Archived: Murree Care Home

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.

The inspection took place on 31 August 2016 and was unannounced.

The last inspection took place on 13 and 14 August 2015 when we found that they were not meeting all the required Regulations. In particular, risks were not always mitigated, recruitment checks did not always ensure staff were suitable and the provider's systems for monitoring the quality of the service did not always identify risks.

At the inspection of 31 August 2016 we found the provider had made the necessary improvements.

Murree Care Home is registered to provider accommodation and personal care for us to six people who have mental health needs. At the time of the inspection six people were living at the service. Their primary need was their mental health needs. Some people also had learning and physical disabilities. The service was owned and managed by a registered individual. They also owned one other care home in North West London.

Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were happy living at the service. They felt well supported and their individual needs had been discussed with them. They helped to plan and review their own care. People were supported to learn independent living skills and to be part of the local community.

The staff were appropriately supported and trained. They had the information they needed to care for people and the manager worked closely with them to ensure people's needs were met.

The environment was suitable for the needs of the people who lived there. They had their own bedrooms which they had personalised. They also had unrestricted access to communal areas. People had their own front door keys and were supported to use community facilities. They were involved in a range of activities both within the home and in the community. They had access to college courses and took part in group and individual social and leisure pursuits.

The service was appropriately managed. The owner was also the manager and she worked closely with the staff. There were systems for monitoring the quality of the service and these were effective. The provider liaised with other professionals and stakeholders to make sure people received the support they needed from those who were important to them.

There were two people using the service at the time of this inspection. We spoke with the provider and one other member of staff. We found that safeguarding policies and procedures had been updated. We saw safeguarding training certificates and the member of staff we spoke with was able to demonstrate their knowledge of their responsibilities in relation to protecting the people who use the service.

We found that people and their relatives were involved in their care and included in decisions about their support needs. People's needs were assessed and care plans developed so staff knew what action to take to meet these. People were supported to access healthcare professionals and any risks to their welfare had been assessed. We observed positive interactions between staff and people using the service and a relative said, "they really care, we are happy with the home".

Recruitment checks were taking place as required, however, these were not always sufficiently robust to ensure that people were protected from staff unsuitable to work with vulnerable people. In addition to this the systems in place to protect people from abuse were inadequate as the provider did not have appropriate policies and procedures in place and staff were unclear about their responsibilities.

The provider had some systems in place for monitoring the quality of the service to identify where improvements were needed.