a good understanding of people's needs and how to meet them.

There was a range of things for people to do. One person said, "There is plenty to do..the exercise group is particularly good." We found the home was trying to provide activities to suit people's varied interests, and accommodate people's different abilities and needs. Several staff had recently undertaken advanced training in dementia care, and were setting up a number of initiatives within the home to reflect the specific needs of people with this condition.

We found that many new initiatives related to food had commenced since our last inspection. We found that people able to eat or drink with little or no assistance were enjoying the range and presentation of meals and the opportunity to request dishes they liked. The weather was very warm at the time of inspection and people told us they had enjoyed ice creams, and the opportunity to have their tea "picnic style" in the garden. Comments about food included, " I enjoy the food, it is varied and tasteful. If I want to change my mind about the meal I am offered there is alternative food available." However we found the meals, support and the care planning available for people at risk of malnutrition or dehydration due to their care needs were not adequate. We could not always see that people had received enough to eat or drink. We did not find they always received consistent staff support through a meal, or that care staff offered the puree meal to people in an attractive way, or one that would enable them to comment on which parts of the meal had been eaten.

We looked at the systems in place for securing people's valuables, for ensuring new staff were checked before they worked in the home, and for making sure staff were trained in the areas of abuse and safeguarding. We found that the home was taking reasonable action to protect people from harm. We asked one visitor if they felt their relative was safe. They said, "I'm happy. I have nothing but good to say about the place. It has been here for years and I have never heard anything bad."

It was apparent as we watched interactions with people and staff that some special bonds and friendships had developed. We asked people how they found the staff who support them each day. People told us,"There is nothing I could grumble about. I have every thing I need. The girls are golden" and "I'm very happy with my care, my chief carer is wonderful." We found that staff had been well trained, and they felt supported. We spoke to a group of staff who said, "We feel well supported by management, and often our concerns are addressed in a reasonable time. If there are concerns about a resident these are acted upon very quickly."

We found there were systems in place to monitor the quality and safety of the service. The effectiveness of these had been variable. We found that the organisation was keen to get the feedback of people using the service, their relatives and staff, and that results of the feedback was being analysed to develop the service. We did not always find that the audits had identified matters of concern, or that the action resulting from an audit was always fully implemented.

This unannounced inspection took place on 13 and 14 May 2015. Our last inspection of this nursing home was in 2013. At that time we found the provider was compliant with the requirements of the law and meeting the needs of the people living at the home.

Selly Wood House is a nursing home that can provide accommodation and nursing care to up to 44 older people. Each person has their own single room, some of which have an ensuite toilet. There are communal bathrooms with assisted bathing facilities on each floor of the home. On the ground floor there is one large communal lounge and two smaller communal lounges are located one each on the first and second floor. There is a dining room. The accommodation is over the ground, first and second floor and there is a passenger lift providing full access to all areas of the home.

Selly Wood House does have a registered manager in post; however they were on extended leave due to poor physical health. The provider was aware of the planned return date of the registered manager. In the interim the provider had secured an agency manager, and provided additional support to the home from within the organisation. 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 were supported by staff who had received training on how to protect people from abuse. Robust safeguarding procedures were in place which the manager was following. Staff we spoke with were able to explain a variety of actions and checks they took both individually and as a team to ensure people received the support they needed and were protected where ever possible from harm.

Medicine administration records and stocks of medicine (including skin patches and inhalers) available in the home did not show that people were getting their medicines at the frequency or in the doses that their doctor had prescribed them. This meant people’s medical conditions were not always being treated appropriately by the use of their medicines.

We found that staff were ensuring that the legal rights of people were protected and the provider was keen further increase their confidence and knowledge.

People were being supported to maintain and improve their health. Strong links had been developed with a wide variety of health care professionals and medical staff to ensure people were assessed and treated to help them maintain good health.

People told us they enjoyed the food served and we observed people in the dining room getting good support to eat a wide variety of foods. We found further support and planning was required to ensure people at higher risk of dehydration and malnutrition always got the support they required.

We observed and heard exceptionally caring and compassionate interactions between staff and people throughout our inspection. People and their relatives consistently praised the approach and attitude of the entire staff team.

The manager had developed systems to respond to concerns and complaints. People we spoke with told us they had been happy with the home and had been able to get any grumbles or concerns dealt with promptly by speaking directly with the manager.

The activities and opportunities available to people were varied and people had been supported to attend events that were important to them in the local community. Activities that were of interest to individuals and small groups had been developed as well as activities that appealed to the majority of people living at the home. We identified further opportunities should be made available for people being cared for in bed.

The systems in place to check on the quality and safety of the service were established. While these had been effective at monitoring the majority of the service they had not identified problems with medicine management and nutrition and hydration for people at highest risk.