The inspection was unannounced, and took place on 22 May 2018. This was the home’s first inspection under the legal entity of “Minster Care Management Ltd.” The location was previously operated by another provider within the same corporate structure, and was last inspected in October 2017. At that inspection concerns were identified in relation to governance, safe care and treatment and consent. Following the inspection, the provider applied to manage the location under another legal entity within the same corporate structure. We therefore imposed a number of conditions upon that registration to ensure that the provider complied with regulations.
Mulberry Manor 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.
Mulberry Manor is located in Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to public transport links. It provides care and support to up to 49 older people. At the time of the inspection, 34 people were using the service.
At the time of the inspection, the service had a registered manager. 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 and associated Regulations about how the service is run.
Staff were kindly in their interactions with people, but they often had to work in a task- based way, meaning that they did not always take opportunities to interact informally with people and provide them with stimulation.
Risk was not effectively managed and the provider did not respond to changing risks. Where people were at risk of malnutrition or dehydration, the provider had failed to take adequate steps to minimise these risks.
Staff had received training in relation to safeguarding and protecting people from the risk of abuse.
Medicines were not safely managed, putting people at risk of harm from not receiving their medication appropriately.
The arrangements in place for obtaining and acting in accordance with people’s consent did not meet legal requirements.
There were activities available in the home but these were limited and people spent time with no engagement or activity.
The arrangements in place for monitoring the quality of the service were not robust enough to identify or address shortfalls in service quality.
The home had a registered manager but we found they did not have an effective oversight of the home.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
We are taking action against this provider, and will report on this at a later date.