Mulberry Care Limited

Mulberry Care Limited is a residential care home providing personal and nursing care to people aged 65 and over who may also live with dementia. Mulberry Care Limited accommodates 35 people across two separate wings, each of which has separate adapted facilities. At the time of inspection, 22 people were living at the service.

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

People knew how to raise concerns and they felt they would be listened to. People felt that staff were caring. An activity coordinator had recently started at Mulberry Care Limited and regular activities had been made available for people to take part in if they wished to.

The service had ensured that medicines were stored and given to people safely. People’s risks assessments were clearly written and gave clear instructions to staff meaning that people were less likely to suffer harm. Regular maintenance checks of the home were undertaken. People had personalised evacuation protocols in place in the event of an emergency. Effective infection prevention control measures were in place to keep staff and people safe.

People’s care was individualised in order to best meet their needs and stimulating social activities enriched the quality of their lives. Care plans were person centred and included the input of the relevant person. 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.

A small number of people in the home lived with a learning disability and needed some additional support with communication and managing anxiety. The provider was working at ensuring that their care plans and communication support was developed in accordance with national best practice guidance.

The service had an open and transparent way of working to ensure the safety of the people living at the service. The provider was able to demonstrate that quality assurance systems had improved to ensure the quality of the service was maintained. People felt there were enough staff at the home and felt safe living there. There was a positive culture amongst staff at the service. Staff knew people they supported well and cared about their wellbeing. The provider was able to demonstrate their compliance with legal obligations and any learning from incidents or accidents was undertaken effectively.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 April 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

Mulberry Care Limited is a ‘care home’. People in care homes receive accommodation and 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. It provides personal care support for up to 35 people living with dementia within an adapted building consisting of two ‘wings’. There were 32 people receiving support at the time of this inspection.

At the last inspection on 29 and 30 November 2016 the service was rated as good. (The domain of well-led was rated as requires improvement. Improvements have been made and all domains are now rated as good.) At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service was now well led and the manager had effective systems to monitor its performance and effectiveness. The service worked effectively and positively with external agencies in meeting people’s needs. Staff felt involved, consulted and well supported by management.

People and relatives were happy with the care and support people received from the service and its staff. People felt safe and well cared for. They were safeguarded because the service had a robust recruitment procedure to help ensure staff employed had appropriate skills and staff were provided with the necessary training and support. Risks were assessed and action was taken to reduce them. People’s medicines were safely managed on their behalf. Safety checks and regular servicing helped ensure the environment and equipment were safe. Additional staffing had been provided to help ensure people’s needs were met in a timely way. Staff understood the signs of potential abuse and knew their responsibility to report any concerns about people’s wellbeing.

People continued to be 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 had positive relationships with staff and staff were alert to their needs and any changes in wellbeing.

People received good healthcare support through effective consultation with external healthcare specialists and were provided with an appropriate diet and sufficient fluids. The service positively promoted dietary and fluid intake.

Some work had been done to make the environment suitable for people living with dementia, there remained potential for further development.

People’s diverse needs and individual preferences were well catered for and where necessary, external support had been sought to meet them. eople felt staff were caring and treated them with kindness. They said staff respected their dignity and privacy. People were encouraged to do what they could for themselves and involved in day-to-day decisions making. Staff were familiar with how people communicated their needs and showed patience when responding to them.

People and relatives were happy the service was responsive to people’s changing needs. They felt a good range of activities and entertainment were provided. People and relatives knew how to complain if they had any concerns. Any issues raised had been resolved. The service complied with the accessible information standard and provided various documents in accessible formats.

Mulberry Care Limited provides personal care without nursing, to up to 35 people with varying degrees of dementia.

A registered manager was in place as required in the service. 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.

People and relatives felt people were well cared for and described staff as kind caring and respectful. People told us staff involved them in their care and sought consent before providing care. The opinions of people and relatives about the service had been sought and action was taken to address any issues identified.

