We carried out a review of the data available to us about Murreyfield Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Murreyfield Care Centre, you can give feedback on this service.
Murreyfield Care Centre is registered to provide accommodation and personal care to adults who may be living with mental health needs, a learning disability or dementia.
The service supports up to 23 people and there were 18 people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because people received person-centred care and where possible people were supported to access leisure and education services in the community. The service applied the principles and values of Registering the Right Support which supported people to achieve the best possible outcomes and live a full and meaningful life.
People’s experience of using this service and what we found
Since the last inspection, the provider had implemented systems to monitor the safety and quality of the service. Improvements were evident, though some shortfalls continued to be found in records and risk monitoring. For example, hot water temperatures were too high. We have made a recommendation about monitoring systems.
People’s medicines were administered safely, care plans contained appropriate guidance and systems were in place to protect people from abuse. Staff understood what to do in the event of a fire and the support people needed.
The provider’s recruitment processes helped ensure only suitable staff were employed. Staffing levels were safe. However, they were lower at evenings and weekends which meant staff had less flexibility to support people. We have made a recommendation about staffing.
Staff had the relevant skills and knowledge. They supported people appropriately to meet their needs and access healthcare services. People were happy with the support they received. They were offered a healthy diet and alternative options which met their dietary needs.
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.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, inclusion and developing people’s independence.
For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 5 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service between 8 January and 24 January 2020. Breaches of legal requirements were found, which included safe care and treatment, staffing, fit and proper persons employed 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 and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Murreyfield Care Centre on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Murreyfield Care Centre is registered to provide accommodation and personal care to 23 adults of different ages who may be living with a learning disability, mental health needs or dementia. At the time of the inspection, 16 people were using the service.
The service was large and supported more people than current best practice guidance. The service did not consistently reflect the principles and values of Registering the Right Support which limited people’s ability to achieve the best possible outcomes and live a full and meaningful life.
People’s experience of using this service and what we found
People’s medicines were not managed safely and risks to people’s health and safety were not always identified or addressed. The provider did not ensure the safe recruitment of staff and had not managed associated risks. Staff did not have the appropriate skills or training to care for people safely. Quality assurance systems had not found or resolved quality shortfalls.
Staff did not feel valued or supported. People’s feedback about the service was not used to drive improvements.
People’s end of life wishes were not discussed and care plans did not always show how people wanted to be cared for. Staff ensured people were referred to relevant professionals and supported people to attend appointments. Most people liked the food and staff understood people’s dietary needs.
Staff were kind, caring and had honest conversations with people about their needs. People were respected, their privacy and dignity was mostly maintained. Staff helped people to maintain their independence.
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. Though appropriate records were not always in place.
The service mostly applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service mostly reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. However, staff were not always available to support one person when they wanted to access the community.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 11 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. After the last inspection, the provider informed us how they planned to address areas of concern and improve the service. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We found the provider failed to notify us of five specific incidents which had occurred at the service since the last inspection which the provider is legally required to inform us of. On this occasion, we did not take enforcement action in relation to this.
We have also identified breaches in relation to the safe management of medicines, identifying and managing risks, staff skills, safe recruitment and the systems for monitoring and addressing quality shortfalls 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Murreyfield Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate a maximum of 23 people. At the time of the inspection 16 people were using the service. The property consists of two large houses that have been converted into a care home and has bedrooms and bathroom facilities located across three floors.
Murreyfield Care Centre has been operating for a number of years and had previously been registered with CQC under a different provider. Changes to the ownership of the service mean the service was reregistered with CQC in November 2017 and therefore this was the first inspection of the service under the new providers ownership.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
At the time of the inspection, a manager was in place, however, they had not yet completed an application to register. 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. The service had been without a registered manager since March 2018.
Staff administered people’s medicines safely and they were stored securely. Audits identified recording errors, but had not found issues with the timing of administering controlled drugs, or the lack of protocols for some when required medicines. The provider had addressed recording issues though we found these continued.
Areas of the service were not always clean or in a good state of repair. The layout of the premises meant people who used the service were often disturbed when watching television. Audits had not identified environmental issues, so issues had not been addressed. You can see what action we have told the provider to take at the back of the full version of the report.
Staff had completed training and further training was booked. However, the provider had not assured themselves that best practice was imbedded and staff had the required skills and knowledge to meet people’s needs, as there was a lack of supervisions and appraisals.
People felt safe and trusted the staff. People were protected from avoidable harm and abuse by staff who were able to identify and report concerns to relevant professionals. Risks to people’s safety and wellbeing were appropriately managed. Recruitment processes helped ensure only suitable people were employed and arrangements were in place to promote continuity of care for people whilst staff were recruited.
People’s health and dietary needs were met and the provider had reviewed meal times and menus; offering people more choice. Staff were kept informed of people’s changing needs by appropriate communication methods.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were supported to maintain relationships with relatives and friends and had built meaningful relationships with staff. Each person was respected as an individual and their privacy and dignity was maintained and independence was promoted by staff.
Staff were knowledgeable about people’s needs, provided person-centred care and included people in their care plans. End of life care plans were in place for those who wanted them to be and end of life training was booked for staff. People were supported to access a range of activities and spent their time as they wished. Processes were in place to investigate and address complaints.
The service had a positive culture and staff worked well as a team and liaised with relevant organisations and professionals. People were included in the development of the service.
This is the first time the service has been rated Requires Improvement.