Archived: Murrayfield Care Home

Updated 1 June 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors and two Care Quality Commission professional advisors who were a nurse and a pharmacist. The inspection was also supported by four Expert's by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. Two Expert’s by Experience spoke to people during the inspection site visit and two other Expert’s by Experience contacted people's relatives by telephone to request their feedback.

Service and service type

Murrayfield care home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Murrayfield care home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 18 January 2022 and ended on 1 February 2022. We visited the service on 18 January 2022 and 20 January 2022.

What we did before the inspection

We reviewed information we had received about the service and formal notifications that the service had sent to the CQC. Notifications are information that registered persons are required to tell us about by law that may affect people's health and wellbeing. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

We spoke with ten people who used the service and one relative. We spoke with 16 members of staff including activities coordinators, registered nurses, the regional manager and registered manager. We undertook observations of people receiving care to help us understand their experiences, especially for those people who could not talk with us. We reviewed a range of records. This included 15 people's care records and eight people's medicines records. We looked at six staff files in relation to recruitment, training and staff supervision. A variety of records relating to the management of the service, accident and incidents, and quality assurance were reviewed. We sought feedback from the local authority and professionals who work with the service.

After the inspection

We looked at more records and continued to seek clarification from the provider to validate evidence found. We spoke with the registered manager by telephone and video call. We spoke with 19 relatives of people living at the home and a further eight care staff.

Updated 1 June 2022

About the service

Murrayfield Care Home is a residential service providing nursing and personal care for up to 74 people, some of whom are living with dementia. At the time of our inspection there were 57 people using the service. The home is purpose built, consisting of individual bedrooms and communal spaces spread over three floors with an accessible rear garden.

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

People and relatives told us they felt safe with the care and support they or their relative received. However, despite the positive feedback received we found concerns with infection control and management oversight and other issues with staff recruitment, training and support and person-centred care.

The provider had systems in place to monitor the quality and safety of the service, however they did not identify some of the issues we found during the inspection.

Not all procedures in place to keep people safe from risk of infection and COVID-19 were being followed.

We observed positive interactions between people and staff. However, some people, relatives and staff told us more activities needed to be offered.

We have made a recommendation around activity provision.

We have made a recommendation around staff training and support.

We made a recommendation around safeguarding adults.

People were supported by staff who had been assessed as safe to work with vulnerable adults and understood their responsibilities to report any concerns.

Staff told us they felt supported and people were supported by staff who knew them well.

We observed there was enough staff to keep people safe. However, some people, relatives and staff told us the service was short staffed.

People’s care was regularly reviewed by the service; however, people and their relatives were not always involved in the process.

The provider had systems in place to assess risks to people before undertaking their care and support. However, we found a couple of examples where peoples health risks were not sufficiently documented.

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.

People received their medicines safely and as prescribed.

People had access to a balanced and healthy diet and were satisfied with the food on offer.

People and their relatives spoke positively of the service and 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 and update

The last rating for this service was requires improvement (published 20 March 2020) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider seek and implement national guidance on the provision of dementia friendly environment. At this inspection we found the provider acted on the recommendation and improvements were made.

The last rating for this service was requires improvement (published 20 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 and 7 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and Well-led which contain those requirements. 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 has remained the same. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Murrayfield Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed. We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.