People’s rights and freedom were protected in the way staff worked with them. Staff knew how to keep them safe and what to do if they had any concerns about people being abused. People’s complaints had been responded to and addressed.

People’s health and nutritional needs were well managed and they were encouraged to make decisions and choices about their daily lives. People enjoyed the food, which was provided via an external catering company. Cultural, religious and other dietary preferences were well met.

We identified some potential health and safety issues regarding safety checks and equipment servicing but the management took action to address these immediately. Some improvement was needed in the maintenance of health and safety related records.

Staff levels were sufficient to meet people’s needs and staff were working more effectively than we had observed at previous inspections. We saw a particular improvement in the way staff engaged with people and involved them in conversation and activities. The level of activities and entertainment had continued to improve.

Improvements had been made in staff induction and training. Staff received ongoing support and development opportunities, through the introduction of ‘champions’ for key aspects of the service such as falls prevention, activities and dementia.

The registered manager and operations manager had systems in place to monitor the operation of the service and both directly observed care practice to monitor this. The monitoring systems had not identified all of the issues which were seen during the inspection so further work was required to develop management proactivity.

The inspectors gathered evidence against the outcomes we reviewed to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The home had risk assessments for aspects of care that posed a risk to people who lived in the home. These assessments helped identify, address and minimise the risks to the individual.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. Staff were aware of how to recognise and report abuse.

The provider did not always carry out effective recruitment and selection processes in place. Appropriate checks were not undertaken before staff began work.

The provider did not use an effective system to make sure staff were providing sufficient care hours to people who use the service. This meant the people who use the service were at risk of not receiving sufficient care and at the right time.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the manager was not aware of the recent Supreme Court Judgment. However, they told us contact would be made with local authority's DoLS team to review each person living in the home to determine if they needed to apply for DoLS and make sure their liberties were safeguarded.

Is the service effective?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People's needs were assessed and care was planned and delivered in line with their individual care plan.

Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions. However, arrangements were not in place for ensuring only those lawfully able to give consent were asked to make decisions where the person receiving the care lacked capacity to consent.

Is the service caring?

During the inspection we observed care staff supporting people who use the service. Staff were respectful, polite and caring. They understood how people communicated and how people would express their likes and dislikes during their care and support.

Is the service responsive?

We saw people's care records and risk assessments had been recently reviewed and updated. People who use the service, their relatives and health care professionals had been involved as appropriate. If any changes to people's needs were identified these were made.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment. The provider had a quality audit system in place. However, it was not always used as effectively as it could be.

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 related to the delivery of care.

The provider did not always make sure there were enough staff to meet people's needs.

Care was planned with the involvement of the people who use the service and their relatives. Care plans reflected their individual needs. We found people were provided with appropriate care to meet their needs.

During our inspection we observed a clean environment throughout the home. People who use the service and relatives we spoke with told us the home was always kept clean and tidy. People were protected from the risk of infection because the guidelines published by the Department of Health had been followed.

The provider had an effective recruitment process, to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable. All the required information checks were in place prior to the employment of staff.

A system of staff supervision and appraisal was in place to support workers. Staff received appropriate training and professional development to enable them to deliver care and treatment to people safely and to an appropriate standard.

People's records and other records relevant to the management of the service were accurate and fit for purpose. People's care documentation was stored securely and only accessible by care workers and management. Records could be located promptly when requested.

We looked at how people's care was being planned and managed effectively, and whether people were happy with the quality of care they were receiving. We received a rather mixed reaction from the people we spoke to regarding their satisfaction with the service. We found that there were effective care planning processes in place, which enabled staff to deliver the care and support needs of each person.

Arrangements had been put in place to ensure that people were kept safe. Staff were able to identify abuse and felt able to report it without fear of recrimination.

There appeared to be enough staff to cover the rotas but we did have questions about the effective deployment of senior staff and the level of English of at least one staff member.

We looked at how the provider assessed and monitored the quality of the service. We found that staff and people who used the service were being asked for their feedback and that the provider was carrying out audits on various aspects of the service.