Mulberry Court

Mulberry Court is a residential care home providing personal and nursing care to 41 people aged 65 and over across three floors, each with their own communal areas and bathing facilities. The service can support up to 64 people.

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

People living at Mulberry Court benefitted from safe and person-centred care, delivered by a team of skilled and co-ordinated staff.

People were kept safe from abuse and avoidable harm and received their medicines on time and as prescribed. Staff were recruited safely, and enough staff were deployed throughout the home to meet people’s needs.

The home was well-run, and staff were clear about their roles and responsibilities. The registered manager was a visible presence in the home promoted an open, learning culture. People, staff and relatives were encouraged to feedback and contribute to the ongoing development of 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.

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 12 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the home. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained the same. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

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

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.

At our last inspection we rated the service 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.

This inspection took place on 3 and 8 October 2018 and was unannounced. 54 people were using the service at the start of our inspection.

There was a registered manager in post. People, staff and relatives spoke positively about the leadership of the home and told us the registered manager was approachable.

There were systems and processes in place to protect people from the risk of harm. There was a safeguarding policy and staff were aware how to report any concerns. The premises were clean and well maintained. Medicines were stored, administered and recorded safely.

The provider assessed risks to people’s safety and well-being and we found that action was taken to reduce risks to people. We observed one incident where staff did not follow guidelines in a risk assessment on the first day of our inspection. The registered manager took swift and appropriate action to address this. This, along with other systems and records we viewed, showed the provider learned from any accidents or incidents that occurred in order to prevent recurrence and drive continual improvement of the service.

Appropriate recruitment checks had been undertaken before staff started work at the home. There were systems in place to ensure there were enough staff to meet people’s needs. In the couple of months prior to our inspection there had been an issue with staff sickness at short notice, particularly on weekends, and we found action was being taken to address this and maintain safe staffing levels.

Staff received an induction, training, supervision and appraisal to give them the skills and knowledge they needed to meet people's needs. There were regular staff meetings.

People were 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 received a nutritious diet and were encouraged to have enough to drink. Staff sought advice from specialists and healthcare professionals when they had any concerns about people’s health.

People and relatives told us staff were kind and caring. Staff treated people with dignity and respect and people received compassionate end of life care.

Detailed care plans were in place to give staff the information they needed to support people in line with their needs and preferences. These were regularly reviewed. There was a programme of activities available at the home, and staff encouraged people to be involved in deciding on the activities, trips and entertainment on offer.

The provider had a procedure in place for responding to complaints. There was a quality assurance system and checks to monitor the quality of the service. People were asked for their feedback in meetings and surveys. The provider worked in partnership with other organisations to enhance the service and increase the opportunities available to people.

Further information is in the detailed findings below.

Mulberry Court provides nursing and personal care for up to 64 residents. The home is purpose built and has accommodation and communal areas on all three floors. All floors can be accessed by a lift. The home has a licenced bar, an activities room and a garden. At the time of our inspection there were 57 residents using the service.

The service is required to have a registered manager, and at the time of our 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 2008 and associated Regulations about how the service is run.

The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns. We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm.

The provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were mixed viewed about the availability of staffing, but we found there were systems in place to ensure there were sufficient staff to keep people safe.

Medication was appropriately stored, administered and recorded on Medication Administration Records. Staff responsible for administration of medication had received training and the provider completed medication audits and staff competency assessments. This showed that there were systems in place to ensure people received their medication safely.

Staff completed a range of training to help them carry out their roles effectively, and there was a schedule for refreshing this training when it was required. The majority of staff were up to date with most of their refresher training, and there were plans to ensure any overdue refresher training was completed.

The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the principles of the MCA.

People were supported to maintain good health and access healthcare services. We saw evidence in care files of contact with healthcare services, such as GPs, speech and language therapists, psychiatrists and opticians. There were mixed views about the quality and variety of food available, and the availability of support for people who ate in their own rooms, but people told us they got sufficient to eat and drink. The registered manager and chef were working with people to increase the variety of food and accommodate individual preferences. There were refreshments available throughout our inspection. Care plans contained information about people’s nutritional needs and preferences, and this information was also available to staff in the kitchen. People’s weight was monitored and action taken where people had lost weight.

Most people told us that the staff who supported them were kind and caring. One person told us staff spoke across them to each other when providing them with support, however the registered manager told us this issue was being addressed. People also reported that they felt their privacy and dignity were respected. We saw that interactions between staff and people using the service were positive and friendly.

