Mulberry Court

Mulberry Court is a residential care home providing personal care to 82 younger and older adults at the time of the inspection. The service can support up to 84 people. The service supports people who may be living with dementia, a physical disability or a sensory impairment.

Mulberry Court has three floors that have been adapted to support people living with dementia. People have their own rooms with en-suite facilities and have access to shared communal areas such as lounges, dining rooms, bathrooms and a garden.

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

People and their relatives were positive about the support from management and staff team. One person told us, ‘‘It is lovely here. [Staff] treat me well, they know what I like, and I could not be living in a better place.’’

People were kept safe. Staff were trained in safeguarding, knew how to identify signs that abuse may be happening and how to report this. Risks to people had been assessed and measures were put in place to mitigate these risks as far as possible. There were enough suitably trained staff to meet people’s needs. People were supported safely with their medicines. The service was kept clean and good infection control processes, including those related to COVID-19 were in place and followed. The management team analysed accidents and incidents and shared any lessons that could be learned with the staff team.

People were supported by a kind, caring and compassionate staff team who knew them as individuals. People were clearly happy and relaxed being supported by the staff team. Staff supported people to make choices about their care. 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. Staff promoted people to live independently and respected their privacy and dignity.

Staff supported people in a person-centred manner depending on people’s preferences, likes and dislikes. Care plans were written in a way which focused staff on these areas. People were supported to communicate in a way that made sense to them. Staff ensured that people engaged in social events and pastimes which matched their interests. There was a complaints procedure in place and people and their relatives knew how to raise concerns. People received dignified and respectful care at the end of their lives.

The registered manager and management team promoted a positive and inclusive culture at the service. They were open and honest about the improvements made at the service and those that still needed to be focused on. Audits were completed to monitor the quality of the service and actions were taken if areas for improvement were found. People, relatives and the staff team told us they were asked to feed back about the service and that their suggestions were considered and taken on board. The staff team linked and worked with external professionals and organisations to support good outcomes for people.

The registered manager was passionate about the improvement that had been made at the service and the improvements that they had planned to make happen going forward. The service had consistently been improving since the registered manager was employed and these improvements were evident at this inspection. People and relatives’ comments reflected a service that had improved and provided a safe, effective and good quality service.

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 requires improvement (report published 30 August 2019). We also completed a targeted inspection which did not lead to a rating change (report published 31 March 2021)

Why we inspected

This was a planned inspection based on the previous rating.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings 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 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 Court is a residential care home providing personal care to 71 people aged 65 and over at the time of the inspection. The service can support up to 84 people. Mulberry Court is spread over three floors and was purpose built.

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

One person’s relative said, “They [staff] are so kind and generous to me, which makes me think they must be to [name of relative]. They love him.” Another person’s relative said, “I have no concerns about the care staff, they look after [name of relative] so well.” This relative went on to explain how specialist support had been arranged for their family member.

People who were at risk of falling and those who were at risk of developing pressure damage to their skin were supported in a safe way. People were supported to have enough to eat and drink.

There were enough staff to meet people’s needs but we were not confident this was enough to give people quality time with staff. Staff worked really hard, multitasking, but they did not have enough time to sit and spend quality time with people.

The registered manager and area manager completed a tool which calculated how many staff were needed on each floor of the home. However, they were not robustly testing staffing levels where appropriate, to assure themselves and other agencies they had enough staff to meet people’s physical and emotional needs.

We have made a recommendation about management oversight and checks of staffing levels.

The risks to people from COVID-19 were minimised through the cleanliness of the home and staff training in infection prevention and control (IPC). People were supported to isolate in their bedrooms on admission as a precaution against the risk of spreading infection.

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 requires improvement (published 30 August 2019).

Why we inspected

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.

The inspection was prompted due to concerns received about falls management and pressure care. Concerns were raised about staffing levels and the completion of people’s medication administration records (MARs). There were also concerns about some aspects of day to day care for example, if there were enough toiletries available for people and the size of the meals. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Court is a residential care home providing personal care to 47 people aged 65 and over at the time of the inspection. The service can support up to 84 people. Mulberry Court is a purpose-built building with three floors.

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

People who we could talk with said they were happy living at Mulberry Court. One person said, “The manager is very nice, I have seen them, and they care about us.” People spoke positively about the food. “The food is good, look, today on a Wednesday it’s a full roast. You don’t get that in most homes. I’ve put weight on the food is that good.” People's relatives also made positive comments about their experiences of the home, but some were cautious as they had seen the quality of the service deteriorate in the recent past.

