Archived: Mulberry Manor

We then inspected on 23 February 2017 to determine if improvements had been made. At this inspection the service remained in special measures, as we judged that although the service was overall rated requires improvement, the service remained inadequate for the key question of “Effective”. At this inspection we found some improvements and there is no key question rated as Inadequate so the service is removed from special measures. However, they remain in continued breach of three regulations in relation to how risks and medicines were managed at the home, how the provider ensured consent was legally obtained and the governance of the service.

The service had 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

Mulberry Manor is a 49 bed care home, providing personal care to older adults with a range of support and care needs. At the time of the inspection there were 25 people living at the home. The home is divided into two units.

Mulberry Manor is located in Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to public transport links.

The provider had safeguarding procedures and staff were aware of the procedures. Staff had received training and people were protected from abuse.

Systems were in pace to manage medicines safely. However, we found these were not always followed to ensure people received medications as prescribed.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, we found these were not always followed.

Staff we spoke with expressed concerns in relation to the overall leadership and management of the service, but said that they were well supported by the unit manager and deputy manager. They confirmed they received training that was required to fulfil their roles and responsibilities.

People who used the service, and their relatives we spoke with, told us they were happy with how the care staff provided the care and support. They spoke positively about the staff and told us they were caring.

The meals provided were well presented, nutritious and appetising. However, the meal time experience did not meet people’s needs who were living with dementia.

People did not always receive personalised care that was responsive to their needs.

At the time of our inspection we found there was sufficient staff on duty to meet people’s needs.

The service was clean. However, we identified some poor hygiene practice that put people at risk.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some records were well completed and clearly documented the decision being made. However, we found some people’s best interests were not always documented; this was identified on both units. If they were documented they did not always involve all relevant people and did not clearly detail the outcome. Decisions being made were sometimes very general and not specific.

People and the relatives we spoke with were aware of how to raise any concerns or complaints and felt listened to. Quality monitoring questionnaires were sent out and the responses had been collated with actions.

The provider had systems in place to monitor the quality of the service. The manager completed several audits such as medication, infection control, staffing, building and premises, and health and safety. We found that some audits had not identified the concerns we highlighted as part of our inspection.

We found three continued breaches and one additional breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this report.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. As we have judged that the service remains inadequate for the key question of “Effective” the home remains in special measures.

Mulberry Manor is a 49 bed nursing home, providing nursing and residential care to older adults with a range of support and care needs. At the time of the inspection there were 34 people living at the home.The home is divided into two discrete units, one being designated for residential care, and one for both nursing care and residential care, however, the provider told us just before the inspection that they intended to cease providing nursing care and was taking steps to assess how the five people who were receiving nursing care could have their needs met in the future.

Mulberry Manor is located in Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to public transport links.

At the time of the inspection, the service did not have 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 and associated Regulations about how the service is run. The home’s manager had applied to register with the Commission and at the time of the inspection the Commission was assessing this application.

Mulberry Manor is a 49 bed nursing home, providing nursing and residential care to older adults with a range of support and care needs. At the time of the inspection there were 40 people living at the home.The home is divided into two discrete units, one being designated for residential care, and one for nursing care.

Mulberry Manor is located in Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to public transport links.

At the time of the inspection, the service did not have a registered manager. The previous manager had left their post around six weeks prior to the 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 and associated Regulations about how the service is run. A new manager had been appointed but they had not yet applied to register with the Commission.

We observed while most staff were kindly in their interactions with people, they often had to work in a task- based way, meaning that they did not always have the time to provide people with the informal support that they needed. On occasion we observed that staff failed to uphold people’s dignity or treat them with respect. There were no arrangements in place to enable people to be involved in making decisions about their care.

Staff had received training in relation to safeguarding, although it was not clear whether this training had been effective as the provider had failed to recognise, or act appropriately upon, incidents of abuse or suspected abuse.

Medicines were not safely managed, and there was no evidence that staff who administered medicines had been assessed as competent to do so. Stocks of medicines did not tally with records, and where people required medication on an “as required” basis, there was little guidance for staff to follow.

Where people were at risk of malnutrition or dehydration, the provider had failed to take adequate steps to minimise these risks, putting people at risk of harm.

The arrangements in place for obtaining and acting in accordance with people’s consent did not meet legal requirements. There was little evidence of best interest arrangements being pursued where people lacked the capacity to consent, meaning that decisions were made for people without appropriate legal processes being followed.

Where people’s needs changed, their care was not amended to reflect this. The provider had failed to identify people’s needs, and care records were poorly kept and at times absent.

The arrangements in place for monitoring the quality of the service were not robust enough to identify or address shortfalls in service quality. Some aspects of the service were not monitored at the provider’s own required frequency. The systems in place for improving the service people receive were inadequate.

The provider had failed to make several, legally required, notifcations to the Commission, and the lines of responsibility for doing this had been unclear for a period of time preceding the inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.