Archived: Murree Care Home

Updated 15 January 2019

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.

The inspection took place on 27 November 2018 and was unannounced. We brought the date forward because we had received information of concern regarding the service. The inspection was carried out by two inspectors and examined those concerns in relation to the five key questions we asked of providers.

Prior to the inspection, we looked at the information we held on the service including notifications of significant events and safeguarding. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. We contacted the local authority’s safeguarding and quality assurance teams to gather further information about their views of the service.

During the inspection we spoke with three people using the service, one care worker and the registered individual who was also the owner. We viewed the care records of three people using the service and four staff files that included recruitment, supervision and appraisal records. We looked at training records for all care workers. We also looked at medicines management for people who used the service and records relating to the management of the service including service checks and audits.

Updated 15 January 2019

This comprehensive inspection took place on 27 November 2018 and was unannounced. The last comprehensive inspection took place in August 2016 and the service was rated ‘good’.

Murree Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection six people were using the service who had mental health needs and/or learning disabilities.

The service is owned and managed by a registered individual. The registered individual also had a second care home in Brent. 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 found risk assessments were not always robust enough to minimise risks and these were not updated to reflect changes and current risks. Incident forms were not completed as required, the staff were using unsafe moving and handling techniques and we identified that processes to manage people’s money were not always robust. This meant the provider was not assessing, monitoring and mitigating risks to people to help ensure that as far as possible, they were not exposed to the risk of harm.

The provider did not have checks in place regarding the safety of the environment, including personal emergency evacuation plans.

The medicines policy and procedure was not dated and as required medicines protocols were not in place. As required medicines were regularly being used to manage behaviour that challenges and medicines administration records were not always signed correctly. Medicines management was inconsistent and audits did not identify discrepancies.

Staffing was unsafe as care workers were working long hours and consecutive days without a rest period. Rotas were not a true reflection of the hours people worked and therefore it was difficult to know if the home had enough staff to meet the needs of people using the service. However, we identified one person who needed two people to provide support with personal care and only member of staff was available at night, should they require personal care at night.

The principles of the Mental Capacity Act 2015 were not always followed to help protect people’s rights.

The provider did not provide appropriate training for staff. Not all staff members had up to date safeguarding adults or MCA training.

The provider did not always support people to express their views and be involved in decision making. They also used inappropriate language in records that was not very respectful.

Personal care was not always undertaken in a dignified and respectful manner.

The provider had detailed care plans when people first moved to the service, but they were not updated to reflect people’s current needs and therefore did not reflect people’s needs accurately. Nor did they reflect people’s end of life wishes.

The provider did not have effective systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. For example, record keeping was not always complete and contemporaneous and there were no checks regarding the safety of the environment.

Safe recruitment procedures were followed to ensure staff were suitable to work with people. Staff received supervision to support their professional development.

People's dietary and health needs had been assessed and people were supported with these needs and to access healthcare services appropriately.

We found seven breaches of regulations in relation to person-centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing.

We are taking action against the provider for failing to meet regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is 'Inadequate' and the service is 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 take action 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.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

We found seven breaches of regulations in relation to person-centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing.

We are taking action against the provider for failing to meet regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Safe recruitment procedures were followed to ensure staff were suitable to work with people. Staff received supervision to support their professional development.

People's dietary and health needs had been assessed and people were supported to access healthcare services appropriately.