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Inspection carried out on 30 January 2018

During a routine inspection

The inspection took place on 30 and 31 January 2018 and was unannounced on the first day. This was a comprehensive inspection, carried out by one inspector.

Mulberry Care Limited is a ‘care home’. People in care homes receive accommodation and 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. It provides personal care support for up to 35 people living with dementia within an adapted building consisting of two ‘wings’. There were 32 people receiving support at the time of this inspection.

At the last inspection on 29 and 30 November 2016 the service was rated as good. (The domain of well-led was rated as requires improvement. Improvements have been made and all domains are now rated as good.) At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service was now well led and the manager had effective systems to monitor its performance and effectiveness. The service worked effectively and positively with external agencies in meeting people’s needs. Staff felt involved, consulted and well supported by management.

People and relatives were happy with the care and support people received from the service and its staff. People felt safe and well cared for. They were safeguarded because the service had a robust recruitment procedure to help ensure staff employed had appropriate skills and staff were provided with the necessary training and support. Risks were assessed and action was taken to reduce them. People’s medicines were safely managed on their behalf. Safety checks and regular servicing helped ensure the environment and equipment were safe. Additional staffing had been provided to help ensure people’s needs were met in a timely way. Staff understood the signs of potential abuse and knew their responsibility to report any concerns about people’s wellbeing.

People continued to be 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 had positive relationships with staff and staff were alert to their needs and any changes in wellbeing.

People received good healthcare support through effective consultation with external healthcare specialists and were provided with an appropriate diet and sufficient fluids. The service positively promoted dietary and fluid intake.

Some work had been done to make the environment suitable for people living with dementia, there remained potential for further development.

People’s diverse needs and individual preferences were well catered for and where necessary, external support had been sought to meet them. eople felt staff were caring and treated them with kindness. They said staff respected their dignity and privacy. People were encouraged to do what they could for themselves and involved in day-to-day decisions making. Staff were familiar with how people communicated their needs and showed patience when responding to them.

People and relatives were happy the service was responsive to people’s changing needs. They felt a good range of activities and entertainment were provided. People and relatives knew how to complain if they had any concerns. Any issues raised had been resolved. The service complied with the accessible information standard and provided various documents in accessible formats.

Inspection carried out on 29 November 2016

During a routine inspection

This inspection took place on 29 and 30 November 2016. The inspection was unannounced. The service was last inspected in September 2015, when it was rated “Requires improvement” in ‘Effective’ and ‘Well-led’ and “Requires improvement” overall. No breaches of regulations were found at that inspection. At this inspection we found the management had continued to make improvements in the areas which required improvement. Some further improvements were needed with regard to record keeping and proactive management as detailed below.

Mulberry Care Limited provides personal care without nursing, to up to 35 people with varying degrees of dementia.

A registered manager was in place as required in the service. 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 and relatives felt people were well cared for and described staff as kind caring and respectful. People told us staff involved them in their care and sought consent before providing care. The opinions of people and relatives about the service had been sought and action was taken to address any issues identified.

People’s rights and freedom were protected in the way staff worked with them. Staff knew how to keep them safe and what to do if they had any concerns about people being abused. People’s complaints had been responded to and addressed.

People’s health and nutritional needs were well managed and they were encouraged to make decisions and choices about their daily lives. People enjoyed the food, which was provided via an external catering company. Cultural, religious and other dietary preferences were well met.

We identified some potential health and safety issues regarding safety checks and equipment servicing but the management took action to address these immediately. Some improvement was needed in the maintenance of health and safety related records.

Staff levels were sufficient to meet people’s needs and staff were working more effectively than we had observed at previous inspections. We saw a particular improvement in the way staff engaged with people and involved them in conversation and activities. The level of activities and entertainment had continued to improve.

Improvements had been made in staff induction and training. Staff received ongoing support and development opportunities, through the introduction of ‘champions’ for key aspects of the service such as falls prevention, activities and dementia.

The registered manager and operations manager had systems in place to monitor the operation of the service and both directly observed care practice to monitor this. The monitoring systems had not identified all of the issues which were seen during the inspection so further work was required to develop management proactivity.

Inspection carried out on 16 & 17 September 2015

During a routine inspection

This inspection took place on 16 and 17 September 2015 and was unannounced. This was a comprehensive inspection which included follow-up of progress on the non-compliance identified in the reports of the previous inspection on 28 and 30 October 2014.

