Dimensions The Mulberries

About the service

Dimensions The Mulberries is a care home for up to 7 people with learning disabilities and/or autism. At the time of our inspection, 5 people were living at the service.

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

The service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. However, they needed to make improvements to fully meet these.

Right Care

People mostly received care that was kind and staff respected their privacy, but we saw people were not always treated with dignity and respect at all times.

Staff understood and responded to people’s individual needs. They communicated with people in ways that met their needs. The service gave people care and support to meet their sensory and physical needs, but some areas of the environment was not always kept sufficiently clean or safe at all times.

The service had enough staff to keep people safe. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Support

Staff supported people with their medicines, but the medicines management arrangements were not always effective.

Staff enabled people to access health and social care support. Staff helped people to enjoy a variety of activities at home and in the community.

The provider follow appropriate recruitment procedures to ensure only suitable staff were recruited to work at the service.

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.

Right Culture

The provider's monitoring processes were not always effective in helping to ensure people consistently received good quality care and support.

There was a culture of supporting people to receive compassionate care that was tailored to their needs, but we received mixed feedback about the leadership at the home.

The service involved relatives and advocates in planning and reviewing people’s care.

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 13 December 2018).

Why we inspected

We received concerns in relation to providing safe support to people. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. We inspected and found concerns about people being treated with dignity and respect so we widened the scope of the inspection to include the key question of caring as well.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dimensions The Mulberries on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to dignity and respect, safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report. We have also made a recommendation regarding mealtime support.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dimensions The Mulberries 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 provides care and accommodation for seven people with complex needs, including physical and learning disabilities. When we inspected, four men and three women were using the service.

The service was a purpose built building with seven single rooms and shared communal areas, bathrooms and toilets. There was an enclosed garden area where people could spend time safely.

The service had a registered manager who was on maternity leave at the time of this 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 provider had informed CQC of the registered manager’s maternity leave and the arrangements they had put in place to manage the service in their absence. The acting manager told us they had received their Disclosure and Barring Service check through the Care Quality Commission and planned to apply to register as the manager of the service.

The provider had systems in place to protect people from abuse. They assessed possible risks to people and acted to mitigate any risks they identified.

There were enough staff to meet people’s care needs and the provider carried out checks on new staff to make sure they were suitable to work in the service.

People received the medicines they needed safely and as prescribed.

The provider had a policy and procedures for staff on the prevention and control of infections.

The provider kept a record of accidents and incidents that affected people using the service and acted to make sure accidents did not reoccur.

The provider and staff in the service delivered support to people in line with best practice guidance and current legislation.

Support staff working in the service completed training the provider considered mandatory.

Staff knew people’s food preferences and prepared meals accordingly. Where people needed a special diet, for example pureed food, staff worked with the dietician and speech and language therapist to provide this. Our Short Observational Framework for Inspection (SOFI) observation showed people had a positive experience at lunchtime.

Dimensions The Mulberries is a purpose-built, single-storey home that is fully accessible to people who use a wheelchair.

The acting manager was aware of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

The service’s end of life care policy was reviewed by the provider in May 2017.

Staff treated people with kindness, compassion and respect.

Staff knew people’s care and support needs well and had developed trusting relationships with people, their families, friends and other carers.

People’s individual expressions of choice were respected and their privacy and dignity were promoted.

People and their families or representatives were involved in developing and reviewing people’s care plans.

The service worked with people and their families to establish and promote how people expressed their preferences and choices.

Staff supported people to access a variety of activities at home and in the community.

The provider encouraged people’s relatives to raise concerns and responded to these appropriately.

Staff and the relatives of people using the service told us they felt the service was well managed and the provider listened and responded when they expressed their views or suggested improvements. Staff also told us they felt well supported by managers in the home and the provider.

The provider had systems in place to monitor quality in the service and make improvements.

The service engaged and involved people, their families, the public and staff in reviewing the care and support people received.

At our last inspection in May 2015, we found two breaches of the Regulations as the provider was not informing the local authority or the Care Quality Commission (CQC) of possible safeguarding incidents involving people using the service. At this inspection, we found the provider had addressed the issues we raised and made improvements.

Dimensions The Mulberries is a care home for up to seven people with a learning disability. When we inspected, six people with a learning disability, physical disability and complex needs were using the service.

The service had a registered manager who was appointed in October 2015 and registered by the Care Quality Commission in February 2016. 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.

There were enough staff to meet people’s needs and the provider carried out checks on staff before they worked with people using the service.

People received the medicines they needed safely.

The provider had supplied new equipment, redecorated and refurbished parts of the service.

Staff had the skills and knowledge they needed to support people.

The provider and registered manager acted within the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People had access to the health care services they needed.

People’s relatives told us people were well cared for in the service.

Staff treated people with kindness and patience knew people’s care and support needs well.

The provider produced information for people using the service in a format they could understand.

People’s care and support was individually provided, based upon their needs and preferences.

Staff encouraged and supported people to engage in social and recreational activities.

The provider made information available to people using the service and their relatives on how to make a complaint.

The provider had appointed a full-time manager who had registered with the Care Quality Commission.

The provider and registered manager completed audits to monitor the service and identify areas of improvement.

The registered manager, deputy manager and staff carried out regular maintenance and safety checks.

Relatives spoke positively about the service people received, one person told us "over the last few years the home has turned around, care is very good, people go swimming, see films and do lots of community things". The same person told us "my relative has annual reviews where we are always invited. We see our relative every week and we always have regular meetings with the manager. We are invited to BBQ's and Christmas parties. We were also involved in staff recruitment."

Another person's relative told us "the care is very good, however there is often agency staff working in the home and we don't know who these people are. It would be helpful if they wore name badges."

We observed staff caring for people in a kind and compassionate way. Staff understood people's needs and had a good understanding of how people communicated using signs or objects of reference.

We looked at the care records of people and found care was well planned and people were regularly involved with the planning of their care to ensure there needs were met.

We found staffing arrangements in the home had improved and people had a good understanding of people's needs to ensure they were protected from the risks of abuse.

We noted that improvements were needed in recording information because care records were not kept comprehensively.