From the last two inspections we at the Care Quality Commission (CQC) have been very concerned about people’s care at this home. We took urgent action in response to this. However, we found at this inspection significant improvements had been made.

People were now safe. There were systems in place to support the staff and the management team to identify when a person was at risk of being an unhealthy weight. Although, we did find that systems to manage aspects of people’s pressure care needed to be improved. We saw that staff had taken action when a person fell, to try and prevent this from happening again. Staff had a better understanding of what harm and abuse could look like. They knew what to do if they had concerns. People’s medicines were now stored and managed in a safe way.

Staff were now more effective in their work. Staff had improved inductions and training. The management team were now monitoring staff competencies and knowledge to promote better staff practice. Staff said they felt supported and motivated to do well in their work. People’s experiences of eating and drinking had improved.

People were supported to have more 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.

We have made a recommendation about the management team promoting a more dementia friendly environment. We also made a second recommendation for staff to communicate with people in a more effective way.

Staff practice in how they treated people had improved. We saw staff being kind to people and treating them as individuals. However, there were still other times when staff did not always respond to people in a thoughtful and respectful way. Staff practice in this area still needed further work.

People’s care assessments, and reviews also needed more work to make them more relevant to individuals. People’s records lacked some details to assist staff in meeting and promoting people’s wellbeing. There were now more activities and events happening at the home. We heard people laughing and saw people enjoying themselves. At previous inspections this had not happened.

There was now an improved culture in the leadership and staff team of the home. Improvements had been made by the management team, but we still found shortfalls in some areas of people’s care. The provider and the registered manager had received a lot of support and direction in how to improve the service from the local authority. The provider’s own quality assurances systems had previously failed in identifying the significant issues which we had found at the home. Although, improvements had been made we were still not fully confident the management team could effectively manage the service in the future. More time was needed to test this.

Rating at last inspection and update

The last rating for this service was Inadequate (published 28 February 2019) and there were multiple beaches of the regulation. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. We had also requested they sent us a report each month showing the improvements they were making. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since July 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection and to confirm if we needed to take further legal action against the provider.

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.

Following the last inspection, we met with the provider to confirm the providers action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive, and Well Led to at least good. However, we found at this inspection the provider had failed to achieve this.

People’s experience was poor living at Mulberry Court. There had been substantiated concerns from the local authority about neglect and acts of omission. The people who we spoke with did not speak very positively about the service. We had concerns that people were not always safe who were at risk of falls, those who were an unhealthy weight, and those who needed certain medicines. Staff did not always respond to safeguarding concerns in a safe way. People’s dignity and comfort was not always promoted. Staff did not engage with people in way which demonstrated that they knew the people they were looking after. There were no activities or events taking place to help people enjoy life at the home. The home looked tired and uncared for. The management team and the provider had ineffective systems or no systems at all to test and ensure that people were safe, well cared for, and led meaningful lives at the home.

The last rating of the home was Inadequate this report was published on 25 July 2018. For more details please see the full report on www.cqc.org.uk

We inspected in January 2019 because the home was placed in Special Measures at the last inspection which means we must return in six months to check the service again. We were aware before the inspection of concerns raised by other professionals.

Full information about the CQC’s regulatory response to the more serious concerns found at inspections and appeals is added to reports after any representations or appeals have been concluded.

The overall rating of this service is Inadequate and the service therefore remains 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.

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.

Mulberry Court 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 Court provides personal care and accommodation for older people. Many people living at the home were living with dementia. Mulberry Court is registered to provide care for up to 84 adults. At the time of this inspection 75 people were living at the home. Mulberry Court comprises of a purpose built building offering accommodation over three floors. 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.

There was a registered manager in place. 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 local Clinical Commissioning Group (CCG), which is a group of health professionals who work for the NHS, recently shared their concerns they had about the home with us. At this time some people’s relatives had also contacted us and told us about the concerns which they had about the home. We looked into those issues during the inspection.

People did not have detailed and full risk assessments. With accompanying plans for staff to follow to ensure their needs were met in a safe way.

We observed staff supporting people to move in unsafe ways. Other health professionals told us that they had also seen this happen before. The leadership of the home were not fully responding to these concerns and looking at ways to prevent this from happening again.

Following a serious safeguarding incident and there was not a full investigation into what had happened to try and prevent it from happening again. We found that staff knowledge of how to protect people from harm was not complete.

There had not been an evacuation drill. Other systems were not in place to maximise people’s safety, if there was a need to evacuate the building in the future. Recently a person had gone missing when the alarms were activated.

We saw that staff were not always adhering to good infection prevention and control practices.

