This comprehensive inspection took place on 13 November 2018 and was unannounced. The last inspection of the service was on 18 April 2016 when we rated it good for each of the five questions we ask.

Dimensions The Mulberries 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. The service provides care and accommodation for seven people with complex needs, including physical and learning disabilities. When we inspected, four men and three women were using the service.

The service was a purpose built building with seven single rooms and shared communal areas, bathrooms and toilets. There was an enclosed garden area where people could spend time safely.

The service had a registered manager who was on maternity leave at the time of this 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 2008 and associated Regulations about how the service is run. The provider had informed CQC of the registered manager’s maternity leave and the arrangements they had put in place to manage the service in their absence. The acting manager told us they had received their Disclosure and Barring Service check through the Care Quality Commission and planned to apply to register as the manager of the service.

The provider had systems in place to protect people from abuse. They assessed possible risks to people and acted to mitigate any risks they identified.

There were enough staff to meet people’s care needs and the provider carried out checks on new staff to make sure they were suitable to work in the service.

People received the medicines they needed safely and as prescribed.

The provider had a policy and procedures for staff on the prevention and control of infections.

The provider kept a record of accidents and incidents that affected people using the service and acted to make sure accidents did not reoccur.

The provider and staff in the service delivered support to people in line with best practice guidance and current legislation.

Support staff working in the service completed training the provider considered mandatory.

Staff knew people’s food preferences and prepared meals accordingly. Where people needed a special diet, for example pureed food, staff worked with the dietician and speech and language therapist to provide this. Our Short Observational Framework for Inspection (SOFI) observation showed people had a positive experience at lunchtime.

Dimensions The Mulberries is a purpose-built, single-storey home that is fully accessible to people who use a wheelchair.

The acting manager was aware of their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

The service’s end of life care policy was reviewed by the provider in May 2017.

Staff treated people with kindness, compassion and respect.

Staff knew people’s care and support needs well and had developed trusting relationships with people, their families, friends and other carers.

People’s individual expressions of choice were respected and their privacy and dignity were promoted.

People and their families or representatives were involved in developing and reviewing people’s care plans.

The service worked with people and their families to establish and promote how people expressed their preferences and choices.

Staff supported people to access a variety of activities at home and in the community.

The provider encouraged people’s relatives to raise concerns and responded to these appropriately.

Staff and the relatives of people using the service told us they felt the service was well managed and th

This inspection took place on 18 April 2016. We gave the provider short notice of the inspection because the location was a small care home and we needed to be sure the registered manager and people using the service would be in.

At our last inspection in May 2015, we found two breaches of the Regulations as the provider was not informing the local authority or the Care Quality Commission (CQC) of possible safeguarding incidents involving people using the service. At this inspection, we found the provider had addressed the issues we raised and made improvements.

Dimensions The Mulberries is a care home for up to seven people with a learning disability. When we inspected, six people with a learning disability, physical disability and complex needs were using the service.

The service had a registered manager who was appointed in October 2015 and registered by the Care Quality Commission in February 2016. 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.

There were enough staff to meet people’s needs and the provider carried out checks on staff before they worked with people using the service.

People received the medicines they needed safely.

The provider had supplied new equipment, redecorated and refurbished parts of the service.

Staff had the skills and knowledge they needed to support people.

The provider and registered manager acted within the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People had access to the health care services they needed.

People’s relatives told us people were well cared for in the service.

Staff treated people with kindness and patience knew people’s care and support needs well.

The provider produced information for people using the service in a format they could understand.

People’s care and support was individually provided, based upon their needs and preferences.

Staff encouraged and supported people to engage in social and recreational activities.

The provider made information available to people using the service and their relatives on how to make a complaint.

The provider had appointed a full-time manager who had registered with the Care Quality Commission.

The provider and registered manager completed audits to monitor the service and identify areas of improvement.

The registered manager, deputy manager and staff carried out regular maintenance and safety checks.

We last inspected the home on 15 May 2013. We found that the service did not maintain accurate and up to date records. The provider told us that they would make the necessary improvements to records by 16 August 2013. We carried out this inspection visit to check this. We found that record keeping had improved.

The people who use the service were non-verbal in their communication. We observed staff being polite and courteous with people, where they understood the different ways that people communicated their needs, and they addressed these promptly. We also contacted health and social care professionals who were involved with people who use the service.

However, we identified that the staffing of the service was minimal and meant that care staff were often directed away from their care responsibilities to carry out cleaning duties.

This inspection took place on 19 and 27 May 2015. We gave the provider short notice of our visit on the 19 May as the service is small and we needed to make sure people and appropriate management staff were available. We arranged with the acting manager to return on 27 May to finish the inspection. We last inspected the service in May 2013 when we found the service was meeting four of the standards we inspected. We did identify some improvements were needed to the service’s record keeping systems.

Dimensions The Mulberries provides accommodation and personal care for up to seven people with complex needs. When we inspected, six people with learning and physical disabilities were using the service.

The service has a manager who is registered with the Care Quality Commission. A registered manager is a person who has registered with the CQC 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 inspected, the registered manager was on maternity leave and the provider had arranged for management cover to be provided.

We found two breaches 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 back of the full version of the report.

People using the service may have been at risk of receiving care or support that was inappropriate or unsafe, as the provider did not report possible safeguarding incidents to the local authority or the Care Quality Commission.

The premises did not meet people’s individual needs. Equipment and facilities had been out of use for extended periods and parts of the service had limited space to provide support for people using manual handling equipment.

The provider assessed risks to people using the service and others and support staff had access to guidance on managing identified risks.

Where people were not able to make decisions about the care and support they received, the provider acted within the law to make decisions in their best interests. The provider met the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Support workers treated people with kindness and patience. They gave people the support they needed promptly and efficiently and individuals did not have to wait for staff to help them.

The provider produced all care planning and risk management documents in easy read formats to make the information easier for people using the service to understand.

People’s relatives commented positively on the care and support their family members received. They told us they were involved in reviews of their family member’s care and support plans and met with the manager regularly.

People’s relatives described the provider as “very caring” and “an organisation that listens.”

Staff described the organisation as “a good employer” and “open and supportive.” Staff also told us they found their managers supportive.