Care plans were reviewed monthly and contained information about people’s needs, routines and preferences. Staff were also able to demonstrate a good understanding of people’s needs and preferences. The home employed two activities co-ordinators and there was a range of leisure and social activities available to people.

There was a complaints procedure in place and most people using the service told us they knew how they could raise a complaint if they needed to. People also had opportunity to raise concerns or give their views in resident’s meetings, food and activity forums, and through individual review meetings.

There was an effective quality assurance system in place, which included a range of audits and surveys conducted by the registered manager and deputy manager, as well as quality assurance checks conducted by regional management. This enabled the registered provider to identify issues and measure the delivery of care.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with visitors, people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risk to people and helped the service to continually improve.

People told us they received their medicines in a timely manner and as prescribed by their GP. We found that appropriate arrangements were in place in relation to recording, handling and safely administering medicines to people who used the service.

The home was designed to meet the needs of people who lived there and the provider ensured the environment was regularly maintained, safe and fit for purpose. People were protected from unsafe or unsuitable equipment because the provider had ensured the equipment used in the service was serviced and maintained and service certificates were available for inspection.

The manager set the staff rotas. Records showed the manager had taken people's care needs into account when making decisions about the number of staff the service required; the particular qualifications, skills, experience staff would need and the layout of the building. Our observation of the service found that people had their needs attended to throughout the day. Staff were busy but always found time to speak to people and respond to any requests for support that were made.

Is the service effective?

People's health and care needs had been assessed and care plans and risk assessments were in place and reviewed by the staff on a regular basis. The care records documented people's needs, choices and preferences on an individual basis and our observation of the service indicated these were respected by the staff and followed in practice.

All the people we spoke with were asked about their care files and the care plans within them. They either didn't know what a care file was or were not particularly interested in being aware what was in it. One person said 'I am satisfied with my care plans'. The relatives we spoke with said 'They tell me about everything in it that they need to.'

Our checks of the records and documents within the service showed that staff received training in safe working practices. Health and safety risk assessments were in place with regard to fire, moving and handling and daily activities of living. The equipment used in the service was serviced and maintained and service certificates were available for inspection.

Is the service caring?

When asked about their care, all the people we spoke with said they were satisfied with it. Three people commented that 'I'm quite satisfied,' 'The care is marvellous' and 'I have no particular concerns about the home'. The relatives we spoke with said 'This place is like a 5-star hotel. It's beautiful. Everything is done perfectly.'

Our observation of the service indicated people's needs, choices and preferences on an individual basis were respected by the staff and followed in practice. One person told us it was their choice when they went to bed. Another person said 'I am happy that I am given choices about what I would like.' A third person told us 'The staff do suggest what I ought to do for my own good.'

Feedback from people who used the service, relatives and staff was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was usually analysed by the provider and where necessary action was taken to make changes or improvements to the service.

Is the service responsive?

People had access to a range of activities both inside and outside of the service. However, some individuals said they found the activities were either not suitable for their gender or did not find them interesting / stimulating.

People we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that when this happened action was taken quickly to resolve any problems. One relative told us they had brought up a concern with the manager and they were satisfied with the manager's response.

Is the service well led?

The manager of the service was fairly new in post. We were told that there had been a number of changes to staff working practices since the manager took up their position. All staff who spoke with us said 'The new manager has solved a lot of staff problems', 'Care staff have been promoted within the service and now have the opportunity to achieve further qualifications' and 'There are good opportunities for training and we get good supervision.' The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

The service had an open door policy so staff were able to discuss any concerns with the manager and there were regular staff meetings so that people could talk about any work issues. This meant that staff were able to provide feedback to their managers and their knowledge and experience was recognised and taken into account.

One person we spoke with during our visit said: 'The home is lovely and clean.' Staff told us they had worked hard to address the issues we had identified during our last inspection. They said 'It is much better we are all working as a team making sure the standards of cleanliness are kept up.'

People's nutritional needs were assessed and continued to be monitored. Food being served looked appetising. People could eat wherever they preferred. A person we spoke with said 'The food is good we have never had to complain, we have had no reason to.' However, we did receive some negative comments which the manager was aware of and was acting upon.

There were policies and procedures in place to help to protect people from abuse. Staff knew what action they must take if they suspected abuse was occurring. This helped to keep people safe from harm. One person we spoke with said 'I would report any issue I was not happy with and it would be dealt with.'

People were not protected from the risk of infection because appropriate guidance had not been followed. We have asked the provider to address this.

Staff had the skills they needed to be able to help and support people. A person we spoke with said 'The staff look after me very well they are trained and know what they are doing.' Staff supervision and appraisals occurred which helped to identify any further staff training needs.