Selborne House

Updated 17 September 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by one inspector and an assistant inspector.

Service and service type

Selborne House is a 'care home'. People in care homes receive accommodation and nursing or

personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. This was discussed with the provider at the time of the inspection and they told us it was their intention to submit an application to register a manager imminently.

Notice of inspection:

The inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke and or spent time with seven people who use the service. We also 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. We spoke with six members of care staff, the manager, operational manager, regional director and the providers behaviour specialist. We also had contact wit two health care professionals.

We looked at three people's care records, three staff recruitment records and records relating to the governance of the service. This included quality assurance audits, records of accidents and incidents and complaints records.

Updated 17 September 2019

About the service

Selborne House is a ‘care home’ and accommodates up to 15 people with learning disabilities. Some people living at the service were also diagnosed with mental health conditions and had complex support needs. At the time of our inspection 11 people were living at the service.

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

At our previous inspection we found a breach of regulation11, 13, 17 and 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. This was due to risks to people not being managed effectively. There was a lack of intervention around assessing incidents as they arose and taking appropriate action, people were exposed to the risk of ongoing harm. Decision were made by the provider on the person’s behalf without ensuring these were taken in the persons best interest in line with the law. The provider had not ensured appropriate audits and governance systems were in place within the service and there were failures in effective reporting systems. At this inspection we found that improvements had been made and breaches had been met.

Some further improvements were needed to ensure the quality systems in place were fully effective and imbedded into day to day practice.

Risks to people had been assessed and staff had a good understanding of these risks and how to minimise them. People were supported to receive their medication as prescribed and staff demonstrated a good knowledge of types and signs of abuse and how to report concerns of abuse.

People were supported to access healthcare professionals when required.

Improvements had been made to the training and support that staff received so they had the skills to meet people’s needs. Where further training was needed plans were in place to provide this. Not all staff understood the importance of seeking people’s consent before providing support.

People's care records were person centred and guided staff on the way they preferred their care and support to be provided. People were supported to do things they enjoyed doing and to maintain relationships that were important to them. The provider had a system in place to ensure any complaints received would be logged, investigated and responded to and any learning used to improve the service provided.

The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include, age, disability, race, religion or belief etc. Staff members we spoke with knew people they could tell us about people's individual needs and how they were supported.

People

The care service had not been designed and developed in line with the values that underpin the Registering the Right Support and other best practice guidance. People with varied and diverse needs were living together and these needs were not always compatible. The building layout and design was not always suitable for people with complex needs and challenging behaviour. There are long narrow corridors, numerous internal doors, internal locked doors with key coded pads, bedrooms close to communal areas. The environment is not conducive for its intended purpose.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 (report published March 2019)

This service has been in Special Measures since our inspection in January 2019. During this inspection, the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any key question. Therefore, the 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 reinspection programme. If we receive any concerning information we may inspect sooner.