About the service: Muriel Street Resource Centre provides nursing care to men and women with a range of needs including physical disabilities, dementia and mental illness. The home is able to accommodate a maximum of 63 people over three floors. There were 56 people using the service on the day of the inspection.

• Since our last inspection the home had undergone a major managerial change. There was a new registered manager who had worked at the home in different roles for over three years. Other members of the senior management team, including the deputy manager and the clinical lead, had joined the team in January 2019. The lack of a complete management team up to January 2019 was reflected in the running of the home. During our visit we identified shortfalls that needed to be addressed.

• People were not always protected from harm from others. Prompt action had not always been taken by staff when concerns about the lack of person-centred care were raised by people. The management team had investigated all known safeguarding concerns to ensure people were protected.

• Feedback about staff at the home received before and during our inspection was mixed. Alongside some positive comments, we received information suggesting that staff were not always kind or attentive to people. This had been confirmed by our observations during both days of our visit.

• Staff had not always received regular support to assess their skills and to help them to care for people effectively. Not all staff completed their mandatory training within the given time frame. Staff supervisions and appraisal were irregular and for some staff infrequent. Staff conduct had not always been properly managed.

• People were not always sufficiently supported to eat and drink. People needed to wait a long time for their meals and they had not always received appropriate assistance to eat their meals. People’s fluid intake had not been monitored closely as staff did not have guidelines on how much individual people should drink.

• Staff were knowledgeable about people’s individual dietary requirements. However, records related to nutrition had not always been updated promptly. It was possible that staff would refer to guidelines about people’s dietary requirements that were not current.

• Risks to people’s health and wellbeing had been assessed and reviewed regularly. The information about the level of risk had not always been checked to ensure consistency with information in other care documents. It was possible that staff would not have access to correct information about the risk.

• Regular health and safety checks of the premises and the environment had been done. Most of the equipment had been checked regularly. Recording of the airflow mattresses checks needed to improve.

• Quality assurance audits were effective in highlighting issues and shortfalls in care provided. However, the implementation of the improvement plans was not effective in addressing issues, which meant they happened again.

• Relatives said that they had been involved in making decisions about people’s care. However, when people lacked capacity to make decisions, there was not always clear evidence to show that people’s representatives had been consulted.

• Overall, medicines were managed safely. However, a small number of shortfalls were identified during our visit.

• Staff were recruited safely. Appropriate checks had been carried out to protect people from unsuitable staff.

• New staff received an induction to the home and their specific role. Staff felt supported by the management team and they said they could approach managers any time for additional supervision and support.

• People could choose what they ate. There was a selection of food to choose during each meal and throughout the day. Jugs of water and juice were always available to people across the home.

• Staff supported people to have access to external health professionals when needed. Appropriate referrals had

This inspection took place on 8 and 9 January 2018 and was unannounced.

Our previous comprehensive inspection was undertaken on 25 and 26 January 2017 and we rated the service ‘Requires improvement’. During the inspection in January 2017, we did not find any breaches of The Regulations. At that time, the provider had been working on meeting the action plan submitted to the CQC following the focused inspection in September 2016. Although significant improvement had been observed in January 2017 more improvement were still required. At this inspection in January 2018 we observed ongoing progresses in improving the quality of the service delivery had been taking place at the home and more improvement were still needed.

Muriel Street Resource Centre provides nursing care to men and women with a range of needs including physical disabilities, dementia and mental illness. The home is able to accommodate a maximum of 63 people over three floors. There were 48 people using the service on the day of the inspection.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager with the support of the deputy manager and the clinical lead had worked continuously on addressing areas for improvement that had previously been identified at our previous inspections.. Our overall observation was that the safety and quality of the service provided had significantly improved.

At the previous inspection, we found that the provider had not managed the administration of topical creams appropriately. At this inspection, we found that this issue had been fully addressed and there were clear records when staff administered creams to people.

At the previous inspection, we found that staff had not received a yearly appraisal of their performance. At this inspection, we saw that the home was in the process of completing staff yearly appraisal and staff had received formal supervision.

At our previous inspection, we found that some people’s records were stored electronically and some in a paper form and it was difficult to find up to date information about people’s care. At this inspection, we saw that this issue had been fully addressed and it was clear which documents staff should look at for up to date information on people.

At the previous inspection, we saw that staff had not always acted in a caring way towards people. At this inspection, we saw the management team had been proactive in addressing any staff conduct issues. However, we observed that some staff practices during a handover process needed further improvements to ensure they supported people in a thoughtful and compassionate way.

There were limited meaningful social and leisure activities at the home. This area of the service provision needed to be improved. The management team were taking action to ensure the quality and the amount of meaningful activities for people would increase.