The management of the home were not checking that staff always had the skills and knowledge to do their job well. We saw examples of poor staff practice which the leadership of the home had not identified. Staff did not receive training in areas relevant to all the people they were supporting. Some people had particular cultural needs, but staff did not receive training on this.

People were not always treated with dignity and respect. We observed that some staff treated people in a disrespectful way. Staff were not always caring towards the people they supported.

We found that people did not have personal assessments which explored their needs as an individual, their interests and backgrounds. Reviews of the care which people received were not holistic. These reviews were not used as an opportunity to capture their views about the care they received at the home. When the service had captured some of this information, they were not using it when they designed and planned activities at the home.

The service was not considering people’s personal spaces, their bedrooms. The service was not checking if people liked them and needed support to make them personal and relevant to them as individuals.

The management of the home and the provider were not completing quality and robust audits to test the quality of the service. Robust investigations were not being completed to learn from incidents, with strong measures being put in place to prevent these from happening again.

These issues constituted breaches in the legal requirements. There were breaches of seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Relatives told us there was not always enough staff to meet people’s needs. We found that people were not being supported to walk and move about the home by staff as a way to promote their ability to mobilise independently. Staff also did not spend time chatting and talking with people.

People were receiving their medicines appropriately by staff. The management of the home had worked with the CCG recently to improve how they did this. Although some people’s prescribed creams were not being stored in the correct way.

Some staff were not supporting people in an inappropriate way to eat their food. People were being rushed into the dining rooms and some people were being encouraged to eat at a quick pace. People’s dining experiences were not considered. We found that lunch time was chaotic. People’s food and drinks likes and dislikes were not being fully identified. People were not being asked about their views of the food and drinks they had in a meaningful way. We were not confident that some people’s cultural dietary needs were always being met.

People were not always being asked if they consented to the support and assistance from staff. Staff lacked knowledge of how they ought to be promoting people’s freedoms.

The leadership of the home was developing links with the local community. They were trialling out a regular holiday experience for some people at the home.

Mulberry Court is a residential care home that is registered to provide personal care to up to 83 people over the age of 65. At the time of our inspection there were 80 people using the service.

The service had 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.

People had care plans in place which were detailed and included information about their backgrounds, healthcare needs, likes and dislikes and interests. People and their relatives had opportunities to be involved in the planning and review of their care. Risk assessments were in place for individuals and the environment to help keep people safe from harm. People had enough to eat and drink and were provided with a balanced and varied menu. The service provided activities which kept people engaged and allowed them to pursue interests and hobbies where possible.

Staff had a good understanding of safeguarding and received appropriate training to enable them to keep people safe from risk of harm. They had received training that was appropriate to their role and were regularly supervised by management. Staff had opportunities to contribute to people’s care planning and the development of the service. Interactions between staff and people were positive and staff were knowledgeable about the people who used the service. Staffing levels within the home were appropriate to keep people safe. People provided consent to receiving their care and staff understood their responsibilities under the Mental Capacity Act.

Medicines were managed, stored and administered safely and people had access to relevant healthcare professionals where needed. The service had robust auditing systems in place and used these to identify areas for improvement and take appropriate action to resolve issues. Complaints were handled appropriately and meetings were held for staff, people and relatives to discuss matters concerning the service. Regular checks were completed to ensure the environment was safe.

We found that the home had systems in place to gain and review consent from people who use services and acted on them. People were provided with sufficient food and drink to meet their needs.

People said that they were satisfied with the care they received from staff at Mulberry Court. They told us staff respected their privacy and dignity. One person said, "I'm well looked after.' A relative of a person who use the service said, 'is absolutely treated with respect. I've never seen anybody lose their patience, always in a good humour.'

We found that the home had systems in place to reduce the risk and spread of infection.

There were sufficient staff available with the appropriate knowledge and skills to care for people. Suitable arrangements were in place to ensure that the staff were appropriately supported to deliver care safely and effectively.

The home had systems in place to monitor and assess the quality of the care it provided to people to ensure it was safe and effective.

We observed that people were offered support at a level which encouraged independence and assured that their individual needs were met. People were supported to make choices about their every day lives and we observed staff were friendly and polite in their approach and interacted confidently with people. We noted that the midday meal service was relaxed and unhurried and people were enjoying appetising and nutritious meals.

People's care needs were clearly documented in a way which promoted personalised care and continuity of care delivery. People had been encouraged to express their views, and their personal preferences and choices were integrated into their care plans. Within the care files we saw that care documentation had been signed by the individual or a representative to confirm their involvement and agreement with their particular care needs.