Archived: Murree Residential Care Home

The last inspection took place on 27 June 2017 where we found no breaches of Regulation and rated the service as “Good”.

Murree Residential Care Home is a care home that is registered to accommodate up to four people who have learning disabilities and who require support with personal care. At the time of our visit, there were four people living in the home.

The home is owned and managed by Shahnaz Abbasi and therefore there is no requirement for a separate registered manager for this location. For the purposes of the inspection report, we have referred to Mrs Abbasi as the ‘manager’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection.

We carried out this inspection on 20 November 2018 following concerns that were reported to us by the local authority. Concerns were raised in respect of the cleanliness of the home, maintenance, medicine administration, staff training, staffing numbers and the lack of activities available in the home. Prior to the inspection, the manager had attended various meetings with the local authority and other external care professionals in respect of the concerns raised and an action plan was in place to monitor the home and ensure they make improvements.

During our inspection, we found that there were aspects of the care provided that were not safe. The arrangements for ensuring that people living in the home and staff were kept safe in event of a fire were not adequate. There were some fire safety arrangements in place. These included weekly alarm checks, a fire risk assessment and a fire evacuation plan. However, during the inspection we noted that Personal Emergency Evacuation Plans (PEEPs) were not in place. These are required as they provide staff or emergency services detailed instructions about the level of support a person would require in an emergency situation such as a fire evacuation. We also noted that whilst a fire risk assessment was in place, it did not include information about the arrangements for people who smoked. We also noted that only one fire drill had been carried out in the past 12 months. We found some deficiencies in respect of fire arrangements and found a breach of regulation in respect of this.

During the inspection, we looked at the arrangements for medicines in the home. There were systems in place for obtaining and disposing of medicines and the home had a suitable medicines storage facility in place. We looked at a sample of medicine administration records (MARs) and noted that there were no unexplained gaps which demonstrated that medicines were administered as prescribed. We however found that the medicines administration policy was not sufficiently comprehensive and we discussed this with the manager who said that it would be amended.

On the day of the inspection we observed that care staff did not appear rushed and were able to complete their tasks. The manager explained that since concerns had been raised by the local authority, she had ensured that an extra member of staff was on duty during the day. However, we noted that there was one care staff on duty at night and we queried this with the manager and explained that due to people displaying behaviour that challenged the service, one member of staff may not be appropriate to effectively care for people whilst also considering the safety of care staff. The manager said that she would review this.

Risk assessments had been carried out which detailed potential risks to people and how to protect people from harm. People's care needs and potential risks to them were assessed.

The local authority had previously raised concerns about the cleanliness and maintenance of the home. There had also been concerns raised about cockroaches found in the home. During this inspection, we checked communal areas and all people’s bedrooms. We found that the home was clean and there were no unpleasant odours. We also found no evidence of cockroaches in the home and saw documented evidence that pest control had recently visited the home.

Staff spoke positively about their experiences working at the home. They said they felt supported by management within the home and said that they worked well as a team. However, we noted that there were significant gaps in staff training. Some people in the home demonstrated complex challenging behaviour and there was a lack of evidence to confirm that staff had received such training so that they could deal appropriately with instances where people displayed behaviour that challenged the service. We were therefore not satisfied that staff were aware of what action they should take in such situation. Such training was essential to effectively support people living at the home. The lack of training meant that staff may not have had the skills and competencies to enable them to support people safely. We found a breach of regulation in respect of this.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that where people were potentially being deprived of their liberty, the home had evidence to confirm that they had made the required applications.

People spoke positively about the food in the home. Arrangements for the provision of meals were satisfactory. Staff confirmed that they asked people what they wanted to eat and then prepared meals based on this. On the day of the inspection we observed people had a home-cooked lunch prepared by care staff. The lunch provided was a chicken curry, rice and salad. We noted that for dinner care staff prepared a homemade vegetable soup.

We observed interaction between staff and people living in the home during our visit and saw that people were relaxed with staff and confident to approach them throughout the day. Staff interacted with people, showing them patience and respect. People had free movement around the home and could choose where to sit and spend their recreational time.

Each person had a formal activities timetable, however we observed that it did not correctly reflect what activities were available on the day of the inspection. We spoke with the deputy manager about this and he explained that there was flexibility in terms of activities as it depended on what people wanted to do on a particular day depending on their mood. We did not see evidence of activities designed to mentally stimulate people and we made a recommendation in respect of this.