At the previous comprehensive inspection we identified non-compliance against Regulations10 (Assessing and monitoring the quality of service provision), 12 (Cleanliness and infection control), 13 (Management of medicines), 17 (Respecting and involving service users), 20 (Records), 21 (Requirements relating to workers) and 23 (Supporting workers), of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

From April 2015, the 2010 Regulations were superseded by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider was meeting the requirements of the comparable current regulations. Regulations 17 (Good governance), 12 (Safe care and treatment), 10 (Dignity and respect), 19 (Fit and proper persons employed) and 18 (Staffing).

We found that the service had taken action to address the previous concerns although some further improvements were needed. Some issues were still addressed reactively rather than proactively. The service has not always maintained previous improvements in response to inspection so it was too early to be sure that recent changes would be sustained. This will be monitored going forwards and at the next inspection.

Mulberry Care Limited provides services for up to 35 people with needs relating to old age, many of whom were living with dementia. There were 24 people present at the time of this inspection.

The service has 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 2008 and associated Regulations about how the service is run.

At this inspection we found that people were kept safe by a staff team who understood how to do this, how to recognise potential abuse and to report any concerns. There were sufficient staff to meet people’s needs although some would benefit from further training on engaging effectively with people, involving them in their care and seeking their consent. Staff were seen to be caring and to give people time to make decisions and choices.

People and relatives were happy with the care and support provided by the service and told us staff were gentle kind and caring. People were offered an improved range of activities and entertainment and further developments were planned. Care staff were actively involved in providing activities and people responded positively to their enthusiasm.

Staff training and support had improved with regular supervision and additional training provided. However, In some cases key training was not provided in a timely way and staff appraisals were not used effectively as a development tool.

Infection control practice had improved and the service had introduced a new medicines management system which enabled more effective monitoring.

Improvements had been made to the premises in terms of décor and signage. However, some further environmental improvements were necessary to maximise the usability and appearance of the building.

Care plans and other records had improved and were now more detailed. More information was included about people’s individual likes and wishes. Systems for monitoring the effectiveness of the service had been improved with support from the NHS care home support team and the local authority.

Inspection carried out on 28 and 30 October 2014

During a routine inspection

We inspected the home on 28 and 30 October 2014. This was an unannounced inspection.

Mulberry Care Limited is a care home without nursing that provides services for up to 35 people with dementia. The home has two wings, east and west. At the time of our inspection 32 people were using the service.

A registered manager was employed by this service. 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’s safety was compromised in the home. The premises and some equipment were not cleaned or well maintained. Procedures to control the spread of infection were not robust. There was ineffective support for people who became distressed or who were unable to make their needs known.

Changes to people’s care needs were not always well recorded. In some cases this put people at risk or meant they were not having their individual care needs met. People had sufficient to eat and drink to meet their nutrition and hydration needs, however support from staff at meal times was inconsistent. People had access to health care professionals which helped them to stay healthy.

We observed kind and friendly interactions with staff. People and relatives made positive comments about the staff and the care they provided. However, we observed people’s dignity was not always respected and their privacy was not always maintained. There was an activities programme, however opportunities for social engagement were limited and some people living at the home were not engaged in meaningful activities.

The registered manager had a system to assess staffing levels and make changes when people’s needs changed. People told us they thought there were enough staff and that they did not have to wait for staff to support them. We saw that calls bells were answered quickly. Relatives told us there weren’t always enough staff to support people with activities.

Staff training records indicated which training was considered mandatory by the provider. Not all staff were up to date with, or had received their mandatory training. We saw evidence that learning was not always put into practice when staff supported people. The provider and the registered manager could not be sure staff had the appropriate knowledge and qualifications to meet people’s needs at all times.

Staff said they felt supported to do their job and could ask for help when needed. They received regular supervision and had opportunities to discuss any matters in the team meetings. Staff were able to obtain further professional development such as National Vocational Qualifications (NVQ) or Qualifications and Credit Framework (QCF) awards and some were in the process of achieving them.

Relatives felt their family members were kept safe and were satisfied with the care and support provided. Care staff knew how to identify potential abuse and understood their reporting responsibilities in line with the service’s safeguarding policy.

Staff followed the principles of the Mental Capacity Act 2005 (MCA) when supporting people who lacked capacity to make decisions. The manager had knowledge about Deprivation of Liberty Safeguards (DoLS) and MCA. They had taken appropriate action with the local authority to ensure where restrictions were placed on people, these were reviewed and agreed. Where people’s liberty was restricted, this was carried out in the least restrictive way in order to help protect people’s rights and freedom.

