Mulberry Court Care Home

People's experience of using this service:

People felt safe and staff ensured that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people’s needs and that staff had received training to ensure they had the knowledge to protect people from the risk of avoidable harm or abuse, whilst providing care.

People were protected from the risk of an acquired health infection, as the service employed dedicated cleaning staff to ensure the environment was clean and had appropriate policies and procedures to monitor and reduce the risk

Systems were in place to support people to take their medicines safely. Staff received relevant training and felt well supported. People were asked for their consent to their care and appropriate steps were taken to support people who lacked capacity to make decisions.

People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people using the service and the staff who cared for them. Staff promoted people's right to make their own decisions about their care where possible and respected the choices they made. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required.

People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff.

There were robust quality monitoring procedures in place. The management structure of the service was clear.

People's safety had been considered and risks had been reduced by the introduction of equipment or guidance. Staff had received training in relation to safeguarding and knew how to protect people from harm.

Information was provided in a range of formats to support understanding. People were able to access spiritual support to meet their religious beliefs.

There was a registered manager at the home and the rating was displayed at the home and on their website. When required notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

Rating at last inspection: Requires Improvement (Published May 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this

inspection we found the service had improved to Good, and in one area improved to Outstanding.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out an unannounced inspection of the service on 31 January 2017 and 1 February 2017.

We carried out a comprehensive inspection of this service on 19, 21 April 2016 and four breaches of legal requirements were found. These included; medicines not being safely administered, people being unlawlfully deprived of their liberty, quality assurance audits were not effective and people were not supported by sufficient numbers of suitably qualified staff. We undertook this inspection to check that they had followed their action plan and to confirm that they now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mulberry Care Home on our website at www.cqc.org.uk.

Mulberry Court Care Home is registered to provide personal care for up to 43 people. At the time of our inspection there were 21 people using the service. Mulberry Court was newly registered in November 2015.

Mulberry Court Care Home is a two storey home situated in the middle of a housing estate in Bilborough, a suburb of Nottingham city. There are 43 single rooms with shared bathroom facilities. There is a communal lounge and separate dining room. There is a reminiscence area. Outside is a garden area that can be accessed with support from staff.

Since our last inspection there had been a change of management and a new registered manager had been recently recruited and was in post during our inspection. 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.

Staff were aware of the safeguarding adult procedures to protect people from avoidable harm and most had received appropriate training or were booked onto training. Most risks to people’s health were known by staff and these were reviewed regularly.

People received their medicines as prescribed and these were managed correctly. However, medicines given ‘as required’ did not always have the appropriate guidance or protocols that staff needed to follow.

Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. There had been improvements made to the cleanliness and décor of the home.

Safe recruitment practices were followed and only people suitable to work for the service were employed. Staff received an induction, training and appropriate support necessary to carry out their roles.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People’s weight was regularly recorded where needed. People received a choice of meals. People’s healthcare needs had been assessed. We observed healthcare professionals visiting people throughout our inspection and records we checked confirmed this was taking place regularly.

The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected. Best interest decisions had been recorded but records did not always show who had agreed these.

Staff were kind and caring when supporting people. Most care records were up to date and effective in meeting people’s needs.

People or relatives were involved as fully as possible in their care and support, however records checked did not always confirm this. There was a complaints policy and procedure available and complaints were responded to effectively. Information was available to inform people of independent advocacy services. There were no restrictions on people visiting the service.

People were supported to participate in activities of their interest. An activities coordinator led group activities which were run daily. Staff supported people with their goals and aspirations that promoted independence.

The provider had made improvements in monitoring the quality and safety of the service. Quality assurance audits had been recently introduced and were being reviewed regularly by the provider and registered manager. These needed to be sustained over a period of time to confirm their effectiveness.

The provider had sent out feedback surveys to clients, relatives and staff.

The provider was aware of their regulatory responsibilities.

Mulberry Court Care Home is a registered to provide personal care for up to forty three people. At the time of our inspection there were fifteen people using the service. Mulberry Court was newly registered in November 2015. People began using the service in early February 2016.

Mulberry Court Care Home is a two storey home situated in the middle of a housing estate in Bilborough, a suburb of Nottingham city. There are 43 single rooms with shared bathroom facilities. There is a communal lounge and separate dining room. There is a reminiscence area. Outside is a garden area but this is not yet fully accessible for people who live at the home.

At the time of our inspection, there was no registered manager in place. The manager of the home had applied to become the registered manager and was waiting for their registration application to be processed. 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 at the home told us they felt safe. Staff we spoke with could identify the different types of harm and knew how to raise any concerns.

The risks to people's health and safety were not always adequately managed by the service.

It was not clear whether people were receiving their medicines as prescribed, as accurate records regarding the administration of people’s prescribed medicines were not always kept.

The environment was not always clean and hygienic. We saw some of the seating areas were stained, and found waste bins with no lids. The bath and shower chairs were not clean and we saw a red dirty laundry bag left in the bathroom.

Not all staff had received the relevant training and support to enable them to meet people's care and support requirements. Staff supervisions had not yet been put in place where staff could discuss any issues they may have, and where they could review and agree their skills and development needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. The manager had submitted applications to the local authority for authorisation of Deprivation of Liberty Safeguards [DoLS] where it was identified this this was required for people who lack mental capacity. However, there was an inconsistent use and understanding of the MCA by the manager and staff.

People were given a sufficient choice of meals and drinks. Any potential risks around malnutrition were not always adequately assessed and acted upon. People did not always receive adequate support or supervision in relation to any risks at mealtimes, such as people who required prompts and encouragement to eat their meals.

A range of external health professionals were involved with people’s care such as GP’s, dentists, opticians, and the dementia outreach team when people had changing health conditions but staff did not always follow instructions and recommendations made by external health and social care professionals.

Some people had developed caring relationships with staff, but we observed other people received a more task focused approach with their support. Care planning documentation did not always evidence people's involvement in planning their care, and not all the people we spoke with felt they were involved in planning their care in a way that was personal to them.

People's dignity, privacy and respect was not always fully promoted. Some bedroom doors did not close properly, and we observed staff sometimes talking to people in front of others about things that were personal to people. Staff did not always ask people’s permission before providing their care.

People's records did not always contain enough information regarding their personal preferences and choices to enable staff to provide the care in a way that people preferred. People from different ethnic backgrounds did not always have their individual cultural needs met.

The provider had recently recruited an activity coordinator. Activities were being organised for people. Some people were being assisted to access the community.

There was a complaints procedure in place, but people told us that they did not know how to make a complaint. The service did not demonstrate learning from complaints.

People found the manager was approachable. Staff meetings and handovers were taking place.

Some quality audits were taking place, but these were not always highlighting, or taking forward some of the issues with the service.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.