This inspection took place on 11 and 13 October 2016 and was unannounced. We last inspected the service in September 2014. At that inspection we found the service was compliant with the essential standards we inspected.

Murdoch House is a care home without nursing that provides a service to up to 27 older people The accommodation is arranged over three floors, with lift access to each floor and is close to Wokingham town centre. At the time of our inspection there were 23 people living at the service.

The service had a registered manager as required. A registered manager is a person who has registered with the CQC 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 registered manager was present and assisted us during this inspection.

People felt safe living at the service and were protected from abuse and risks relating to their care and welfare.

People were mostly protected against environmental risks to their safety. During our inspection we found hot water temperatures were higher than the recommended temperatures to prevent scalding in all baths and two of the three showers. Once pointed out to the registered manager prompt action was taken to ensure people were safe from harm. Other premises risk assessments and health and safety audits were carried out and issues identified dealt with quickly. Furniture and fixtures were of good quality and well maintained.

People were protected by recruitment processes and staff were well trained. Staff had the tools they needed to do their work and provide good quality care. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk.

People received effective care and support from staff who knew them well. Staff training was up to date and staff felt they received the training they needed to carry out their work safely and effectively. People received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans were reviewed monthly or as changes occurred.

People received effective health care and support. They saw their GP and other health professionals when needed. Medicines were stored and handled correctly and safely. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure those rights were promoted.

Meals were nutritious and varied. People told us they enjoyed the meals at the service and confirmed they were given choices.

People were treated with care and kindness. People's wellbeing was protected and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity.

People were aware of how to make a complaint and told us they would speak to the registered manager or one of the staff. They told us they could approach management and staff with any concerns and felt they would listen and take action. They benefitted from living at a service that had an open and friendly culture and from a staff team that were happy in their work.

People living at the service felt there was a good atmosphere and thought they were provided with a comfortable and homely environment to live in. Staff felt the service was well-managed. They told us the management were open with them and communicated what was happening at the service and with the people living there.

The inspection team consisted of one adult social care CQC inspector. On the day of our inspection 22 people used the service. We spoke with three people, one person’s relative, four care workers and the registered manager. We reviewed records relating to the management of the home which included 10 people’s care plans, 22 medicine administration records (MAR) and six topical medication administration records (TMAR).

During our visit we saw people were asked for their consent before they received any care, and staff acted in accordance with their wishes. Since our last inspection the provider had taken action to ensure suitable arrangements were in place for formally obtaining the consent of people regarding their care and treatment. One person told us “The staff always ask if they can get me dressed in the morning.”

People’s verbal and written consent had been sought in relation to the care provided. When the service believed that one person lacked the capacity to consent to a specific decision in relation to personal care the registered manager had completed a mental capacity assessment. We noted that the person was assessed as having capacity to make this decision and we found staff acted in accordance with this person’s wishes.

Since our last inspection the provider had taken action to ensure people were protected against the risks associated with medicines. The provider had appropriate arrangements in place to manage people's medicines safely.

The inspection team who carried out this inspection consisted of two adult social care inspectors and a pharmacist inspector. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of the inspection there were 25 people who used the service. As part of this inspection we spoke with four people who use the service, one visitor, the registered manager, the regional manager, two care staff and a visiting health care professional. We also reviewed records relating to the management of the home which included, eight people’s care plans and monthly reviews, the infection control folder, staff training records, service audits, staff handover records, and communications book.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

Relatives of people who use the service were complimentary of how the provider maintained people’s safety. Personal evacuation plans were in place for each person to ensure their safety in the event of a fire at the service.

The provider carried out appropriate risk assessments, checks and servicing to maintain the service to a safe standard. For example, we saw servicing records for the lift and fire alarms.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to this type of service. While no applications have needed to be submitted for the people using the service, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.

People had been cared for in an environment that was safe, clean and hygienic. One person told us "the home is spotless." People were protected from the risk of infection because protocols based on current Department of Health guidelines were followed.

However, people were not protected against the risks associated with medicines. The provider did not have appropriate arrangements in place to manage people's medicines safely. We have asked the provider to tell us what they are going to do to ensure they have effective processes in place to ensure the safe management of medicines. This is a requirement to meet the Regulations.

Since our last inspection on 8 and 9 January 2014 we found actions had been taken by the provider to ensure records for people and staff were accurate and fit for purpose. We saw people's records were stored securely and could be located promptly when requested.

People were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

There was a system for monitoring and learning from incidents relating to the welfare and safety of people who use the service. The provider could identify possible trends that may require additional actions, such as risk assessments and the implementation of appropriate actions, to minimise the risk of occurrences to people and others who use the service.

Is the service effective?