The provider had a range of systems to ensure the service delivery was continuously monitored and improved. However, a few of these had not been that effective because the provider had not identified the areas that we found during the inspection, as needing improvement. Whilst the service was rated ‘Requires Improvement’ at a previous inspection, improvements made by the provider had not been sufficient to rate the service ‘Good’. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. You can see what action we have asked the provider to take at the back of this report.

People told us they felt safe at the home. The management team had been working towards providing staff with additional traini

This inspection took place on 25 and 26 January 2017. The inspection was carried out by four inspectors and an expert by experience over the course of two days.

Muriel Street Resource Centre provides nursing care to men and women with a range of needs including physical disabilities, dementia and mental illness. The home is able to accommodate a maximum of 63 people over three floors. There were 49 people using the service on the day of the inspection.

The home did not have a registered manager. However, there was an interim manager in post at the time of our inspection that had begun the process of applying to the Care Quality Commission for registration. 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.

We conducted a focused inspection at Muriel Street Resource Centre on 29 September and 11 October 2016 as a result of concerns that we received and an increased level of safeguarding adult's notifications since April 2016. The concerns related to medicines management, falls management, skills and knowledge of staff in relation to supporting people with mental health conditions and dementia and the general quality of the care being provided at the home. We found significant shortfalls in the care provided to people and identified breaches of regulations 9, 12, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to infection control, monitoring of staff to ensure they remained fit to carry out their roles, staffing and person centred care.

We undertook this fully comprehensive inspection before the completion date of the action plan that resulted from the last focused inspection in September 2016, as we remained concerned at the level of issues being raised about the support being provided to people at the home. These included safeguarding concerns and complaints. We conducted a review of all the five domains, including safe, effective, caring, responsive and well-led to ensure the service provided was meeting people needs.

After the last inspection we received an action plan relating to the four breaches identified. The dates for completion of the actions were between the end of February and March 2017. At this inspection we found an overall improvement in most aspects of the care and support provided at the home. Management oversight of the home had improved as well as staff morale.

In the action plan, sent to us following the last inspection, it stated that improvements in relation to Regulation18, staffing, would be completed by March 2017. From evidence we saw, improvements had begun in relation to staff receiving supervision. As this inspection was in January 2017, the actions were not fully completed, particularly in relation to appraisals and training therefore the effective domain still required improvement. The manager told us it was envisaged that they would be completed by April 2017.

There had been a slight decrease in the amount of staff who had received face to face moving and handling training, although three staff had recently completed a train the trainer course and plans were in place for them to start delivering the training to staff in early February 2017. Other mandatory training was up to date and there were systems in place to flag up when refresher training was due.

People were supported to eat, drink and maintain a balanced diet. People received the support and supervision they needed to eat safely. However, we noted one person’ s eating and drinking assessment identified them as being at risk of choking and a recommendation was made for a referral be made to the dietician. Staff could not confirm to us whether this referral had been made since ther

We carried out an unannounced focused inspection of this service on 29 September and 11 October 2016 as a result of concerns that we received and an increased level of safeguarding adult’s notifications since April 2016. The concerns related to medicines management, falls management, skills and knowledge of staff in relation to supporting people with mental health conditions and dementia and the general quality of the care being provided at the home. This report covers our findings in relation to the concerns recently raised and issues we found during the inspection. At our last comprehensive inspection in June 2015, we found that the service was meeting all of the standards that we inspected.

Muriel Street Resource Centre provides nursing care to men and women with a range of needs including physical disabilities, dementia and mental illness. The home is able to accommodate a maximum of 63 people over three floors.

The home did not have a registered manager. However, there was an interim manager in post at the time of our inspection. 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 previous registered manager had left the service in December 2015. Since this time, there had been one permanent and three interim managers at the home. One of the interim managers left after our first visit on 29 September 2016 and a further interim manager was in post on our second visit on 11 October 2016. We were advised that recruitment was underway for a permanent registered manager and that the provider was awaiting final recruitment checks.

Managers and staff were not always aware of people’s status in relation to methicillin-resistant staphylococcus aureus (MRSA) infections. Infection control procedures were not always in place or being followed to ensure the safety of service users and staff.

Disclosure and Barring Service (DBS) checks were carried out before staff commenced working with people to ensure their suitability for the role. However, effective systems were not in place to monitor that the rechecks took place as well as following up on positive DBS outcomes. A positive DBS is disclosure and barring check that may reveal a matter that might impact on the suitability of an individual to carry out their role.

Agency staff including nurses did not always have appropriate identification when working at the home. Managers on duty at the home were unaware if staff had the qualifications, competence, skills and experience to carry out their role safely.

People had an up to date Personal Emergency Evacuation Plan (PEEP) on their record. However not all staff were aware of the systems in place to safely evacuate people in the event of a fire.

