Archived: Marray House

This is a summary of what we found-

The inspector was joined by an expert by experience. An expert by experience is a person who has experience of using care services. During our inspection of Marray House, they spent time talking with people who used the service and observing the environment.

On the day of our inspection we spoke with the registered provider, three members of care staff and five of the eight people who were living at Marray House.

Is the service caring?

At the time of our inspection we found the service to be caring.

We observed a sense of humour between the staff and people who lived at Marray House and observed people approach staff without any hesitation, which showed they were comfortable in their presence.

People told us, that staff were 'gentle and kind' when supporting them.

Is the service effective?

At the time of our inspection we found the service to be effective.

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We found care planning for people had improved and that staff delivered care in line with people's care plans.

Of the five people we spoke with, everyone was confident that the doctor or district nurse would be called immediately if needed. People told us that the doctor visited every Thursday.

We found the meals being offered to people had improved and people were more aware of the options available.

Social activities continued to be limited; one person told us 'we could do with a bit more entertainment'.

Is the service well-led?

At the time of our inspection we did not find the service to be well-led.

It is an essential requirement of the Health and Social Care Act 2008 that a provider has a registered manager in place to ensure people who use the service have their care, treatment and support needs met because there is a competent person leading the service. At the time of our inspection the home did not have a registered manager in place.

At our last inspection the provider told us that he was going to be introducing a system for monitoring the quality of the service. However, at this inspection the provider told us that it had not been introduced, which meant there were no processes in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

This is a summary of what we found-

Is the service safe?

We felt that the service was safe and people told us they felt safe living at Marray House.

There have been concerns regarding the care provided to people who live at Marray House, and because of this, the home is currently subject to local authority safeguarding procedures. The manager is working collaboratively with external health and social care professionals to make improvements.

We found Marray House to be clean and there were no unpleasant odours.

At the time of our inspection there were eight people living at Marray House. We assessed the staffing numbers of the home, which showed there was sufficient staff on duty to meet people's needs throughout the day. However, people told us that they were aware that there were only two members of care staff on duty during the day and that they had to sometimes wait for assistance.

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DOLs) is a legal framework which protects people who do not have the mental capacity to make decisions for themselves. We saw from the provider's training records that staff had completed training in respect of the Mental Capacity Act (MCA). We found in people's care plans that documentation showed the manager was aware of his responsibility regarding MCA and DOLs.

We found that people's care plans contained risk assessments to support staff to reduce and prevent a risk to the person or to themselves. This documentation was under review by the manager with support from social services.

Is the service effective?

We did not feel that the service was effective.

People who lived at Marray House were complimentary of the care and support they received and told us 'the staff are very good', 'lovely, even the boss is lovely' and 'I have no complaints'.

Since our previous inspection, communication with outside professionals such as the community district nursing team had improved and the manager was becoming more aware of other professionals who could support the staff team.

However, we found stimulation and social activity was lacking, and people told us that the meals provided did not always meet their expectations. People told us the food options were limited and that they would prefer more variety.

There had been an improvement in the creation and design of people's care plans. However, we found that further action was required to address care planning documentation, to ensure it was accurate, up to date and a true reflection of peoples care needs.

Is the service caring?

We found the service to be caring. People who lived at Marray House told us staff were kind and caring. However, we were also told that 'when things get a little bit hectic we get rushed'. Another person told us that they felt staff were sometimes abrupt in their tone when they answered their call bell if they were busy. During our inspection we found staff to be attentive to people's care needs and request for assistance.

We found staff engaged in friendly conversation with people, but we observed that at times staff spoke with people in a childlike manner. Although this was not with any unkindness, it was not respectful to people.

Is the service responsive?

We found the service to be responsive.

As part of our inspection we spoke with a community district nurse who had responsibility for the care home. Since our last inspection the community district nursing team have been supporting the home to ensure nursing care needs as well as general care and welfare needs were being met appropriately. We were told that they felt the home was improving and had reduced the level of support required. They told us that communication between the staff team had improved and that they felt the community nurses were being contacted for appropriate reasons and in a timely manner.

During our inspection we observed staff to respond to people's need when requested.

Is the service well-led?

We did not find the service to be well-led.

The service had a manager who was registered with the Care Quality Commission and staff confirmed the manager was approachable. It was clear from speaking with people who lived at Marray House that the manager was available for people to speak with him at any time.

We found the manager and provider did not currently have effective systems in place to monitor the quality of the service being provided. We found the monitoring and auditing of care records required improvement.

We spent time talking with staff and observing care practices as well as talking to people who used the service. We also met with one visiting relative. Three people we spoke with individually were positive about their experience at the home. Comments included 'No complaints, very good on the whole.' And 'The food is good, I eat more now.' A relative told us 'Very happy with the care given, it's lovely here.'

We found that people's care and welfare needs were met while living at the home but not all the records of their care needs were up to date or reflected their current needs.

Peoples care requirements were not always recorded in a way to ensure that their privacy, dignity and preferences were carried out.

We found that not all medications were being stored in a safe manner.

The home was comfortably furnished although floors were uneven and staff did not always follow safe practice to ensure people's safety.

There were not always enough staff working at the home to meet people's needs in a timely manner. People living in the home told us 'The staff are very good.'

We found that the home had not told the Care Quality Commission of incidents when people had been injured or required emergency treatment as a result of an accident within the home.

We talked with three people living at he home. They told us "I can't fault them, I have nothing to grumble about" and "Its very homely here, its clean enough as far as I am concerned". People told us that they felt there were enough staff to meet their needs each day. One person told us that they had rang their bell at 5am that morning and the night staff had brought them a cup of tea.

We saw staff speaking to people in a kind and considerate way and supporting them to make choices about how they spent their day.

We looked at five recruitment records for staff and found them to be mostly complete. These checks were there to ensure that people using the service were safe.

We also looked at staff training records to ensure that staff working at the home had the skills to care for everybody at the home. Most training had been updated, some training in the safeguarding of vulnerable adults was planned for the near future.

We talked with five people who lived in the home. Comments from people who lived in the care home included 'we are looked after very well' and 'they (the staff) are very good here, very attentive'.

We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences.

We looked in detail at the care three people received. We saw from their records that areas of need had been identified and a plan of care put in place. Not all areas of identified need could be met by the staff available.

We saw ongoing building work taking place in the home. People who used the service told us that as a result there was no call bell in the lounge and so they had difficulty attracting the attention of staff. One person said 'if they are busy in the kitchen they cannot hear you and you just have to wait'.

We looked at staffing arrangements and saw that recruitment was not managed safely. The training of staff for moving and handling was not up to date to ensure that people were being assisted by suitably trained staff at all times.