Mulberry Court

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Assessments of people’s needs were not comprehensive, and people’s care plans had not always considered the full range of people’s diverse needs, including psychological and emotional well-being. Different parts of people’s care and treatment were not efficiently coordinated to ensure consistently positive outcomes for them. The provider had not taken full responsibility for ensuring that care and support was coordinated, leaving it to other agencies or relatives to manage. People did not always have care plans to guide safe practice. Systems and processes for referring people to external services had not been applied consistently, and there was no clear strategy to maintain continuity of care and support. Staff had not always recognised and had not responded promptly and adequately to people’s changing needs. Systems and processes on how information was shared to ensure continuity of care and support were inconsistent and had not always been effective. Staff lacked the skills and guidance to coordinate care and support and had not always worked collaboratively with external stakeholders to understand and meet people's needs. Staff had received training in The Mental Capacity Act (MCA) but not always followed principles of a best interest process in accordance with legal requirements, when a person lacked capacity to consent to the arrangements for their care and treatment. Consent to care and treatment and subsequent best interest’s decisions had not been obtained in line with legislation and guidance. Staff had not fully understood or demonstrated a good working knowledge of the key requirements of the MCA.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received mixed feedback from people and their relatives about the coordination of care and support at Mulberry Court, and on how staff worked together with other health and social care professionals and with them to achieve their desired outcomes. Relatives told us: “Due to a difficult period of downturn, uncertainty and change at Mulberry Court in the past 6 months, I now spend more time in Dorset so that I can visit and support [my loved one] as much as I can. That has included me arranging a private [referral to healthcare professional] again, obtaining GP prescription for [a medicine] and liaising with the managers to ensure it is administered and chasing up for [my loved one] to have a visit from a [healthcare professional]“, “Communication has improved with contact details for 3 members of the senior team beyond the managers” and “I think [my loved one] is getting very good care. We are very happy with everything; they always act quickly to get an ambulance if [they] are unwell, and the staff always let me know.”

Staff told us they had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Staff felt communication, coordination and collaboration within the team and with external partners had improved in recent months with the change in management team. Comments from staff included: “There is good communication among all staff, family members and people we support. Since the previous manager left, I have gotten my love of my job back, I look forward to going to work and working alongside my peers and management team to improve the service on a daily basis”, “We established close working relationship with GP surgery. We have monthly visits from a nurse practitioner. Recently we requested medication review for everyone” and “We have regular chats with the diabetic nurses. We will have a telephone conversation and update them on blood sugar levels and what we can do to help people with maintaining healthy blood sugar levels.” The provider had processes in place to ensure there was effective communication and information sharing to help maintain continuity of care. Management told us: “Full preassessments are completed before residing at Mulberry and this includes a compatibility matching tool which ensures that any new individual will be a good fit for the service for their benefit and the benefit of existing residents” and “As we get to know the resident better the care plan is updated accordingly. We always seek advice and support from other agencies to ensure that the individuals' psychological needs are met. When a new referral is received, we use tools to ensure that there are no issues regarding compatibility. If it were to emerge that there was a significant issue within Mulberry Court, we would work very closely with the individuals concerned to resolve any issues and/or concerns and monitor the situation closely.”

We received positive feedback from health and social care professionals working with the provider about effective sharing of information from the staff team at Mulberry Court. Professionals told us staff knew people well and information they shared was clear and sufficiently up to date, so they could understand people’s assessed needs when reviewing care plans or records. They felt communication and partnership working had improved in recent months. Comments included: “A visiting health and social care professional told us: "The residents appear to be well looked after by the staff, from what I have seen the staff appear to be aware of potential risks and this has improved over the last couple of months with new managers. The are very welcoming, and obviously know the residents well” and “The experience I have with the staff at Mulberry Court is positive. There have been times that I have rung the home wanting to find out the wellbeing of my client, I have spoken to different staff, and all have been very professional. They have questioned me when l have rung for welfare checks asking me the right questions. They don’t just disclose information until they have ensured that they are talking to the right person.”

