Mulberry Court Care Home

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service promoted a proactive and positive culture of safety based on openness, learning, and improvement. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff said they felt comfortable raising issues and told us that incidents were discussed at team meetings. Team meeting notes showed communication of learning from incidents and staff had also completed reflective practice forms in relation to the recent prevention of future death report.

A duty of candour policy and an accident and incident policy were in place and accessible to staff. Incident forms were completed and analysed for themes.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People experienced safe care, with effective systems for managing risks and transitions. Referrals to partners were made in a timely way. Systems were in place to provide information to healthcare partners in the event of an emergency admission to hospital.

Care plans were reviewed if people’s needs changed following discharge from hospital. Care records included information from hospitals to support these reviews.

A residents’ guide provided information to people who used services on what to expect in relation to their move into the home to support them.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty Safeguards (DoLS) applications were made, however monitoring systems were not well developed and one application to renew an authorisation had been made just after the authorisation had expired. The home had relied upon local authority prompting for these renewal applications which had been effective in other instances; however, the registered manager told us that a formal system to track the progress of DoLS applications would be put in place.

Most people raised no concerns about their family member’s safety. A relative said, “My mind is so at peace, I don’t have to worry about [my family member].” Another relative said, “I can sleep at night knowing my [family member] is in good hands.” A third relative said, “There’s always someone there to keep people safe.” However, one relative said, “I’ve not got peace of mind about [family member] so come most days for a few hours, as I just feel I need to keep an eye on [them].” They also raised concerns about moving and handling incidents at the home. We did not observe unsafe moving and handling practices during our assessment; however, we shared the information with the registered manager to investigate further. Following our visit the registered manager informed us that due to a lack of specific information they had been unable to investigate further but had introduced additional moving and handling competency assessments for staff going forward.

Information was available to people who used the service and their relatives on how to report abuse and most relatives told us they were comfortable raising concerns with staff and were confident action would be taken.

Staff had completed safeguarding training and knew how to report abuse and were confident to do so. Safeguarding policies were in place. Referrals were made to the local authority where required and notified to the CQC as appropriate.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments and care plans were in place to manage risks and some involvement of relatives was seen in care planning.

Staff completed training regarding the management of risks including pressure care, choking and moving and handling. Policies were in also place to provide guidance on potential risks including bedrails and falls.

Staff received alerts when specific interventions needed to be completed to ensure they were carried out as assessed to manage risk. For example, where people needed repositioning, alerts were sent prompting staff and if these were not completed as expected these alerts were forwarded to the management team for their attention. Records we looked at confirmed people received appropriate care interventions when needed.

Staff were knowledgeable of people’s individual risks regarding nutrition and hydration, and systems were in place to ensure effective communication of these risks. A relative said, “All the food is to the correct consistency and their drinks are thickened.”

A policy and training were in place regarding responding to distressed behaviour and documentation was completed in relation to this to learn from any incidents. During our review of medicines, we saw no evidence that medicines were being used to control behaviour and alternative approaches were used to support people in distress.

Systems were in place to ensure equipment and the premises were monitored as required. However, we identified several concerns with the environment including poorly functioning doors and windows that could not be fully closed.

The environment was not fully adapted to meet the needs of the people living there. Limited adaptations had been made to support people living with dementia with no directional signage to support people to move around the home independently and armchairs in the lounge were positioned in a line which did not create a relaxed, informal and inviting atmosphere for people to enjoy. There was limited stimulation available other than a television. There was a consistent noise throughout the home due to staff setting off movement sensors each time they went into a person’s room which contained them. The registered manager told us that staff were not taking appropriate action to ensure this did not happen. They stated that they would address this with staff.

Environmental risk assessments were in place and servicing of equipment and utilities were taking place in line with requirements. Health and safety policies were in place and staff completed health and safety training.

The provider made sure there were generally enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, a significant number of staff had not received an annual appraisal, and the provider was recruiting additional staff to support the provision of activities for people to participate in.

One relative was concerned about staffing levels and the language proficiency of some staff. They said, “There’s definitely not enough [staff] on the first floor and at weekends, it’s terrible. There’s one male carer who doesn’t even speak English - staff have to ask him in his own language to do a task. There are language barriers too with so many foreign staff - some don’t speak good English or slowly for [family member] or the other residents to understand their accents.” However, no one else we spoke with raised concerns in this area. A relative said, “I’d say there’s enough [staff] from what I see.” Another relative said, “There seems to always be staff around down here.”

A dependency tool was used to inform decisions about staffing levels, and the home was currently staffed above those levels. However, the provider was recruiting for additional activities staff to improve activities provision. Staff felt sufficient staff were on duty, which included kitchen, laundry and maintenance staff, though one staff member felt that it would be useful to have a cleaning staff member on duty after 2pm. Call bell response times were monitored.

Staff were safely recruited. Professional registrations were monitored to ensure clinical staff remained registered.

Staff felt supported and received induction, training and supervision and records supported this. The registered manager gave staff example scenarios to respond to which allowed them to identify where additional training may be required.

However, most staff had not received an annual appraisal in line with the provider’s policy. The registered manager was currently responsible for the appraisal of all staff. They confirmed that they would review this to ensure that appraisals were shared out to more staff to ensure all staff received an annual appraisal.

Risks of infection were not fully managed and controlled.

Systems were in place to maintain and monitor cleanliness including cleaning schedules and an Infection, Prevention and Control (IPC) audit. However, cleaning schedules were not fully completed, and the IPC audit was not sufficiently detailed or effective to identify and address the concerns we saw during our inspection. This included some unclean pressure cushions, cushions and mattresses. These were immediately removed for cleaning by staff when it was brought to their attention. Staff did not dispose of gloves and other waste in line with IPC policies. The internal courtyard was untidy, and animals were being kept in an unclean and unsuitable environment. Staff immediately cleaned this area when it was brought to their attention and the animals have been re-homed.

Relatives’ views were mixed on whether the risks of infection were being minimised. A relative said, “[My family member] smells of urine, sweat, greasy hair. Bedroom smells.” Another relative said “The home is clean; [Family member’s]’s room is spotless. Laundry comes back lovely.” Another relative said, “It’s a clean home.” Another relative said, “[Family member’s] room is modern, kept nice and there’s no bad odours.” We discussed the showers with the maintenance team who told us that there had been a water pressure issue with a shower but temperatures had not been affected. We checked documentation which confirmed this.

Staff had completed IPC training and IPC policies were in place.

Medicines were managed safely and effectively.

A relative said, “They’ve reduced [family member’s medicine] now, so they look better and isn’t as stooped since they came here.” Another relative raised concerns about the number of medicines their family member was taking, however, we saw that this had been reviewed regularly by the GP. A professional commented, ‘Medication changes are always chased up following our reviews with consultant psychiatrist and if there are any concerns, staff will contact for us to come and review.’

Staff received training and their competency was assessed. Medicines policies were in place. Medicines were administered safely including time-sensitive medicines. Medicines were stored appropriately.

Medicines audits were completed; medicines errors were investigated and lessons learned shared with staff. This helped to identify and reinforce good practices in medicines management.

Systems were in place to monitor medicine reviews and when covert medicine use required review. Decisions around covert medicines were made following GP involvement and completion of appropriate paperwork, however, the provider’s audit had identified that pharmacist advice had not always been received so actions were being taken to address this.