Murray House is a local authority run care home that can provide permanent or short stay respite or hospital discharge rehabilitation assessments (between six to eight weeks) for up to 38 people. The service specialises in supporting older people living with a range of health and social care needs, including dementia, who require varying degrees of personal care and support. At the time of our inspection because the service was not accepting any permanent admissions there were only 12 people living at the home either permanently or on a temporary basis.

At the last Care Quality Commission (CQC) inspection of this service in May 2015, although we rated them ‘Good’ overall, we rated them ‘Requires Improvement’ for the key question ‘Is the care home safe’. This was because the provider had failed to store substances hazardous to health safely, which meant the people living at the home had been placed at unnecessary risk of harm. We undertook a focused inspection in November 2015 to check the provider had taken appropriate action to resolve this issue and found they met legal requirements. At this inspection we found the service continued to meet the regulations and fundamental standards and therefore remains rated ‘Good’ overall.

The service had a registered manager in post who had returned to work in June 2017 after being on maternity leave for the past year. In the registered manager’s absence the service’s deputy manager had been in operational charge of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

When people were nearing the end of their life, they received compassionate and supportive care. However, staff had not received any end of life care training. We discussed this with the registered manager who agreed to arrange for staff to attend this training to help them meet the needs and wishes of people nearing the end of their life. Progress made by the service to achieve this stated aim will be assessed at their next inspection.

People received personalised care that was responsive to their individual needs. Each person had a comprehensive and individualised support plan that encompassed all aspects of their lives. This set out clearly for staff how they should be meeting people's needs and wishes. This meant people were supported by staff who knew them well and understood their personal and health needs, food and drink preferences and social interests. Staff encouraged people to actively participate in meaningful leisure and recreational activities that reflected their social interests and wishes, and maintain relationships with people that mattered to them. In addition, the Eden Alternative Foundation recently accredited Murray House for its innovative work providing older people who lived there with person centred and fulfilling care and support. The Eden Alternative is an internationally recognised Foundation that promotes person centred care, independent living skills and accessing meaningful social activities for older people.

People remained safe at Murray House. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. Although there had been a reduction in staffing levels there continued to be enough staff on duty to keep people safe. Medicines were managed safely and people received them as prescribed.

Staff continued to be suitably trained and received all the support they needed to perform their roles effectively. People were supported to have enough to eat and drink to meet their dietary needs. They also received the

The last inspection of this home was carried out on 28 May 2015 when we found the provider was in breach of the regulations. This was because the provider did not always mitigate identified risks associated with the Control of Substances Hazardous to Health (COSHH). Specifically, chemicals and other substances hazardous to health were not always kept safely locked away by staff when they were not in use.

After the home’s last unannounced comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. We undertook an unannounced focused inspection on the 26 November 2015 to check the provider had followed their action plan and now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Murray House’ on our website at www.cqc.org.uk’

Murray House is a care home that provides accommodation and personal care for up to 38 older people. There were 17 people living at the home permanently and nine others receiving respite care when we visited. Most people using the service were living with dementia.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

During our focused inspection, we found that the registered provider had followed their action plan, which they had said would be completed by July 2015. We saw legal requirements had been met because the provider now safely managed substances hazardous to health. This meant people were protected from the risks associated with substances hazardous to health because staff now kept them safely stored and out of harm’s way when they were not in use.

We spoke with twenty people with dementia using the service and they said that they were well treated by staff and their health and social needs met. This was confirmed by relatives. Comments people made included "I've always been happy here". "It's like one big family home". "Very good people here". "Very good to us all, that is my honest reading of the home".

A relative said "I have always found Murray House staff very caring and sympathetic towards all residents. There is a borderline between ageing and dementia symptoms, but the residents are all treated with compassion, respect and dignity and the residents are well cared for in a safe, caring environment".

We saw that people were involved in choosing the type of care and support they needed and when they needed it. One person we spoke with said "From the minute I stepped in here, when I viewed it, I thought this is the home I want and I've seen a few. I've been here over three years".

We saw that the quality of care people who used the service received was good and enabled them to maintain a healthy and good quality of life in a safe and comfortable environment. People's needs were being met in an atmosphere that acknowledged the importance of person centred care. One person said "It's given me a new lease of life". "Everything is to my liking, especially the people. I can relax".

People told us and we saw that their opinions were sought and acted upon regarding the care and support they received and activities they wished to pursue. One person we spoke with said "The activities stimulate our brains, I'm delving into lots of things that happened in the past and the activities bring them to life". Relatives we spoke with said they were in frequent contact with the home and encouraged to put their views forward regarding the service provided.

We saw records and care practices that demonstrated peoples' preferences, choices and wishes were taken into account and were met in a person-centred way. The activities provided had a group and individual focus and were suggested by people who used the service.