Supervisions and appraisals for staff were not always consistent. Mandatory training was provided and 70% of staff were up to date with most of their mandatory training, however only 52% of staff had received the face to face fire safety training and 59% of staff received face to face moving and handling training.

Staff were not always appropriately deployed to meet the needs of people staying at the home.

Support was not always person centred and appropriate to people’s needs and preferences

A combination of a lack of day to day management oversight and the frequent change of managers within the home had led to an unstable management structure. Feedback received from a health and social care professional and relatives indicated that the lack of consistent management had impacted on communication with them.

There was a relative’s survey completed for 2016. The general satisfaction level had declined in all areas since the previous survey in 2015. Amongst the lowest scores were, making new resi

We carried out an unannounced inspection on the 11 June 2015. Our previous inspection took place on 24 July 2014 and we found the provider met the regulations inspected.

The service provides nursing as well as residential care to people with a range of needs including physical disabilities, dementia and mental illness. The home is able to accommodate a maximum of 63 people over three floors. There were 58 people using the service on the day of the inspection.

There was a registered manager in place at the time of the inspection. 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 undertook regular training relevant to keeping people safe and free from harm. They showed a good understanding of the different types of abuse and how they would look out for signs. There was a whistle blowing policy in place and staff knew how to use it

Risk assessments formed part of the person’s agreed care plan and covered risks that staff needed to be aware of to help keep people safe.

People had a Personal Emergency Evacuation Plan on their record (PEEP). Their PEEP identified the level of support they needed to evacuate the building safely in the event of an emergency.

People received appropriate staff support to meet their needs. Staff responded promptly when people needed assistance.

We saw that recruitment practices ensured staff were appropriately checked prior to employment to ensure they were suitable to work with the people using the service.

Medicines were stored, administered and recorded appropriately by staff who had undertaken relevant training.

Staff told received training and support to help them carry out their work role and demonstrated good knowledge on the subjects they were asked about, including promoting independence, choice, dignity, engagement and person centred care.

Staff demonstrated a good knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS exist to protect the rights of people who lack the mental capacity to make certain decisions about their own wellbeing. It also allows people’s movements to be restricted for their own safety. Staff always discussed with people, how they wished to be supported and waited for consent.

People were supported to eat drink and maintain a balanced diet. There was a menu on display and this was in pictorial form. People were not hurried and were supported appropriately.

People were supported to keep well and had access to the health care services they needed.

Advice from other healthcare professionals was incorporated in to care plans to ensure that people received appropriate care.

People received support in a dignified manner. We saw that staff demonstrated good knowledge about a person by asking appropriate questions relating to their personal history, thus enabling this person to engage in familiar conversation.

Care files showed that people's needs were assessed before moving in to the service, with relatives and health professionals supporting the process where possible. People had care plans which identified their assessed needs and set out how to support them appropriately.

Information regarding how to make complaints was given to people as well as a leaflet was available and visible. People and their relatives told us they knew how to make a formal complaint and staff were clear about how to support people to do so.

There was evidence of regular audits and spot checks undertaken by the management team, including checks of care records, the environment and staff practice. Learning from audits as well as incidents and investigations was shared with the staff team.

There were opportunities for people’s voices to be heard. Meetings were organised for people using the service and their relatives as well as regular coffee mornings to discuss issues relating to how the service supported them.

We issued two warning notices on 9 October 2013 for a failure to meet the requirements of regulations 10 and 20 of the Regulated Activities Regulations 2010. Both warning notices required the provider to become compliant with these regulations by 6 November 2013.

We found that the provider was still failing to meet the requirements of regulations 10 and 20 and had failed to meet the requirements of the warning notices.

Care and treatment was not planned and delivered in a way so as to maintain people's welfare.

People were not protected against the risks associated with medicines because the provider did not have effective arrangements in place for the handling of topical medicines and the auditing of medicines.

People were at risk of unsafe or inappropriate care as the provider did not have effective systems to regularly assess and monitor the quality of service that people received.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

Three inspectors visited the home over the course of a day on the 18th May 2012. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spoke with five people who use the service, one relative and with four staff members. We also spoke with the manager and deputy manager. We examined records relating to the running of the home including the personal files of six people who use the service. We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service and their relatives generally spoke highly of the service. They commented “the staff are very good and patient”, “I feel my partner gets very good care, he came here as the previous home could not meet his needs” and “staff are very kind”. People we spoke with commented that staff promoted their privacy and dignity whilst assisting them with personal care.

On the day of our inspection we arrived at the home at 7.15 am. We were concerned that the majority of people using the service were already up at such an early hour, and our discussions with people using the service and staff did not satisfactorily address why this was the case. From the information available to us at the time of the inspection we could not be satisfied that the time that people got up each day was determined by their individual needs and preferences.