The service demonstrated effective practices through the assessment of people’s health and care needs. People's views about the type of care they wanted had been sought. Relatives of people who use the service confirmed their involvement in the development of their family member’s care plan. They told us the care plans were up to date and reflected their family member’s needs. We found staff had a good understanding of people’s care and support needs, for example, in relation to pressure sore prevention and moving and handling

We spoke with four people who use the service and a relative of another person. They were complimentary about the care received. One person we spoke with said “If I need help I can get it from staff. The staff are very good”

During our visit we saw people were asked for their consent before they received any care, and staff acted in accordance with their wishes. However, the provider did not have suitable arrangements in place for formally obtaining the consent of people using the regarding their care and treatment. This meant staff asked relatives or friends to sign for or verbally agree to consent on the person’s behalf, without ensuring the relatives or friends were lawfully able to do so. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to gaining lawful consent to care and treatment on other people’s behalf.

Is the service caring?

People were supported by kind and supportive staff. One person told us “Staff are very nice.” A relative said “Staff are very friendly, I can come to the home anytime. I never feel excluded. This is a very pleasant home.” All interactions we observed between the staff and people were open, respectful and courteous. We saw that care workers gave encouragement when supporting people. People were able to do things at their own pace and were not rushed.

A customer survey was conducted in April 2014 by the provider. This recorded 14 responses from 22 surveys sent out to people and their relatives. We saw feedback was positive. People rated staff support and care highly.

Is the service responsive?

People’s needs were assessed before they were admitted to the service. Records confirmed people’s preferences and diverse needs had been recorded. Staff provided examples of care and support being provided in accordance with people’s wishes, for example, in relation to where they received their meals.

People and their relatives knew how to make a complaint if they were unhappy. In the customer survey held in April 2014 90% of the responders stated they were aware of the provider’s complaints process.

Is the service well-led?

We saw people’s feedback was sought through meetings and surveys. The provider was responsive to comments from people, such as reconsideration of a planned refurbishment to meet people’s wishes and suggestions.

Audits and checks ensured people’s safety and wellbeing was promoted. Where issues were identified, an action plan for progress and completion of this was monitored. We saw issues were identified and actions completed appropriately.

Since our last inspection on 13 and 14 January 2014 we found actions had been taken by the provider to ensure the dignity and privacy of people using the service. We saw people’s bedroom and ensuite bathroom doors were closed whilst they were using the toilet or having a wash or changing into their day clothes. People we spoke with were complimentary about how staff maintained their privacy, dignity and independence.

Action had been taken to enable people who use the service or those acting on their behalf to make, or participate in making, decisions relating to their care and treatment. Throughout the care plans and risks assessments we reviewed, we saw numerous recorded examples of people’s involvement in their care.

During our inspection we found the provider had measures in place to strengthen its recruitment and selection process. This was to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable to provide their care. The improvements included adherence to the provider’s employment policy for the recruitment and selection of new staff. Recruitment files for staff employed before the last inspection were reviewed to ensure all of the required information checks were in place.

The provider notified us of incidents which may have affected people who use the service. It did so in line with regulatory requirements.

The provider reported the deaths of people who used the service. It did so in line with regulatory requirements.

We spoke with nine people who were able to give us their view of the services provided. They told us they were treated with respect and were happy living in the home. Comments included, “I like it, people are very friendly and will help you if you have a question”. “It is very nice and comfortable, you can do as you like and you’re well fed”.

People told us that they had no concerns or worries about the care they received. They told us that they could approach staff at any time if they were worried or concerned.

This inspection was carried out to look at new concerns raised with the Care Quality Commission since our last inspection on 4 September 2013.Those concerns related to how the provider was making sure there were always enough staff to meet people’s needs in the home and ensure their safety. Another concern related to how the provider was ensuring people living in the home were being cared for in a clean and hygienic environment. Further concerns related to whether people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. For example, their preferred times of getting up and dressed in the morning. Another concern related to some occasions when care may not have been delivered in a way that was intended to ensure people’s safety and welfare.

During this inspection people who use the service we spoke with were complimentary about the service. One person said “The food is lovely here. We can have whatever we want.”

All interactions we observed between the staff and the people using the service were open and courteous. However there were some occasions when we observed people’s dignity and privacy were not always respected by staff when providing their care. For example, some people’s bedroom and ensuite bathroom doors were left open whilst they were using the toilet or having a wash. People’s views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

Care was planned and reflected the individual needs of people living in the home. Care was not always delivered in a way that was intended to ensure people's safety and welfare. However, there was no evidence that people or their representatives had been involved in developing their care plans, or that their views had been sought about the type of care they wanted.

People we spoke with told us the home was kept clean and tidy. However, there were occasions when we noted a strong odour of urine within the home. People were not always protected from the risk of infection because some protocols based on current Department of Health guidelines had not been followed.

People were not always protected against the risks associated with medicines because staff did not follow the provider’s policy and procedures in relation to the safe administration of medicines. For example, people’s medicines were not handled and stored securely during morning and midday medication administration rounds.

The provider had ensured that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced staff working at the home to provide care and support to the people living there.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. For example, some potential risk assessments had not been completed and assessments of people’s care needs were very brief and incomplete. People’s records could be located promptly but were not securely kept.

The provider notified us of incidents which may have affected people who use the service. It did so in line with regulatory requirements.