Mulberry House

Updated 23 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors, a member of the medicines team and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Mulberry House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was no registered manager in post. However, a new manager had been employed and was commencing the role at Mulberry House in August 2022. At the time of this inspection there was a peripatetic manager, interim home manager supported by a deputy manager in place, whose work was overseen by an area manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, including their action plan and monthly report. We sought feedback from the local authority and health professionals who work with the service. The provider was not asked for a provider information return. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and eight relatives about their experience of the care provided. We spoke with ten members of staff, including the current home manager, peripatetic manager, deputy manager, senior care workers, care workers, housekeeping staff and the cook. We reviewed a range of records. This included four people's care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received feedback from three professionals who regularly visited the service and further feedback from four staff via email.

Updated 23 July 2022

About the service

Mulberry House is a residential care home providing personal care to 42 people. There were 16 people living there at the time of the inspection, although one person was in hospital. The home is spacious, and purpose built with a large garden, accommodating people across two floors with adapted facilities accessed by a lift.

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

Since the last inspection, there have been various changes in the management structure as a new management team was recruited. At this inspection, there was a peripatetic manager who will remain in post until the new manager starts at the home in August 2022. The peripatetic manager will then become the area manager for two South West Buckland services. An interim home manager has been in place since February supported by a permanent deputy manager since March 2022. A new permanent home manager has been employed to start in August 2022.

The service had received extensive support from the local authority and quality assurance team during the unstable period since the last inspection. This support had enabled the service to improve along with the service management team changes. The service was beginning to embed the learning and new systems with positive results for people. The management team were now working with reduced local authority support using effective new systems.

Although the quality assurance governance systems were new and had not yet had time to fully embed to show sustainability, the current management team had worked hard. They had ensured the breaches found at the previous inspection had been addressed with a more stable and supported staff group. The provider had put more effective and robust governance systems in place to improve their oversight of the service and the work of the home and area management team.

We saw examples of how the positive improvements had impacted on ensuring people's needs were well met. There had been substantial investment to further promote good quality care at Mulberry House.

People were safe at the service. Staff had been trained to safeguard people from abuse and understood how to manage risks to people to keep them safe. Risks had been identified and addressed to ensure people remained safe. Staff had up to date information and actions taken were reflected in daily records. The service was still being supported by the local authority and the processes and training to keep people safe were still new, they needed to be embedded to ensure people continued to be safe in the service.

There were enough staff to support people, with staffing levels regularly reviewed and increased in relation to people’s dependency levels. The staff worked well as a team, including agency staff and were clear about what they needed to do. Recruitment checks had been undertaken to make sure staff were suitable to support people.

People chose to spend time in a choice of comfortable places, with staff supervision, if necessary.

The provider had adapted the premises to meet people's needs, for example creating a homely library area, a room for family and friends to meet in, attractive outside spaces and a large, welcoming communal area.

The premises were clean and tidy. Staff followed current hygiene practice to reduce the risk of infections with effective systems in place, including a designated laundry person and new housekeeping team. Visitors to the service were given information to help them reduce the risk of catching and spreading infection. Health and safety checks of the premises and equipment were carried out at regular intervals.

Peoples’ care and support needs were assessed prior to them using the service. There had been no new admissions since the last inspection. The peripatetic manager said care would be taken to ensure staff could meet peoples' needs before admissions in the future using a robust format.

Peoples’ care plans set out for staff in detail how their needs should be met; all care plans had been reviewed and were up to date. Staff understood peoples’ needs and how they should be supported with these. They received relevant training with ongoing competency checks to help them to do this.

Because staff had detailed and up to date information, they knew people’s care needs well. People received personalised support based on their assessed needs and preferences. A range of activities took place and people were supported to maintain their relationships and interests.

Staff were calm, kind and respectful of people. 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 were supported to stay healthy and well. Staff helped people eat and drink enough to meet their needs, to take their prescribed medicines and to manage their healthcare conditions promptly.

People, relatives and staff feedback indicated that since the previous inspection there had been great improvement in the way the service was run. Staff approached us throughout the inspection to tell us how much the service had changed for the better.

People and relatives were satisfied with the quality of care and support they received. The managers reviewed accidents, incidents and complaints to identify how the service could improve further and had taken action based on peoples' views.

People were encouraged to have their say about how the service could improve and there was good communication. Resident and relatives’ meetings had re-commenced alongside regular communication by telephone and email and a newsletter. The service worked with other agencies and healthcare professionals. We received positive feedback from visiting health professionals. The provider and management team had acted on their recommendations to improve the quality and safety of the service for people and had worked closely with the local authority and quality assurance team since the last inspection, thanking them for their support.

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 the service was Inadequate, published on 7 February 2022. We identified breaches in relation to safe treatment and care, safeguarding, risk management, person centred care, need for consent, infection prevention and control, meeting nutrition and hydration needs, staff training and competency and good governance.

This service has been in Special Measures since February 2022. 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. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. We also 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.