Mulberry Court is a residential care home that was providing personal care and accommodation for 69 people aged 65 and over at the time of this inspection.

Following the last inspection, we met with the provider to confirm the providers action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive, and Well Led to at least good. However, we found at this inspection the provider had failed to achieve this.

People’s experience was poor living at Mulberry Court. There had been substantiated concerns from the local authority about neglect and acts of omission. The people who we spoke with did not speak very positively about the service. We had concerns that people were not always safe who were at risk of falls, those who were an unhealthy weight, and those who needed certain medicines. Staff did not always respond to safeguarding concerns in a safe way. People’s dignity and comfort was not always promoted. Staff did not engage with people in way which demonstrated that they knew the people they were looking after. There were no activities or events taking place to help people enjoy life at the home. The home looked tired and uncared for. The management team and the provider had ineffective systems or no systems at all to test and ensure that people were safe, well cared for, and led meaningful lives at the home.

The last rating of the home was Inadequate this report was published on 25 July 2018. For more details please see the full report on www.cqc.org.uk

We inspected in January 2019 because the home was placed in Special Measures at the last inspection which means we must return in six months to check the service again. We were aware before the inspection of concerns raised by other professionals.

Full information about the CQC’s regulatory response to the more serious concerns found at inspections and appeals is added to reports after any representations or appeals have been concluded.

The overall rating of this service is Inadequate and the service therefore remains 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.

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.

Mulberry Court is a Care Home. People in care homes receive accommodation and nursing or 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.

Mulberry Court provides personal care and accommodation for older people. Many people living at the home were living with dementia. Mulberry Court is registered to provide care for up to 84 adults. At the time of this inspection 75 people were living at the home. Mulberry Court comprises of a purpose built building offering accommodation over three floors. 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.

There was a registered manager in place. 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.

The local Clinical Commissioning Group (CCG), which is a group of health professionals who work for the NHS, recently shared their concerns they had about the home with us. At this time some people’s relatives had also contacted us and told us about the concerns which they had about the home. We looked into those issues during the inspection.

People did not have detailed and full risk assessments. With accompanying plans for staff to follow to ensure their needs were met in a safe way.

We observed staff supporting people to move in unsafe ways. Other health professionals told us that they had also seen this happen before. The leadership of the home were not fully responding to these concerns and looking at ways to prevent this from happening again.

Following a serious safeguarding incident and there was not a full investigation into what had happened to try and prevent it from happening again. We found that staff knowledge of how to protect people from harm was not complete.

There had not been an evacuation drill. Other systems were not in place to maximise people’s safety, if there was a need to evacuate the building in the future. Recently a person had gone missing when the alarms were activated.

We saw that staff were not always adhering to good infection prevention and control practices.

The management of the h

This inspection took place on the 18 January 2016 and was unannounced.

Mulberry Court is a residential care home that is registered to provide personal care to up to 83 people over the age of 65. At the time of our inspection there were 80 people using the service.

The service had a registered manager in post. 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 had care plans in place which were detailed and included information about their backgrounds, healthcare needs, likes and dislikes and interests. People and their relatives had opportunities to be involved in the planning and review of their care. Risk assessments were in place for individuals and the environment to help keep people safe from harm. People had enough to eat and drink and were provided with a balanced and varied menu. The service provided activities which kept people engaged and allowed them to pursue interests and hobbies where possible.

Staff had a good understanding of safeguarding and received appropriate training to enable them to keep people safe from risk of harm. They had received training that was appropriate to their role and were regularly supervised by management. Staff had opportunities to contribute to people’s care planning and the development of the service. Interactions between staff and people were positive and staff were knowledgeable about the people who used the service. Staffing levels within the home were appropriate to keep people safe. People provided consent to receiving their care and staff understood their responsibilities under the Mental Capacity Act.

Medicines were managed, stored and administered safely and people had access to relevant healthcare professionals where needed. The service had robust auditing systems in place and used these to identify areas for improvement and take appropriate action to resolve issues. Complaints were handled appropriately and meetings were held for staff, people and relatives to discuss matters concerning the service. Regular checks were completed to ensure the environment was safe.

When we visited Mulberry House on 18 September 2013 we spoke to four people who used the service and five relatives. We also spoke to nine staff members and the registered manager.

We found that the home had systems in place to gain and review consent from people who use services and acted on them. People were provided with sufficient food and drink to meet their needs.

People said that they were satisfied with the care they received from staff at Mulberry Court. They told us staff respected their privacy and dignity. One person said, "I’m well looked after.” A relative of a person who use the service said, “…is absolutely treated with respect. I’ve never seen anybody lose their patience, always in a good humour.”

We found that the home had systems in place to reduce the risk and spread of infection.

There were sufficient staff available with the appropriate knowledge and skills to care for people. Suitable arrangements were in place to ensure that the staff were appropriately supported to deliver care safely and effectively.

The home had systems in place to monitor and assess the quality of the care it provided to people to ensure it was safe and effective.

When we visited Mulberry Court on 20 November 2012 we found that most people were satisfied with the care and support they received. People looked at ease in the company of staff and told us the staff were friendly and supportive. One person said. "It's generally good here and they treat me well."

We observed that people were offered support at a level which encouraged independence and assured that their individual needs were met. People were supported to make choices about their every day lives and we observed staff were friendly and polite in their approach and interacted confidently with people. We noted that the midday meal service was relaxed and unhurried and people were enjoying appetising and nutritious meals.

People's care needs were clearly documented in a way which promoted personalised care and continuity of care delivery. People had been encouraged to express their views, and their personal preferences and choices were integrated into their care plans. Within the care files we saw that care documentation had been signed by the individual or a representative to confirm their involvement and agreement with their particular care needs.

On this occasion we did not speak with people who use the service about the way staff handle their medicines, as we were checking that the provider had made the improvements we had asked them to make following our previous visits to Mulberry Court.

We did not speak directly with people who live at Mulberry Court as the purpose of our visit was to look at how the service was progressing with the improvements in the home’s medication management systems that we had asked for following our last review.

On this occasion we did not speak with people who use the service about the way staff handle their medicines.

Most of the people we spoke with during our visits to Mulberry Court were satisfied with the care and support they receive. Comments included "I could have found a lot worse place than this", and "It's great, a fantastic place”. People told us that they feel respected by the staff, their privacy and dignity are upheld and they feel safe. They said that they like the building and their rooms, the home is kept clean and fresh, and most of the time the food is really good. People felt confident that they would find someone to talk to if something was not right.

People who live here, and some of the relatives we met, said how good most of the staff are. They used words such as “caring”, “patient”, and “well-trained” and told us that staff do their job well. One person told us that sometimes they have to wait for assistance if staff are busy with other people.

People told us they make choices about their daily lives, including what time they get up and go to bed, where they spend their day and what they eat and drink. They could not remember being asked to make decisions, for example about whether they want to look after their own medicines, whether they want someone to check on them during the night, or what should be in their care plan, but they were happy with the care they are given.

One person who was unable to move without assistance was rather isolated in a bedroom a long way from the lounge. Plates of partly eaten lunch were not removed until late afternoon, s/he could not reach the alarm to call for help and s/he had been left in a chair so that s/he could not see the television or out into the garden. However, this person said they were quite happy.