The provider had not taken full responsibility for ensuring that care and support was coordinated, leaving it to other agencies or relatives to manage. Care assessments did not always consider the full range of people’s diverse needs. Different parts of people’s care and treatment were not efficiently coordinated to ensure consistently positive outcomes for people. For example, we found conflicting information in people’s care plans on how to support their emotional well-being or what support they need in times of emotional distress. Care plans and risk assessments did not offer effective risk mitigation for incidents of miscommunication and emotional distress experienced by people. Overall impact and long-term effects of these incidents on people’s mental health and social interactions had not been considered. This put people at risk of not having their needs met and repeatedly experiencing such incidents in the future. Systems and processes for referring people to external services had not been applied consistently, and there was no clear strategy to maintain continuity of care and support. Staff had not always recognised and had not responded promptly and adequately to people’s changing needs. The provider did not make referrals for appropriate care and treatment at the right time, and people did not always have access to health professionals when needed. This was a repeated breach of regulation. When referrals to healthcare professionals were made, their instructions were recorded in people's care plans and communicated to staff. Recommendation for care and treatment by other professionals were carried out as directed.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

Formal feedback from people and relatives had been sought, however the results were not always used to make improvement. Relatives expressed their hope this would improve with the new management in place. Comments included: “We initiated a discussion with the previous manager in April, together with two other sets of [relatives] and the area manager because we all had concerns. At the follow up meeting in July [they] announced [their] departure, and we spent our time trying to discuss the interim management plans. A third meeting in September was held with [manager’s names]. Necessarily the staff had had their hands full with dealing with the fallout from the CQC inspection in March, so our original requests, though not ignored, were relegated to a degree. We anticipate a meeting in early December, though with a new manager we realise there may be some areas (structure, regular activities etc) that have not been established”, “We find that there is a variation in the quality of care. We ask that our [loved one] be kept fruitfully occupied but learn that whilst some staff do this other do not. [They] need to be motivated, with active care from assertive, kind staff rather than passive “safe” care. We simply want [our loved one] to be encouraged to live a fruitful and healthy life. [Their] genetic condition pre-disposes [them] to decline so we are keen to include anything which may mitigate this”, “I'd say [my loved one] is content but not fully occupied, and [they] need a sense of purpose. The new management say they'll be trying their best to make it better for [my loved one] and I really hope they will” and “We have been discussing with them about the mental well-being of the residents - as not only physical care is important but their mental stimulation is vital too. We have had discussions about the service they provide, and they have assured us they will be putting things in place as soon as the new management have settled in.”

We received mixed feedback from staff about outcomes for people using the service. Staff felt there could be improvements made to people’s experiences and their quality of life. Comments included: “For the most part people have good lives at Mulberry Court but I can't help feeling things could also be better. I feel I make their lives better by listening and respecting them and their needs and doing my best to bring a bit of fun and not to take things to seriously”, “Sometimes I wish we could support people more. The difficulties are though that people with such mixed abilities and needs and personalities are living together. Some people don't need as much support as others and we can't take them out as much or organise special trips for them as there isn't the time or manpower. So, they often listen to the radio in their room or watch TV”, “People’s care plans are currently being updated to be more in depth and person centred around the individual. This will further support staff to understand how to best support each person” and “I believe people receiving a service from Mulberry Court have a good life. We can all have bad days and so do they, but we all do all we can to support them through these. By giving choice, encouraging independence and having fun.”

Processes to monitor people’s care and treatment and their outcomes were not effective. Assessments of people’s needs were not comprehensive, and people’s care plans had not always considered the full range of people’s diverse needs, including psychological and emotional wellbeing. Staff were working with insufficient or conflicting guidance and had not been supported to effectively mitigate risks to people leaving them at risk of harm. When guidance was in place, it had not always been followed by staff. There was lack of consistency in the effectiveness of the care and support that people received. Expected outcomes were not always identified and people’s care and support were not effectively monitored, reviewed and continuously improved. This meant opportunities were missed to ensure consistently positive outcomes for people’s care and support that promotes a good quality of life. For example, care and support plans were not always updated to provide staff direction as to how to support them in times of distress. Information contained in people's care plans was not always clear and some information was contradictory. This was a repeated breach of regulation and placed people at risk of not having their needs met.

