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Archived: Marray House Inadequate

Reports


Inspection carried out on 10 and 12 December 2014

During a routine inspection

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 carried out on 17 September 2014

During an inspection to make sure that the improvements required had been made

We carried out this inspection to review the actions the provider had taken to address the issues identified during our inspection on 9 May 2014. We gathered evidence against the outcomes we inspected to help answer three key questions: Is the service caring? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

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.

Inspection carried out on 8, 9 May 2014

During an inspection to make sure that the improvements required had been made

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

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.

Inspection carried out on 3, 5 December 2013

During a routine inspection

The person named as the registered manager on this report is no longer employed at the home. The registered provider has been asked to deregister this person.

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.

Inspection carried out on 7 February 2013

During a routine inspection

We (the Care Quality Commission) carried out this inspection to follow up on compliance actions made at our inspection in December 2012. We made two compliance actions relating to the recruitment processes in place at the home and the staffing levels and skills available to support people at 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.

Inspection carried out on 13 December 2012

During an inspection in response to concerns

We (the Care Quality Commission) carried out this inspection following concerns received about the management of staffing at the home and the impact this had on people using the service.

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.

Inspection carried out on 10 July 2012

During an inspection to make sure that the improvements required had been made

We (the Care Quality Commission) carried out this inspection to follow up on what progress had been made with those standards of care which were not compliant with the Health and Social Care Act 2008 at our inspection in March 2012.

We reviewed all the information we held about this provider and carried out a visit on 10 July 2012. We talked with people who used services and relatives, talked with the staff, checked the provider’s records, and looked at the care records of people who used services.

We talked with five people who lived in the home, we were not able to communicate effectively with everyone due to their physical needs. We saw people’s privacy and dignity being respected and staff being helpful. Comments from people who lived in the care home included,

‘I am being well looked after’,’ They are all very kind to me’

and ‘I am happy enough’.

‘The food varies, but I can’t complain’.

'they are supporting my relative to regain their independence'.

Relatives of people who used the service, told us that they were very happy with the service provided. Their comments included,

‘The cleanliness has improved and so has the bathroom, the staff are very good and there are enough of them – my relative is happy’.

Also,

‘Here is loving, caring and attentive, like a home’.

We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. Staff knew what food choices people liked and how they wanted to spend their day.We looked at staff training and procedures in place to protect people.

We pathway tracked three people who use the service. Pathway tracking means we looked in detail at the care three people received. We spoke to staff about the care given, looked at records related to them, met with them, and observed staff working with them. All of the people we spoke with were happy with the service provided. People said that they would feel able to complain if they needed to. One person told us, ‘If I had any problems, I would talk to the deputy manager'.

We found that the home was clean and there were no offensive odours.

We looked at the auditing systems of the service. We found that auditing systems have been put in place and efforts made by the management of the service to monitor and address issues identified.

All of this information helps us to develop a picture of what it is like to live at Marray House.

Inspection carried out on 8 February 2012

During an inspection to make sure that the improvements required had been made

People using the service told us, that they were happy with the help and support they received. Comments included, "I couldn't be better, they do their best", and “I am quite happy and have no complaints". People feel as if they are treated with respect, "staff are polite and knock before they come in".

People, on the whole, enjoyed the food, "Food is adequate, you can't please everybody"

"There is only one choice at lunchtime but you get a choice of vegetables, teatime you have a choice of two options".

We found that there are very limited bathing facilities at Marray House, which mean many people are unable to have a bath or shower, at the moment. One person told us " I have a bath occasionally, the water is not hot enough to have a regular bath "

We found that people were consulted about the care they received, although not everyone was interested in being involved, “ I don't get involved in my care plan, I could but I don't want to, my family sign it".

We found that there were enough staff, although the rotas meant that it was difficult to be certain, one person said, “if you ring the bell you wait a long time, staff are a bit thin on the ground ", although other people thought that there were enough staff. "if you call your bell they come as quick and as prompt as they can do".

Inspection carried out on 6 October 2011

During an inspection to make sure that the improvements required had been made

People told us,

‘You ring but staff don’t come’, ’When you want to get up, nobody is available'.

‘It always seems like they need one more pair of hands’

‘I like one staff member, they make my life easier’

‘I can only have a bath with help from carers, there is not enough hot water to make it worthwhile to soak’.

‘They are a bit short staffed, things don’t get done quickly’

‘If you press the buzzer sometimes they don’t appear to hear it’

‘It’s sometimes ok here and sometimes not very good’

‘Staff never come back, I feel that I may as well not be here’

'Food is alright sometimes’

‘I have a bath but I have to keep on to get it, I would like a bath more than once a week’

‘I moved rooms but I wasn’t asked’

‘There is nobody available to pick up my shopping’

Inspection carried out on 28 July 2011

During an inspection to make sure that the improvements required had been made

People told us ‘The home is a bit slap happy, you have to keep on at people to get wheat you want’, also ‘You can’t always go into the garden because of steps, I love the garden’

Another person told us ‘They can’t afford more staff, short on cash, they told us this at a meeting’.

People told us that they often get bored as there is little entertainment or things to do.

People told us that the food was ‘Ok’. They told us that they had a choice of meals and that the meals were of sufficient quality and quantity to suit their needs.

We saw that the home is not clean in all areas. People expressed concern that cleaning is not consistently done and that care staff are too busy to complete all cleaning duties. People also told us that the environment needed updating to make it pleasant for people using the service.

People using the service, visitors and staff all expressed concerns that there were not sufficient staff available to meet the needs of people using the service.