Following the last inspection in February 2018 when the service was rated as inadequate overall, we met with the provider and asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well Led to at least good.

At the last inspection we found an inadequate level of leadership at the home, fire safety checks were not complete, plans to promote people’s safety were also not complete. Safety checks on new staff to ensure they were safe to work at the home were not taking place. There were low levels of staff on shift. Staff were working long hours despite supporting people with high needs and often with low staffing numbers. Staff training was not effective. There were institutionalised practices in relation to people having drinks. Healthy food was not available. People whose weight was low were not being supported to increase their weight. The environmental condition of the home was poor. People were not being supported to explore their interests. There were no regular social events taking place. The provider was not completing meaningful and effective audits.

We inspected the home again six months after the report was published. We found some improvements had been made. However, there were still areas which required further work. Where improvements had been made further time was needed to see if these improvements were effective, sustained and embedded into the culture and practice of the home. Further work was also needed in terms of the culture of the home.

The overall rating for this service is now ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This service has therefore remained in special measures.

When we inspected the service on 11 October 2018 we rated the service as ‘Requires Improvement’ overall. This inspection was unannounced.

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 House provides personal care and accommodation for people who have a range of learning disabilities. Mulberry House can provide care for up to 8 adults. At the time of the inspection 8 people were living at the home. Mulberry House comprises of accommodation over two floors.

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy. However, some progress had been made to start to develop the service in line with these values.

There was not 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 provider was recruiting for this post.

At this inspection we found some unsafe practices in relation to how infection control was managed at the home. The storage and disposal of people’s medicines were not always being managed appropriately. People’s safety in and outside the home was not being consistently promoted by staff actions and by effective risk assessments and plans. Incidents, accidents, and a safeguarding event were not always be

We inspected this service in January 2016 and rated the home as Good overall. When we inspected the service on 1 and 2 February 2018 we rated the service as Inadequate overall. This is the first time Mulberry House has been rated as Inadequate overall. This inspection was announced the day before we visited. This was to ensure a member of staff would be present to let us into the 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 House provides personal care and accommodation for people who have a range of learning disabilities. Mulberry House can provide care for up to 8 adults. At the time of the inspection 8 people were living at the home. Mulberry House comprises of accommodation over two floors.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

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.

When we visited the home we found there were issues with how the service promoted people’s safety. Timely action was not taken to repair some fire safety equipment. Checks to ensure people were safe in the presence of staff were not always completed or in a robust way. There was a lack of clear leadership at the home. Posts relating to the leadership of the service remained vacant with no plan in place to respond to this issue.

The provider (owner) had not responded in a timely way to requests from the registered manager about making improvements to the home. They did not show a commitment to help the service to make improvements. The building looked uncared for in places. There were delays in making real plans to improve the home. This made us question how the provider valued the people living in the home.

The quality monitoring audits were not robust. We had not always been informed about the important events which we should be notified about, by law.

Staff did not receive competency checks to ensure they had the skills and knowledge to do their work. Staff were critical in how their training was delivered and the registered manager and provider were not checking if the training was effective. Not all staff received regular and complete training.

There was a lack of activities which people engaged with at the home, although the home was starting to work on this issue. There were no planned events and people were not being supported to realise their ambitions and interests.

These issues constituted a breach in the legal requirements of the law. There was a breach of Regulation 12, 19, 18, 10, 9, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a breach of the Registration Regulations (18). You can see what action we asked the provider to take at the back of the full version of the report.

Staff did not have a clear understanding about the process they could follow in reporting potential abuse and harm outside of the home. Staff also did not know how to fully respond if people experienced discrimination. There were no clear systems in place to support staff to respond to these potential situations which also promoted people’s rights at the home.

People received their medicines as prescribed and people were supported to access h

This inspection took place on 15 December 2015 and was unannounced. When we last inspected the home in September 2013 we found that the provider was meeting the legal requirements in the areas that we looked at.

Mulberry House provides accommodation and support for up to eight people who have a learning disability or physical disability. At the time of this inspection, there were seven people living at the home .

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.

People were safe and the provider had systems in place to protect them from harm. Medicines were stored safely and administered by staff who were trained and competent to do so. The service supported people to access healthcare services and worked closely with external professionals. People were encouraged to eat a nutritious and varied diet and were able to contribute to menus with their individual choice of food and drinks. People had a range of activities inside and outside of the home and were supported to pursue their interests and hobbies. People were asked to contribute towards reviews of their care and knew how to make a complaint if required. People were treated with dignity and respect and consented to their care and support with the service.

Staff received training which was relevant to their role. They understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff were caring and knowledgeable about people being supported and contributed to the development of the service. Staff did not always receive appropriate levels of supervision.

The service had quality assurance systems in place which identified improvements that needed to be made. People were positive about the management of the service and felt supported. The service had worked with the local authority to improve upon areas identified as not fully meeting the required standards.

We carried out an inspection of Mulberry House on 18 December 2013 and found that they were not meeting all the regulations that we inspected. The home provided us with an action plan and we re-inspected the home to confirm that the changes had been made to meet the regulations.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

We found that the home was meeting all areas.

If you wish to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. The home had been well maintained. There were enough staff on duty to meet the needs of the people living at the home and a senior member of staff was available to provide support. Staff we spoke with told us that the home was ‘doing well’, and staff were ‘able to get involved’ with the planning of care. One staff member told us that the best thing about the home was ‘the way we care for people’. We could see whilst at the service that people were happy and enjoyed the company of the care staff.

Is the service effective?