Our observations of care and comments from some people using the service indicated that whilst the majority of carers demonstrated good practice and engaged in positive interactions with people, a small number of care workers demonstrated poor care practice that did not promote the dignity or wellbeing of people using the service. People who use the service told us “90% of carers are very good, some of the others less so” and “Staff don’t always explain what’s happening when they are helping you”.

People we spoke with told us that they enjoyed the meals provided. One person commented “I like the food here”. We found some areas of poor food hygiene practice related to food labelling which could impact up on the health and safety of people using the service.

The provider had responded appropriately to any allegation of abuse. The majority of staff we spoke with demonstrated an understanding of safeguarding issues and their responsibilities should they have safeguarding concerns. The provider had appropriate arrangements in place to manage medicines.

The provider had taken appropriate steps to provide care in a suitable environment. We spoke with the manager who told us that the premises were scheduled for refurbishment over the course of the summer. We found the environment to be generally clean and hygienic.

We found that there were sufficient qualified, skilled and experienced staff to meet people’s needs. The training records we saw indicated that the provider had developed a comprehensive core training programme. We found that care staff had been supervised regularly. We did find that some staff had worked in excess of 60 hours for two consecutive weeks. We were concerned that care staff working such extended hours could have a negative impact upon the quality of care provided by staff.

We were concerned that poor record keeping relating to pressure care areas and inaccurate filing of pressure care notes could impact upon the care and treatment that people using the service received.

People who use the service told us that they were happy and settled. The service had a full and varied activities programme that reflected the interests and abilities of people using the service.

Each person using the service had a clearly laid out plan that also identified potential risks. However, some people’s plans had not been regularly updated. People who use the service were supported to access healthcare services and were protected from abuse.

People who use the service told us that they enjoyed the meals provided. The menu included the preferences of people using the service. Some minor improvements in food hygiene practises were identified during this visit.

The premises were safe and accessible, and each person had their own bedroom that they could personalise. During our visit we noted that there was a smell of urine in some people’s bedrooms and in some communal area’s.

People who use the service received their medicines at the times they needed them. However, we found that the home could improve its management and recording of medicines in some instances.

People who use the service told us that staff were friendly and helpful. The provider carried out suitable checks on staff prior to their starting their employment. All staff had completed core training and were competent for their role, however some staff had not completed refresher training.

We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

The service was last inspected on 17 January 2014 after warning notices were served in October 2013 for major breaches of regulations of the Health and Social Care Act 2008 relating to care and welfare of people who use services, management of medicines, assessing and monitoring the quality of the service provided, and records. These breaches of the regulations were not appropriately addressed, and a condition to limit admissions was imposed on the service by CQC to ensure people’s safety and welfare. The provider agreed an action plan with CQC and the local authority to address these issues, and when we visited on 14 July 2014 we found the provider had taken appropriate actions to address the breaches. We have taken action to lift the condition limiting admissions to the service as a result.

The service is a care home with nursing providing accommodation, nursing care and support with personal care for up to 63 people. Most of the people who live in the home are elderly, and many have dementia. Some of the people who live there also have long-standing mental health conditions. At the time of our visit, 39 people lived in the home due to the admissions limit previously imposed by the local authority and CQC. The service is provided over three floors in a large, purpose-built building in landscaped grounds near the Regent’s Canal in Islington.

At the time of our inspection on 14 July 2014, the service did not have a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. However, a manager had been very recently recruited for the service and was due to start shortly, and a deputy manager/ clinical lead had also started at the service two weeks before our visit. The service was being supported by a regional quality manager from the provider organisation until the newly-appointed manager could start.

Many improvements had been made to the service since we last visited in January 2014, and a lot of resources had been allocated to the service to facilitate changes. We found that people’s care needs were appropriately identified and met, in ways that ensured their safety and welfare. Care for people’s specific needs, such as pressure sore prevention and management, continence, diabetes and people at high risk of falls, was assessed, planned for and provided in cooperation with specialist services and using appropriate tools.

Medicines were stored, administered and managed safely and according to guidelines, and the service’s premises and equipment were well-managed and well-maintained. Specialist equipment, such as pressure-relieving mattresses, was checked daily and appropriate stock kept so people always had the equipment they needed.

The service ensured people had a wide range of stimulating activities to choose from, and included activities specifically to support people with dementia to encourage and stimulate memories. People were provided with appropriate and nutritious food and drink, and were supported to eat enough. Specialist advice was sought when staff identified concerns about a person’s nutrition.

The service welcomed visitors, and the care provided to people was kind, compassionate and unhurried. Staff were trained for their roles, and supported through supervision, appraisal and systems designed to reward good practice.

The home had a relaxed and friendly atmosphere, and a variety of spaces for people to use for personal time or with groups.

There were appropriate systems in place to assess and monitor the quality of the service that people received.