The home worked with other providers to deliver a cohesive, sensitive and joined up service, by providing relevant information and services in a timely way.

We spoke to twelve people who use the service and five staff members during our unannounced visit to Murray House.

We were informed that the service was no longer accepting permanent admissions and a consultation had begun looking at the future provision of community services with the Royal Borough of Kingston. All of the people currently living in Murray House had been assured that places would continue to be available for them within one of the four council residential homes for as long as they needed them. Short term assessment and respite admissions were still being accepted at the time of our visit.

The home is part of the Eden Alternative which has a philosophy of creating communities where people make their own rules according to how they desire to live.

Overall feedback about the service included 'I'm very happy here', 'I like it here at Murray House, I like what they do' and 'I feel that we are very privileged'. One person said 'it's a place that makes you feel like somebody'. Comments about staff were positive and included 'very helpful', 'the staff are good', 'they're a good bunch here' and 'friendly'.

We received some very positive feedback from the people who live at Murray House, comments included, ‘I couldn’t wish for better’, and ‘this is the only place I wanted to consider’ and ‘I’m very happy here’.

The home’s use of the ‘Eden alternative’ which is person centred, keeping people at the heart of everything that is done, is embedded into the care provided at Murray House. This is particularly evident with the range of activities that are available and that people participate in.

People who use the service were also positive about the staff team, comments received included, ‘I’m looked after, staff should have gold medals.’ Murray House benefits from a stable staff team, with a low vacancy rate. Any shortfalls in the staffing levels are covered by bank staff who are familiar with the service. These factors play a crucial roll in people feeling that there is consistency and continuity of care.

Murray House also benefits from a recent refurbishment of some of the communal areas, in particular the smaller lounges, kitchen and dining rooms on the first and second floors. There is a real homely feel to the Murray House with attention given to photographs of people living and working there.

During the inspection we were able to talk to six people at length who live at Murray House; we also spoke to other staff and the deputy manager. We would like to thank everyone for their time and cooperation during this inspection.

This inspection took place on 28 May and 2 June 2015. The first day of the inspection was unannounced and we informed one of the assistant managers that we would be returning on the second day to complete our inspection.

At the last inspection, on 14 January 2014, we found the service was meeting all the regulations we looked at.

Murray House is a care home that provides accommodation and personal care and support for up to 38 older people. There were 19 people living at the home and a further five people receiving temporary respite care when we visited. Most people using the service were living with dementia.

Accommodation was arranged over three floors. There was a passenger lift that enabled people to move freely between floors. All the bedrooms were single occupancy. The garden at the rear of the property was well maintained and wheelchair accessible.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

During our inspection, we found staff had failed to store substances hazardous to health safely appropriately. This failure had placed people using the service at risk of harm. This was a breach of the Health and Social Care (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.

People told us Murray House was a safe place to live or stay for respite care. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. The service managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies, such as fire. The building was also well maintained and safe.

People were happy living at the home. They told us staff looked after them in a way which was kind, caring and respectful. Our observations and discussions with people using the service and their relatives supported this. People’s rights to privacy and dignity were respected. When people were nearing the end of their life they received compassionate and supportive care.

People were supported to maintain relationships with their family and friends. There were no restrictions on visiting times and we saw staff made peoples’ guests feel welcome.

People were encouraged to participate in meaningful and age appropriate social activities that interested them. We saw staff actively encouraged and supported people to be as independent as they could and wanted to be.

There was a varied choice of meals, snacks and drinks and we saw staff supported people to stay hydrated and to eat well. Staff routinely monitored the health and welfare of people using the service. Where any issues had been found appropriate medical advice and care was promptly sought from the relevant healthcare professionals.

People received their medicines as prescribed and staff knew how to manage medicines safely.

Consent to care was sought by staff prior to any support being provided to people. They were involved in making decisions about the level of care and support they needed and how they wished to be supported. Where people's needs changed, the service responded by reviewing the care provided.

Sufficient numbers of staff were deployed throughout the home to meet people’s needs. Staff were suitably trained, well supported and knowledgeable about the individual needs and preferences of people they cared for. The registered manager ensured staff knowledge and skills were kept up to date.

The registered manager understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The home’s management team encouraged an open and inclusive culture at Murray House. The views of people using the service, their relatives, professional representatives and staff working at the care home were routinely sought by the provider, which they used to improve the home.

People and their relatives felt comfortable raising any issues they might have about the home with managers and staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately.

The service had a clear management structure in place. We saw the home’s management worked well together as a team and the registered manager and her three assistant managers all led by example. All the home’s managers demonstrated a good understanding of their role and responsibilities, and staff told us they were always supportive and fair.

There were effective systems in place to monitor the safety and quality of the service provided at the home. The registered manager took action if any shortfalls or issues with this were identified through routine checks and audits. Where improvements were needed, action was taken.