Mulberry House

Updated 26 May 2018

We carried out this 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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 14 March 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because it is small and the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in. The inspection was carried out by one inspector and an inspection manager.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

Two people told us about their experience of the service. We spoke with three staff, including the registered manager, and two care workers. We received feedback about the service from three health and social care professionals.

We looked at records held by the provider and care records held in the office. This included three people’s care plans and the recruitment records of three staff employed at the service and the staff training programme. We viewed a range of policies; medicines management; complaints and compliments; meetings minutes; health and safety assessments and quality audits.

The service had been registered with us since 23 February 2017. This was the first inspection carried out on the service to check that it was safe, effective, caring, responsive and well led.

Updated 26 May 2018

This inspection took place on 14 March 2018 and was announced.

This service provides personal care and support to ten adults living in ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. This supported living service meets the needs of people with mental health care needs. People use the service as a stepping stone from residential care to independent living in the community, they were mainly independent and did not require staff support all of the time. The service is run from an office on site. There were ten people using the service at the time of our inspection.

A registered manager was employed at the service and they were present during 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.

We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse.

The registered manager had experience of managing mental health services. The registered manager spent time each week delivering the service alongside their colleagues. This meant that the registered manager had an in depth knowledge of how the service was running and got to know people and staff very well.

The registered manager involved people in planning their care by assessing their needs based on a person centred approach. We observed and people described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. All of the people had the support of a community psychiatric nurse (CPN). People clearly had control over their lives when they were well. People could involve relatives or others who were important to them when they chose the care they wanted.

The person centred care plans developed to assist staff to meet people’s needs told people’s life story, recorded who the important relatives and friends were in people’s lives and explained what lifestyle choices people had made. Care planning told staff what people could do independently, what skills people wanted to develop and what staff needed to help people to do.

The registered manager and staff followed the Mental Capacity Act 2005 (MCA). The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA). Staff received training about this.

Staff assessed and treated people as individuals so that they understood how they planned people’s care to maintain their safety, health and wellbeing and choices. Risks were assessed within the service, both to individual people and for the wider risk from the environment people lived in. Actions to minimise risks were recorded. Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. Staff understood the steps they should take to minimise risks when they were identified. The provider’s health and safety policies and management plans were implemented by staff to protect people from harm.

The registered manager and the provider had demonstrated a desire to improve the quality of the service for people by listening to feedback, asking people their views and improving how the service was delivered.

People and staff felt that the service was well led. They told us that staff and the registered manager were experienced, understood people’s needs, were approachable and listened to their views. The provider and registered manager continued to develop business plans to improve the service.

People were often asked if they were happy with the care they received. The provider offered an inclusive service. They had policies about Equality, Diversity and Human Rights. People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face, or by using formal feedback forms.

Safe recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The provider recruited staff with relevant experience and the right attitude to work with people who had mental health illness.

New staff and existing staff were given an induction and on-going training which included information specific to the people’s needs in the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

The provider trained staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have. Incidents and accidents were recorded and checked by the provider to see what steps could be taken to prevent these happening again. Staff were trained about the safe management of people with behaviours that may harm themselves or others.

Staff received supervision and attended meetings that assisted them in maintaining their skills and knowledge of social care.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. Pictures of healthy food were displayed for people and dietary support had been provided through healthy eating plans put in place by dieticians. Staff supported people to maintain a balanced diet and monitor their nutritional health.

There were policies and procedures in place for the safe administration of medicines. People had control over their medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health.

The quality outcomes promoted in the providers policies and procedures were monitored by the management in the service. Audits undertaken were based on cause and effect learning analysis, to improve quality. All staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice.

Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and carried personal protective equipment like disposable gloves and apron’s.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue.