Mulberry House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People received appropriate care and support that met their health and welfare needs. Staff had good relationships with other health care professionals. Staff understood safeguarding and told us they were able to raise concerns with the manager. Staffed worked with people to manage risk and encourage independence.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Professionals spoken to, and those providing feedback, confirmed staff and the management of the home were willing to work jointly and take on advice and guidance for the benefit of people. They told us the manager understood their role in safeguarding people.

Staff told us they had good relationships with General Practitioners and specialist nurses. Staff said care was safe because they knew where to obtain clinical advice. Staff told us they had good joint working with other health care professionals in the area, including the speech and language therapy (SALT) team which ensured people’s choking risks were minimised. Staff told us they were happy to speak up about any concerns they might have.

People’s care was managed safely by appropriate staff. People received care and support that met their health and welfare needs. A person told us “I feel really safe.” People had a variety of professionals to support their changing needs. For example, when people experienced deteriorating health, staff recognised the changes and contacted appropriate health care professionals. When people’s mental health changed, staff completed a urine sample to establish if there was an underlying infection. Staff used this information to inform discussions with the General Practitioner (GP). Regular contact was maintained with health care professionals.

We saw the safeguarding policy which applied to all staff and showed who was responsible for people’s safety at the home. The policy included information on what safeguarding was and what constituted abuses, as well as how staff should respond to any concerns. Regular contact was maintained with health care professionals, including routine twice weekly contact with the GP or a practitioner from the surgery. Clinical audits were completed and reviewed.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

Care plans included information on risk and showed specific risks were managed well. People at risk of pressure injuries to their skin had appropriate management and advice from the tissue viability team. Where people were at risk of choking or had a swallowing problem they had been referred to the speech and language therapy team. Staff received appropriate training to ensure they could meet the needs of people for example, specific PBS training and training on the care of a tracheostomy.

People at risk from pressure ulcers had suitable equipment in place to reduce this risk. We observed the equipment included air mattresses that staff checked was set at the most therapeutic setting according to people’s weight. Records supported this practice. Records demonstrated risks associated with people’s health were responded to. For example, risk assessments and clear guidelines and care plans were in place to respond to health needs including epilepsy and diabetes. People who showed signs of distress or anxiety were treated kindly and responded to in a gentle soothing way. Staff used de-escalation methods and reduced any risks to the person or other people in the service.

Risks associated with people’s health and welfare were assessed and responded to. This allowed people to have as much independence as possible and be supported to be safe. For example, one person was at risk of falling and did not understand the risks, additional staffing had been provided to promote safety in the least restrictive way. One person had risks around handling medicines. These risks were assessed, and to support them to be involved, they had their medicines given to them in a pot rather than on a spoon, maintaining their dignity.

Staff were able to discuss people’s risks and how they were responded to, in order to reduce any possible risk. They discussed how one to one staffing was used to keep people safe. In addition they knew how people needed to be evacuated in case of emergencies and central records were kept for emergency agencies to access. Staff understood individual risks associated with people’s mental health. People had individual mental health care plans and positive behaviour support (PBS) plans when needed. These clearly recorded steps to promote the best mental health for people and what to do when this deteriorated. For example, one care plan clarified referral routes to mental health hospital if needed. Staff knew and understood these processes. Staff told us they had training in managing risk. Cleaning staff were trained in safe handling and storage of cleaning materials.

There were effective processes in place to ensure there were adequate staff numbers at all times. The registered manager said one to one arrangements for people were normally arranged before admission. Staff files were up to date and staff were recruited safely with all appropriate background checks carried out and recorded. A staff member told us staffing levels were “about the residents rather than ratios. [Senior staff] are happy for me to get the staff in that I need .”

People were supported by staff who knew them well. They had choices respected regarding who worked with them. For example one person requested female staff only. Other staff worked with specific people who they had a rapport with or had specific training to meet their individual needs. People told us staff frequently asked them for consent and encouraged them to join in. One person said, “The staff have a good sense of humour, it’s nice to have a bit of humour.”

Staff told us there were enough trained staff to look after people safely. Some people needed one to one care and this was provided by core staff or occasionally by regular agency staff. Staff told us when they had spoken to the registered manager about a reduction in staffing that did not work with the layout of the building, they were listened to and the staffing levels were corrected. Staff felt well supported in their roles and could extend their roles for example train to be an assistant practitioner.

There were enough staff to support people safely. We spoke to the staff who organised the safe staffing rotas and ratios and we saw the checks carried out to ensure staff were able to work safely with people. We saw that people who needed one to one support were receiving it appropriately. We saw positive interactions between people and staff and saw staff respond quickly to people when they asked for things. Staff had time to chat with people, make them laugh, respond and reassure people who were showing signs of anxiety.

People received their prescribed medicines in a timely and personalised way. When staff administered medicines people were spoken to kindly and asked if they wanted any additional medication. People were given time to take their medicines in a safe way, they were offered a drink and made comfortable. Staff followed safe medicine administration practice that supported people to receive the correct medication. For example, dispensing one person’s medicines and after administration signing the Medicines Administration Record (MAR) . There were clear protocols for staff to follow to ensure people with epilepsy, diabetes or other specific conditions had medicines administered in a safe and timely manner.

Medicines were stored safely and temperatures of the medicines storage area and fridge were checked and recorded. There was guidance for staff on how and when to administer PRN. For people who needed insulin injections there was information on location of injection sites, as well as amounts, frequency, and any other necessary information. Medicines administration records were all documented with no gaps in the records.

Staff told us medicines were well managed and there had not been any recent errors. The deputy manager took the lead on medicines and organised the medicine ordering, delivery, and storage. Staff described the processes followed to administer medicines safely. For example, one staff member demonstrated the process of 'as required medicine' administration (Pro Re Nata - PRN), which included following individual guidelines and ensuring accurate records of what was given, when, why, and the medicine’s effectiveness. The registered manager told us the service was part of the Medicines Optimisation Care Homes (MOCH) programme. Mulberry House was the Pilot Home for this service and it proved to be successful in minimising unnecessary prescriptions, streamlining medication delivery and reducing risk of errors. The registered manager also said instant access to a MOCH pharmacist was helpful and reduced the number of times staff needed to contact GP services.