The registered manager had a system in place to assess and monitor the quality of care. The registered manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. Annual questionnaires were sent so people and relatives could share their views. However, the quality monitoring system did not effectively identify all issues or concerns with the home and practices. Without an effective system the home was not able to make improvements where and when necessary so that people could receive the support and care they needed.

The registered manager did not always take proper steps to ensure people were protected against the risks of receiving unsafe or inappropriate care or treatment. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report. We also made a recommendation to review guidance on making the environment more ‘dementia friendly’.

Inspection carried out on 19, 20 May 2014

During a routine inspection

The inspection team who carried out this inspection consisted of two inspectors. On the first day of the inspection they visited the home. On the second day one inspector went back to the home to gather more evidence.

The inspectors gathered evidence against the outcomes we reviewed to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The home had risk assessments for aspects of care that posed a risk to people who lived in the home. These assessments helped identify, address and minimise the risks to the individual.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. Staff were aware of how to recognise and report abuse.

The provider did not always carry out effective recruitment and selection processes in place. Appropriate checks were not undertaken before staff began work.

The provider did not use an effective system to make sure staff were providing sufficient care hours to people who use the service. This meant the people who use the service were at risk of not receiving sufficient care and at the right time.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the manager was not aware of the recent Supreme Court Judgment. However, they told us contact would be made with local authority�s DoLS team to review each person living in the home to determine if they needed to apply for DoLS and make sure their liberties were safeguarded.

Is the service effective?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People's needs were assessed and care was planned and delivered in line with their individual care plan.

Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions. However, arrangements were not in place for ensuring only those lawfully able to give consent were asked to make decisions where the person receiving the care lacked capacity to consent.

Is the service caring?

During the inspection we observed care staff supporting people who use the service. Staff were respectful, polite and caring. They understood how people communicated and how people would express their likes and dislikes during their care and support.

Is the service responsive?

We saw people�s care records and risk assessments had been recently reviewed and updated. People who use the service, their relatives and health care professionals had been involved as appropriate. If any changes to people�s needs were identified these were made.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment. The provider had a quality audit system in place. However, it was not always used as effectively as it could be.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others related to the delivery of care.

The provider did not always make sure there were enough staff to meet people�s needs.

Inspection carried out on 18 November 2013

During a routine inspection

People who use the service and their relatives were complimentary about the care their relatives received. One relative told us, �They (staff) are marvellous.� A person who uses the service said, �I am quite happy with everything here.�

Care was planned with the involvement of the people who use the service and their relatives. Care plans reflected their individual needs. We found people were provided with appropriate care to meet their needs.

During our inspection we observed a clean environment throughout the home. People who use the service and relatives we spoke with told us the home was always kept clean and tidy. People were protected from the risk of infection because the guidelines published by the Department of Health had been followed.

The provider had an effective recruitment process, to ensure that people who use the service were not placed at risk of being cared for by staff who were not suitable. All the required information checks were in place prior to the employment of staff.

A system of staff supervision and appraisal was in place to support workers. Staff received appropriate training and professional development to enable them to deliver care and treatment to people safely and to an appropriate standard.

People�s records and other records relevant to the management of the service were accurate and fit for purpose. People's care documentation was stored securely and only accessible by care workers and management. Records could be located promptly when requested.

Inspection carried out on 11 March 2013

During a routine inspection

We looked at how the provider ensured that people who used the service and their relatives were able to give their consent to care and treatment. We found that people were asked to give their signed consent and part of their care plans included an assessment of their capacity to make decisions.

We looked at how people�s care was being planned and managed effectively, and whether people were happy with the quality of care they were receiving. We received a rather mixed reaction from the people we spoke to regarding their satisfaction with the service. We found that there were effective care planning processes in place, which enabled staff to deliver the care and support needs of each person.

Arrangements had been put in place to ensure that people were kept safe. Staff were able to identify abuse and felt able to report it without fear of recrimination.

There appeared to be enough staff to cover the rotas but we did have questions about the effective deployment of senior staff and the level of English of at least one staff member.

We looked at how the provider assessed and monitored the quality of the service. We found that staff and people who used the service were being asked for their feedback and that the provider was carrying out audits on various aspects of the service.

Inspection carried out on 17 October 2011

During a routine inspection

We spoke with people who were able to give us their view of the services provided at Mulberry Care Limited. They told us that they were treated with respect by staff and had no concerns or worries about the care they received. They told us that they could approach staff if they were worried or concerned.

Reports under our old system of regulation (including those from before CQC was created)