When we entered the home we were approached by people living in the home, they were keen to tell us about the home and their past experiences. We noted that another person was waiting to go out with a staff member but was worried about money and staff were spending time reassuring them. One person we spoke with said that they regularly spent time with the care staff and enjoyed it. We observed that people were singing in the communal seating area and staff encouraged them and joined in. We observed that people were happy and even those who were in their rooms were also regularly involved in conversations and staff spent time with them. From reviewing the care documents and observing staff with people we saw that they had a good understanding of the people’s care and support needs.

Is the service caring?

People were supported by kind and caring staff. We saw that staff encouraged people to sing and enjoy themselves and also participated with them. Staff spent time with people in their rooms and when asking questions waited patiently for responses. We saw one person was sitting in their room and the lighting was dim so they were straining to read. We observed that staff entered the room after gaining permission and then asked the person if they would like the lights on so they could see better. Staff did not just switch the lights on without asking. Staff told us that they provided people with person centred care. We observed that care staff were patient with people.

Is the service responsive?

Care plans were regularly reviewed and updated according to the person’s needs. Each care document provided staff with clear information about the person and the care they required. Staff told us that since the care documents had been updated ‘grey areas were now being picked up’ and that the care plans ‘help us to get to know the clients better’. Staff were aware of people’s needs and preferences and acted in accordance with their wishes.

Is the service well-led?

Staff told us that the home had ‘come on loads’ since the last inspection. We were told that care staff were ‘able to get more involved’ with the care planning. Staff told us that the management of the home was supportive and proactive. We were told that staff were encouraged to ‘speak out’ if there was an issue and that the manager ‘always listens’ and acts on the concerns raised by staff. For example we were told that staff asked for the carpets for the communal lounge to be replaced because they were worn and dirty and the manager arranged this. Staff told us that they enjoyed working at the home and were given time to spend with people.

When we carried out this inspection of Mulberry House on 18 December 2013, we met five of the seven people who used the service, and spoke with three of them. People looked happy and well cared for, and there was a relaxed atmosphere in the home. One person spoke with us about the carol singers that were due to visit later that day, whilst another was waiting for a family phone call to take place.

The provider employed 10 staff in this home, and we noted from records that recruitment processes were robust, and appropriate checks were undertaken to ensure they were suitable to work in this environment.

We noted people who used the service were encouraged to make choices about how they spent their time, and where able, people consented to the support they received. However where people lacked the capacity to make decisions, this had not been formally assessed.

There were care plans in place, however due to the transition to new documentation, these were inconsistent and could be confusing for staff. However the staff that we spoke with were knowledgeable about the people they supported, and knew how to meet their needs safely.

We found that people received their medication as and when it was required, however where topical medication was prescribed, there were no records to confirm they had been applied appropriately.

The quality and safety monitoring systems were insufficient to ensure all areas of risk were swiftly identified, monitored and managed.

We visited Mulberry House on 20 December 2012 to review the improvements that had been made in response to compliance actions imposed in October 2012.

We looked at records relating to complaints and safeguarding, and spoke with staff about the systems that were in place to protect people in this regard.

We found the provider had reviewed their systems and made changes to strengthen the existing processes to protect people. These changes had been clearly communicated to staff, and we could see from the financial records of people using the service and the complaints file, that staff were following new guidance and these changes had been effectively implemented.

We carried out this inspection at Mulberry House on 29 October 2012 in response to concerns raised with CQC via our website. We used different methods, such as observations, to help us understand peoples' experiences. This was because some people had complex needs which meant that they were not able to tell us about their experiences. We spoke with six of the eight people living at Mulberry House and found they were happy with the care and support they received. One person told us "It's nice living here, it's changed my life".

There was a relaxed atmosphere in the home and people were at ease in the company of the staff supporting them. The staff were friendly and polite in their approach and interacted confidently with people.

We observed some positive interaction between care staff and people using the service, which showed that staff understood the needs of the people they were supporting. We saw that people were offered support at a level which encouraged independence and ensured their individual needs were met. One person told us "The staff look after me well, They have taught me a lot of things since I have been here."

The provider had appropriate policies and procedures in place, however with regards to safeguarding they had failed to report matters consistently, or maintain clear financial audit records. With regards to concerns and complaints we found there were no records to show how these matters had been investigated or resolved.

The people who were living at Mulberry House when we visited on 11 April 2012, had varied levels of verbal communication, however they were all able to demonstrate through speech, facial expressions and gestures that they were satisfied with the care and support they received.

People told us that they liked the staff that looked after them and we observed that they were relaxed and comfortable in the company of the staff who were kind, patient and respectful in their approach when delivering care and support.

We observed that people were encouraged to make choices about all aspects of their lives, including how they spent their time.

Meetings were held each month for people in this home to attend, and they were encouraged to share their views and ideas about all aspects of life at Mulberry House and how it could be improved. This forum was also used for information sharing and planning group activities such as holidays.

The people who were living at Mulberry House when we visited on the 24 October 2011 had varied levels of verbal communication, however they were all able to demonstrate through speech, facial expressions and gestures that they were satisfied with the care and support they received.

People told us that they liked the staff that looked after them and we observed that they were relaxed and comfortable in the company of the staff who were kind, patient and respectful in their approach when delivering care and support.

We observed that people were encouraged to make choices about all aspects of their lives, including how they spent their time, however we noted that this was not always achievable for everyone due to insufficient staffing at some times during the day.

Meetings were held each month for people in this home to attend, and they were encouraged to share their views and ideas about all aspects of life at Mulberry House and how it could be improved. This forum was also used for information sharing and planning group activities such as holidays.