The Care Quality Commission

Archived: Selena House Care Home

192 Oxford Road, Stratton St Margaret, Swindon, Wiltshire, SN3 4HA (01793) 822982

Provided and run by:
Mr Y Abhee

All Inspections

9 October 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience' (people who have experience of using services and who can provide that perspective), and a practising professional. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One person told us about how they liked to spend their time, 'Golf and fishing are my great loves but I can't do that here. I play scrabble sometimes but there is no one here I can play with if you know what I mean.'

Another person said 'No one talks to us about our lives. We keep each other company (referring to another person living at the home )'. The other person agreed, 'We are good friends aren't we?' The first person continued 'They make me feel alive, no one else does here.'

Another comment was, 'I like it here because there are no rules, I just sit here really, and I don't do much.' We asked this person if this was what they wanted and they said 'Yes, although I would like to do more. It is very quiet here; there is no one to have a laugh with.'

We observed that the care staff who worked directly with people were kind, gentle and respectful and supported people at an appropriate pace giving reassurance and support to help people mobilise. The manager did not always respect people's dignity and some care records were written in a disrespectful manner.

People's likes and dislikes were not always recorded and people's preferences with respect to daily routines were not recorded at all. People's cultural needs were not fully considered and supported. Food choices for people with allergies or religious requirements were poor.

Care plans were of poor quality and were not tailored to the individual. Plans were

computer generated and most care plans contained either insufficient information or suggested inappropriate care tasks. People's mental capacity was not considered in care plans and there was no information to guide staff on how to support people with limited capacity.

People could not be assured they would be protected from abuse as incidents of concern were not always reported to the local safeguarding team or to CQC. There were no processes in the home to assess and monitor accidents and incidents and manage risk. Processes and procedures for ensuring people received their medicines safely were not always followed.

We found that the home was not clean and that regular infection control checks in the home were not robust. The environment was poor and dated with dirty carpets, bedroom furniture was in poor repair and chairs were grubby and worn. The environment was not suitable for people with dementia and insufficient adaptation had been made to provide orientation and visual stimulation for people.

There were not enough staff on duty. Two people living at the home required a high level of staff support throughout the day which left one member of staff to support the other thirteen people. In addition the two care workers on duty were expected to carry out domestic duties as well as provide care.

The provider had failed to carry out regular checks to ensure that people received safe care of a suitable standard in a pleasant, well-maintained and safe environment.

9 February 2012

During an inspection looking at part of the service

Our previous inspection of Selena House Care Home was in September 2011. At that inspection we made one compliance action concerning staffing, and an improvement action in relation to cleanliness and infection control. We visited the home again on 9 February 2012 to see what improvements had been made in these areas.

Seven people were using the service at the time of our visit and another person was shortly to move into the home. We were told how the staff team were preparing for this move to ensure that the person's religious and cultural needs were met.

People said that the staff were helpful and caring towards them. We saw staff supporting people in a friendly way. We were told that staffing levels were being kept under review to ensure they were sufficient to meet people's individual needs.

Cleanliness within the home had improved since our previous inspection. We were told that hygiene and infection control was being given a higher priority.

We had not intended to look at outcome 16 as part of our inspection. However we discussed the use of bedrails during our visit to the home and found a shortcoming in how their safety was being assessed and documented.

13 September 2011

During an inspection looking at part of the service

Our previous inspection of Selena House was in May 2011. The home had been providing nursing care at that time, in addition to personal care. The provider's registration has since changed and nursing care can no longer be provided at the home.

After our inspection in May 2011, the provider told us about the work they would do in response to the compliance action and the improvement actions which we made at the time. Our visit on 13 September 2011 focused on looking at the improvements that had been made. The evidence and judgement sections in this report do not therefore reflect all aspects of the standards and the service that people receive.

Six people were using the service at the time of our visit, including one person who was in hospital. We were told that the people in need of nursing care had moved out of the home.

People's nursing needs were now being met through the community nursing service. We saw people using the communal areas of the home, which had been redecorated and improved since our previous visit. Other areas of the home had also been improved and a new system of care planning was being used. This meant that there was better information about people's care needs and how these would be met.

We were told about changes in staffing which had taken place following a reduction in the number of people who were using the service. The staffing level at night had reduced, however the deployment of staff was not taking into account the range of factors which would be relevant when assessing staffing levels. This meant that there was a risk of people's needs not being met.

12 May 2011

During a check to make sure that the improvements required had been made

A relative told us that the staff were 'very good with people ' talking and caring'. They said that the staff worked very hard, but they didn't have time to spend on activities, such as going out with people.

Staffing had increased in the afternoons, which helped to ensure that people received a consistent level of support during the day. However, the home was without an activities co-ordinator at the time of our visit and a lot of people spent their time just sitting in the lounge.

A number of improvements had been made since we reviewed the service in January 2011. Overall however the provider needed to do more to ensure that they maintained compliance with the essential standards.

A relative told us that the staff were 'very good with people ' talking and caring'. They said that the staff worked very hard, but they didn't have time to spend on activities, such as going out with people.

Staffing had increased in the afternoons, which helped to ensure that people received a consistent level of support during the day. However, the home was without an activities co-ordinator at the time of our visit and a lot of people spent their time just sitting in the lounge.

A number of improvements had been made since we reviewed the service in January 2011. Overall however the provider needed to do more to ensure that they maintained compliance with the essential standards.

20 January 2011

During a routine inspection

One person told us that they were settling in at Selena House after recently moving there from hospital. They were being cared for in their bedroom, although most people were sitting in the lounge while we were at the home. There were people who needed a lot of support from staff, for example with their mobility, and with eating and drinking. We found that people were at risk of not having all the care that they need.

The staffing level made it difficult to ensure that people were safe and their needs were being met in all areas.

The people we saw did not engage in a lot of conversation with staff, but staff spoke to people to reassure them, for example when the hoist was being used. We found that staff had received some training, although further training was needed in a wider range of subjects.

There was a planned menu which included a choice of dishes. Some people were in need of further support, so that they could make their preferences known and these could be acted on. There were people who were at risk of poor nutrition, although this was not always being followed up with a clear action plan and monitoring.

The lounge was a large space with chairs around the outside of the room and in the middle, with televisions in two corners. The televisions were on when people were talking together and engaged in other activities, such as games and reading. One person felt that there was a lot of noise and it was difficult having the televisions on in the background, which they said was not their choice.

People told us that they didn't know what was for lunch; they weren't aware of having a choice although they usually liked the meals.

People who use the service said that the staff were friendly and did a lot of things for them. They told us that staff were busy throughout the day and there were times when there were fewer staff around. Sometimes the nurses also had to deal with visitors and answer the telephone. The manager spent their time working as a nurse, which made it difficult to complete all the management tasks that needed to be done. There were risks to this arrangement and it had an impact on the quality of service that people received.