Relatives told us staff had not always understood or followed the principles of the MCA when supporting people to maintain their independence. Comments included: “[My loved one] has capacity to make some choices but not all. [They] can choose between having a yoghurt or cereal for breakfast. When it comes to what is in [their] best interests, [they] cannot always consider consequences. Some staff are able to appreciate this and present [them] with choices which are appropriate to [their] abilities and also healthy. Others are less able to encourage [my loved one] and are content for [them] to do little. Bathing alone was an example of supporting [their] independence. Because of [my loved one’s] condition [they] had no idea whether [they] had reached all parts of the body. We intervened when we noticed a grey and unwashed skin patch. This issue obviously relates to understanding people’s abilities and capacity to make choices for themselves.” Relatives told us they were involved in best interest decision meetings for their loved ones. Comments include: “There had been lots of trouble with [my loved one’s] finances. [They] just go out and spend all [their] money. Staff don’t stop [them] because they say it’s [their] right but [my loved one] don’t understand, [they] will have no money left. We did the best interest decision, and we’ve now got permission to support [my loved one] with their finances. I give them [their] budget every few weeks. I just wish staff would tell me when the money it is running low rather than wait until there’s nothing left” and “We had a meeting to agree a video monitor so that they can keep an eye on [my loved one] and keep [them] safe.” However, people’s views and wishes were taken into account when their care had been planned. People received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. Easy read format and pictures had been used for in capa

Staff told us they understood the importance of ensuring that people fully understand what they are consenting to and the importance of obtaining consent before they deliver care or treatment. Comments included: “People have a choice, information is given and explained and again they are listened to. Depending on capacity, people’s wishes, power of attorney etc, the service informs relatives of events and issues keeping them up to date about what is happening in their lives”, “We ensure people’s needs are taken into account by simply asking what they want. The majority of people at Mulberry Court can state whether they like something or not and what they'd like to do. For the ones that can't say what they want to do, their family members might support them in deciding on meaningful activities for them etc”, “I ensure that people’s needs and wishes are taken into account by regularly consulting their care plans and engaging with them directly to understand their preferences. I always take the time to ask individuals about their choices, such as what they would like to wear, eat etc” and “Ultimately, people have a choice in everything we do for them but occasionally we have to suggest what is in their best interests.”

Staff had not considered whether people had capacity to make particular decisions whenever this was necessary. Staff had received training in the Mental Capacity Act (MCA) but not always followed principles of a best interest process in accordance with legal requirements, when a person lacked capacity to consent to the arrangements for their care and treatment. Consent to care and treatment and subsequent best interest’s decisions had not been obtained in line with legislation and guidance. Staff demonstrated some working knowledge of the relevant legislation but lacked guidance on how to put these into practice effectively to ensure that people’s human and legal rights were consistently upheld and respected. For example, we reviewed MCA assessments and consents to care and treatment for 2 people. These assessments included acts intended to control or restrain. The subsequent best interest decisions had not been completed in line with the MCA. We found forms used were incomplete and did not clearly record how people were supported to make each specific decision about their care and treatment, or if they were deemed to have or to lack capacity to make each particular decision. MCA assessments did not determine if people understood information given to them, retained that information long enough to be able to make the decision, weighed up the information available to make the decision or communicated their decision in line with the MCA. The use of less restrictive options were not considered or recorded in the best interest decision process. We were not assured principles of MCA were fully understood and followed in line with the MCA assessment process. This meant people’s human and legal rights were not always understood and respected. This was a repeated breach of regulation.