Murton Grange

Murton Grange is a residential care home providing personal care to up to 10 people. The service provides support to autistic people and people with learning disabilities. At the time of our inspection there were 10 people using the service. People’s rooms were over 3 floors.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Murton Grange is larger than what is usually considered practicable to provide person-centred care

and support for autistic people and people with learning disabilities. However, the service was able to demonstrate they met the principles of ‘right support, right care, right culture.’ People received safe and effective person-centred care and support from staff who knew them well.

People received exceptionally responsive support from dedicated, highly motivated and compassionate staff. Staff fully understood people's needs and wishes and supported them to achieve their goals. Staff knew people extremely well and supported them to promote and improve their independence and quality of life. People were supported by a stable staff team which provided a consistently high standard of care and support.

People had personalised and tailored positive behaviour support (PBS) plans which met their individual needs. PBS plans provided staff with detailed guidance to promote a positive quality of life for people and identified when they needed to intervene to prevent or reduce the likelihood of distressed behaviour.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People received extremely kind and compassionate care from staff who were passionate about achieving the best outcomes for them. They worked alongside other professionals to empower people to achieve their goals. They respected people's abilities and strengths and went the extra mile to ensure people's achievements were celebrated.

Staff understood and responded to people’s individual needs. Staff understood how to keep people safe and promoted positive risk-taking where appropriate. Staff had training on how to recognise and report abuse and they knew how to apply it. People's medicines were managed safely.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the registered manager and staff team. The registered manager led by example and was open about the high expectations they had of all the staff team. Staff supported people to live a quality life of their choosing. They evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

The staff team were valued by the provider and registered manager, and they were recognised for their achievements. Staff were complimentary about the support they received from the management team.

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 good (published 17 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook a focused inspection to review the key questions of safe and well-led only. However, we identified exceptional practices in relation to the provider’s approach to person-centred care, so a decision was made to include the key question of responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Murton Grange on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager had identified, assessed and mitigated all COVID-19 related risks to people, staff and visitors. Risk assessments and policies were in place to help keep people safe.

Staff wore appropriate PPE and had access to this throughout the home. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control from the provider.

The home was clean. Enhanced cleaning was being carried out including frequent touch points such as handrails and door handles. The registered manager had implemented the use of a UV hand hygiene machine which was used by staff to ensure their hands were clean.

The provider had implemented effective contingency plans, including occasional use of staff from local services, to ensure there were sufficient staff available to meet people's needs.

Murton Grange 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.

Murton Grange accommodates up to ten people in one adapted building. This care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. On the day of our inspection there were seven people using the service.

The service did not have a registered manager in place. The previous registered manager had left the service in June 2016. Between June 2016 and September 2017 there had been several temporary managers. The current manager had been in post since September 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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. Since our inspection the manager has applied to become the registered manager.

We last inspected the service in November 2015 and rated the service as ‘Good’ in all areas and ‘Good’ overall. At this inspection we found the service remains ‘Good’ overall, although the rating for the key question of ‘is this service well-led?’ has deteriorated to ‘Requires Improvement.’ This is because the service has been without a registered manager since June 2016.

Medicines were managed safely. Guidance around ‘when required’ medicines such as painkillers sometimes lacked detail but staff could tell us about people’s needs in this area. The manager told us they would ensure guidance in this area was updated to include more detail. Accidents, incidents and safeguarding concerns were dealt with appropriately and lessons learnt where appropriate. There were enough staff to meet people’s needs in a timely way. Risk assessments relating to people's individual care needs and the environment were reviewed regularly.

Staff received appropriate training and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

Relatives told us they were happy with the care provided. Staff engaged with people in a caring and relaxed way. Staff knew how to communicate with people according to their individual needs. Staff promoted people’s independence and involved people in planning and reviewing their own care.

Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people's individual needs.

There was an effective quality assurance system in place. Staff said management changes had been unsettling but things had improved since the current manager arrived. Staff felt the service was well managed and described the manager as approachable. Staff said morale had improved significantly.

Further information is in the detailed findings below.

Where appropriate we found the provider acted in accordance with legal requirements where people did not have the capacity to give consent themselves.

We found that members of staff were very attentive to people's needs. People looked well cared for and at ease with the staff members who were supporting them. People's needs were assessed and care and treatment was planned and delivered in line with their individual support plan.

People's medication was managed safely.

Staff recruitment procedures were followed and appropriate checks were undertaken before staff began work.

People's personal records were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.

We found that members of staff were very attentive to people's needs. People looked well cared for and at ease with the staff members who were supporting them.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.