The home had a complaints policy in place and there were procedures for receiving, handling and responding to comments and complaints.

During the inspection, we spoke with the manager about how the home was meeting people’s needs. She explained that the home was experiencing difficulties managing two people’s care needs due to their behaviour that challenged the service. She confirmed that the local authority was currently looking to find alternative suitable accommodation for them.

During this inspection, we found that the home had implemented checks in respect of care plans, risk assessments and the maintenance in the home. However, we found that whilst the home had these in place, there was a lack of evidence to confirm that the manager was continuously carrying out these checks. We also found that the home had failed to identify their failings in respect of fire drills, fire arrangements, staff training and lack of activities. We found a breach of regulation in respect of this.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We last inspected the home on 30 April 2015 and found no breaches of regulations and rated the home as “Good”.

There was a registered manager in post at the time of our inspection. 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.

During the inspection we observed people were treated with kindness and compassion. It was evident that positive caring relationships had developed between people who used the service and care staff. People who used the service spoke positively about staff and the care provided at the home. People who used the service told us they felt safe in the home and around care staff.

We also found that appropriate arrangements were in place in relation to the recording and administration of medicines.

There were enough staff to meet people’s individual care needs and this was confirmed by staff we spoke with. On the day of the inspection we observed that care staff were not rushed and were able to complete their tasks.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people.

Care staff told us that they felt supported by management. They told us that management were approachable and they raised no concerns in respect of this. We saw evidence that staff had received training in various areas but found that there was a lack of evidence of training in relation to safeguarding procedures and medicines management. We saw evidence that staff received regular supervision sessions.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were clearly documented and included comprehensive detail. People told us that they received care, support and treatment when they required it. Care plans were reviewed regularly through key worker sessions and were updated when people’s needs changed.

People in the home had capacity to make their own decisions and care plans demonstrated that they were involved in making decisions about their care.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. Following a recommendation made at the previous inspection, the provider had taken appropriate action to ensure that two people had necessary DoLS authorisations in place.

People spoke positively about the food arrangements in the home. They explained that they had a choice of foods and there wasn’t a set menu as people ate what they liked and when they liked. People’s weights were recorded regularly. This enabled the service to monitor people’s nutrition so that staff were alerted to any significant changes that could indicate a health concern related to nutrition.

People spoke positively about the atmosphere in the home and we observed that the home had a homely atmosphere. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

We found the home had a management structure in place with a team of care staff and the registered manager. Staff told us that the morale within the home was good and that staff worked well with one another. They spoke positively about working at the home. They told us management was approachable and there was an open and transparent culture within the home and they did not hesitate about bringing any concerns to management.

Staff were informed of changes occurring within the home through staff meetings and we saw that these meetings occurred regularly and were documented. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

We noted that there was a lack of documented evidence to confirm that comprehensive regular audits were carried out by the provider. We made a recommendation in respect of this.

At this inspection we were satisfied that people who used the service received their medication as prescribed.

The provider had developed procedures or guidance on the safe administration of PRN medicines. This meant that medicines were given to the individual appropriately because the provider had guidance to indicate at what point the medicines would be given.

We found that action had been taken to ensure that appropriate standards of cleanliness and hygiene were maintained to prevent or minimise disease and spreading of disease in the home.

We talked with staff to check how they respected and promoted people's dignity when delivering care. Overall they were knowledgeable about the need to protect people's privacy and dignity.

We looked at how the service reduced the risk of people receiving unsafe and inappropriate care. We saw that the care needs of people had been assessed, together with actions for minimising potential risks.

We checked to see if people who used the service were protected against the risks of acquiring infection. The provider failed to maintain appropriate standards of cleanliness and hygiene to prevent or minimise disease and spreading of disease in the home.

We checked to see if people who used the service received medicines at the time they needed them and whether medicines were handled safely and securely. We found, although there were appropriate arrangements for ordering and receipt, the provider did not always record on the medicine administration records (MAR) when medicines were given.

Overall, the provider had arrangements to monitor and manage risks to people who used the service.

We were satisfied that people received effective and safe support because their needs were assessed along with support plans.

Staff demonstrated they understood aspects of safeguarding process relevant to them. They told us they were well supported by the management and were aware of their limitations but confident to approach managers when they needed to.

We noted the provider did not have systems to monitor the quality of the service provision.