Archived: Murree Residential Care Home

Updated 20 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 20 November 2018 and was unannounced.

The inspection visit was carried out by two inspectors.

Before the inspection visit we looked at all the information we held about the service. This included notifications of significant events and the last inspection report.

During the inspection we met and spoke with three people who lived there. Whilst they were able to communicate with us, this was limited. We therefore observed how they were cared for and supported by care staff. We spoke with the manager, deputy manager and four care staff. Following the inspection we spoke with two relatives.

At the visit we looked at the care plans and records for three people, records of staff recruitment for four members of staff, support and training for four members of staff, records of complaints, accidents, incidents and other records the provider used for monitoring and managing the service. We also looked at the environment and how medicines were managed and stored.

Updated 20 December 2018

This inspection took place on 20 November 2018 and was unannounced.

The last inspection took place on 27 June 2017 where we found no breaches of Regulation and rated the service as “Good”.

Murree Residential Care Home is a care home that is registered to accommodate up to four people who have learning disabilities and who require support with personal care. At the time of our visit, there were four people living in the home.

The home is owned and managed by Shahnaz Abbasi and therefore there is no requirement for a separate registered manager for this location. For the purposes of the inspection report, we have referred to Mrs Abbasi as the ‘manager’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection.

We carried out this inspection on 20 November 2018 following concerns that were reported to us by the local authority. Concerns were raised in respect of the cleanliness of the home, maintenance, medicine administration, staff training, staffing numbers and the lack of activities available in the home. Prior to the inspection, the manager had attended various meetings with the local authority and other external care professionals in respect of the concerns raised and an action plan was in place to monitor the home and ensure they make improvements.

During our inspection, we found that there were aspects of the care provided that were not safe. The arrangements for ensuring that people living in the home and staff were kept safe in event of a fire were not adequate. There were some fire safety arrangements in place. These included weekly alarm checks, a fire risk assessment and a fire evacuation plan. However, during the inspection we noted that Personal Emergency Evacuation Plans (PEEPs) were not in place. These are required as they provide staff or emergency services detailed instructions about the level of support a person would require in an emergency situation such as a fire evacuation. We also noted that whilst a fire risk assessment was in place, it did not include information about the arrangements for people who smoked. We also noted that only one fire drill had been carried out in the past 12 months. We found some deficiencies in respect of fire arrangements and found a breach of regulation in respect of this.

During the inspection, we looked at the arrangements for medicines in the home. There were systems in place for obtaining and disposing of medicines and the home had a suitable medicines storage facility in place. We looked at a sample of medicine administration records (MARs) and noted that there were no unexplained gaps which demonstrated that medicines were administered as prescribed. We however found that the medicines administration policy was not sufficiently comprehensive and we discussed this with the manager who said that it would be amended.

On the day of the inspection we observed that care staff did not appear rushed and were able to complete their tasks. The manager explained that since concerns had been raised by the local authority, she had ensured that an extra member of staff was on duty during the day. However, we noted that there was one care staff on duty at night and we queried this with the manager and explained that due to people displaying behaviour that challenged the service, one member of staff may not be appropriate to effectively care for people whilst also considering the safety of care staff. The manager said that she would review this.

Risk assessments had been carried out which detailed potential risks to people and how to protect people from harm. People's care needs and potential risks to them were assessed.

The local authority had previously raised concerns about the cleanliness and maintenance of the home. There had also been concerns raised about cockroaches found in the home. During this inspection, we checked communal areas and all people’s bedrooms. We found that the home was clean and there were no unpleasant odours. We also found no evidence of cockroaches in the home and saw documented evidence that pest control had recently visited the home.

Staff spoke positively about their experiences working at the home. They said they felt supported by management within the home and said that they worked well as a team. However, we noted that there were significant gaps in staff training. Some people in the home demonstrated complex challenging behaviour and there was a lack of evidence to confirm that staff had received such training so that they could deal appropriately with instances where people displayed behaviour that challenged the service. We were therefore not satisfied that staff were aware of what action they should take in such situation. Such training was essential to effectively support people living at the home. The lack of training meant that staff may not have had the skills and competencies to enable them to support people safely. We found a breach of regulation in respect of this.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that where people were potentially being deprived of their liberty, the home had evidence to confirm that they had made the required applications.

People spoke positively about the food in the home. Arrangements for the provision of meals were satisfactory. Staff confirmed that they asked people what they wanted to eat and then prepared meals based on this. On the day of the inspection we observed people had a home-cooked lunch prepared by care staff. The lunch provided was a chicken curry, rice and salad. We noted that for dinner care staff prepared a homemade vegetable soup.

We observed interaction between staff and people living in the home during our visit and saw that people were relaxed with staff and confident to approach them throughout the day. Staff interacted with people, showing them patience and respect. People had free movement around the home and could choose where to sit and spend their recreational time.

Each person had a formal activities timetable, however we observed that it did not correctly reflect what activities were available on the day of the inspection. We spoke with the deputy manager about this and he explained that there was flexibility in terms of activities as it depended on what people wanted to do on a particular day depending on their mood. We did not see evidence of activities designed to mentally stimulate people and we made a recommendation in respect of this.

The home had a complaints policy in place and there were procedures for receiving, handling and responding to comments and complaints.

During the inspection, we spoke with the manager about how the home was meeting people’s needs. She explained that the home was experiencing difficulties managing two people’s care needs due to their behaviour that challenged the service. She confirmed that the local authority was currently looking to find alternative suitable accommodation for them.

During this inspection, we found that the home had implemented checks in respect of care plans, risk assessments and the maintenance in the home. However, we found that whilst the home had these in place, there was a lack of evidence to confirm that the manager was continuously carrying out these checks. We also found that the home had failed to identify their failings in respect of fire drills, fire arrangements, staff training and lack of activities. We found a breach of regulation in respect of this.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.