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Archived: Marray House Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 9 March 2015

This was an unannounced inspection on 10 December and 12 December 2014. Marray House provides accommodation for up to 20 older people who require support in their later life or are living with dementia. There were seven people living at the home because the service was subject to safeguarding processes, and the local authority were not commissioning with the service at the time of our inspection. The home is comprised of two separate houses which are joined together by a kitchen. Accommodation is arranged over two floors, and there is a stair lift to assist people to get to the upper floor. The home has 20 single bedrooms. There are shared toilets, bathroom and shower facilities.

After our last inspection in September 2014 we told the provider to take action to make improvements to how the quality of the service was monitored. The provider sent us an action plan on 7 November 2014 confirming all the improvements had been made. During this inspection we looked to see if these improvements had been made, but they had not all been completed.

The service has not had a registered manager since September 2011. 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.

Staff did not understand how the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS) protected people to ensure their freedom was supported and respected. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

People’s comments about the staff were variable; some people told us staff were kind and caring, whilst others felt differently. Relatives told us they were happy with the care their loved ones received, and like people who lived at Marray House, were complimentary of the provider. Relatives and professionals told us they always received a warm welcome when visiting. However,

people were not supported by sufficient numbers of staff who had the knowledge, skills, experience and training to carry out their role.

Staff were not aware of people’s individual nutritional needs and people were not always supported to drink enough. People had access to health care services however services were not always contacted in a timely manner. The provider did not have effective systems in place to ensure information about people’s health care needs were shared. This poor communication affected the ability of staff to meet people’s individual needs.

The provider did not always embrace feedback from health and social care professionals to enable learning and improvement to take place. For example, the provider had chosen not to implement changes as suggested by social care professionals to improve the care planning documents for people.

People did not receive care which was personalised to their needs because staff did not always follow advice from health professionals. Care plans and risk assessments were not individualised and did not give clear direction to staff about how to meet a person’s needs. This meant the care being provided was inconsistent between staff. People were not involved in creating and reviewing their own care plan. This meant people’s care plans were not reflective of their own choices.

People’s independence and social life were not promoted. People had requested trips outside of the home but no opportunities were provided.

People’s medicines were not managed well which meant people did not receive them at the correct time and documentation was inaccurate. People’s end of life wishes were not understood by staff and people’s care planning documentation was not reflective of their wishes. This meant people were not well supported at the end of their life and did not always receive consistent and compassionate care.

The quality monitoring systems in place did not help to identify concerns and ensure continuous improvement.

Staff were able to explain what action they would take if they suspected abuse was taking place. People were protected by safe recruitment procedures as all employees were subject to necessary checks which determined they were suitable to work with vulnerable people. People told us, if they had any concerns or complaints, they felt confident to speak with the staff or provider.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.<Summary here>

Inspection areas

Safe

Inadequate

Updated 9 March 2015

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Aspects of the service were not safe.

Staffing numbers were not adequate to meet people’s individual needs.

People were not protected from risks associated with their care and documentation relating to this was not reflective of people’s individual needs.

People did not receive their medicines at the prescribed time, and documentation relating to medicines was inaccurate.

People told us they felt safe. Staff knew what action they would take if they suspected abuse was taking place. Safe recruitment practices were in place.

Effective

Inadequate

Updated 9 March 2015

The service was not effective.

People did not receive support from staff who had the necessary knowledge, skills and training to meet their needs.

People’s changing care needs were not always referred to relevant health services in a timely manner. People’s care needs were not always properly met as staff did not always follow the advice from health professionals.

People were not supported to eat and drink enough and maintain a balanced diet.

People were not protected by the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) as staff had poor knowledge of the legislative framework.

Caring

Requires improvement

Updated 9 March 2015

Aspects of the service were not caring.

People told us staff were sometimes caring and meant well. However, there were times when people did not feel well cared for. Staff did not always speak with people in a respectful manner.

People’s confidentiality, privacy and dignity were not always respected.

People’s end of life wishes were not understood by staff. People did not always experience compassionate care at the end of their life.

Responsive

Inadequate

Updated 9 March 2015

The service was not responsive.

People were not involved in the design and implementation of their own care plans which meant care planning documentation was not reflective of their wishes. People’s care plans were not individualised and did not provide guidance and direction to staff about how to meet people’s care needs.

People’s needs were not always met in line with professional advice.

People’s independence and social life were not promoted, which meant people had very little to occupy their time.

Concerns which were raised by people were not always used as an opportunity to make improvements.

Well-led

Inadequate

Updated 9 March 2015

The service was not well-led.

The service did not have a registered manager in place.

People and staff were not empowered to be involved in the running of the home. Lack of leadership meant staff did not know what action they needed to take to meet people’s needs.

People did not receive a high standard of quality care because the provider’s systems and processes for quality monitoring were ineffective in ensuring people’s needs were met and the environment was safe.

Relationships with external professionals were not always positive which meant advice was not always implemented to the detriment of people and staff.