Mulberry House

The service had received extensive support from the local authority and quality assurance team during the unstable period since the last inspection. This support had enabled the service to improve along with the service management team changes. The service was beginning to embed the learning and new systems with positive results for people. The management team were now working with reduced local authority support using effective new systems.

Although the quality assurance governance systems were new and had not yet had time to fully embed to show sustainability, the current management team had worked hard. They had ensured the breaches found at the previous inspection had been addressed with a more stable and supported staff group. The provider had put more effective and robust governance systems in place to improve their oversight of the service and the work of the home and area management team.

We saw examples of how the positive improvements had impacted on ensuring people's needs were well met. There had been substantial investment to further promote good quality care at Mulberry House.

People were safe at the service. Staff had been trained to safeguard people from abuse and understood how to manage risks to people to keep them safe. Risks had been identified and addressed to ensure people remained safe. Staff had up to date information and actions taken were reflected in daily records. The service was still being supported by the local authority and the processes and training to keep people safe were still new, they needed to be embedded to ensure people continued to be safe in the service.

There were enough staff to support people, with staffing levels regularly reviewed and increased in relation to people's dependency levels. The staff worked well as a team, including agency staff and were clear about what they needed to do. Recruitment checks had been undertaken to make sure staff were suitable to support people.

People chose to spend time in a choice of comfortable places, with staff supervision, if necessary. The provider had adapted the premises to meet people's needs, for example creating a homely library area, a room for family and friends to meet in, attractive outside spaces and a large, welcoming communal area.

The premises were clean and tidy. Staff followed current hygiene practice to reduce the risk of infections with effective systems in place, including a designated laundry person and new housekeeping team. Visitors to the service were given information to help them reduce the risk of catching and spreading infection. Health and safety checks of the premises and equipment were carried out at regular intervals.

Peoples' care and support needs were assessed prior to them using the service. There had been no new admissions since the last inspection. The peripatetic manager said care would be taken to ensure staff could meet peoples' needs before admissions in the future using a robust format.

Peoples' care plans set out for staff in detail how their needs should be met; all care plans had been reviewed and were up to date. Staff understood peoples' needs and how they should be supported with these. They received relevant training with ongoing competency checks to help them to do this.

Because staff had detailed and up to date information, they knew people's care needs well. People received personalised support based on their assessed needs and preferences. A range of activities took place and people were supported to maintain their relationships and interests.

Staff were calm, kind and respectful of people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to stay healthy and well. Staff helped people eat and drink enough to meet their needs, to take their prescribed medicines and to manage their healthcare conditions promptly.

People, relatives and staff feedback indicated that since the previous inspection there had been great improvement in the way the service was run. Staff approached us throughout the inspection to tell us how much the service had changed for the better.

People and relatives were satisfied with the quality of care and support they received. The managers reviewed accidents, incidents and complaints to identify how the service could improve further and had taken action based on peoples' views.

People were encouraged to have their say about how the service could improve and there was good communication. Resident and relatives' meetings had re-commenced alongside regular communication by telephone and email and a newsletter. The service worked with other agencies and healthcare professionals. We received positive feedback from visiting health professionals. The provider and management team had acted on their recommendations to improve the quality and safety of the service for people and had worked closely with the local authority and quality assurance team since the last inspection, thanking them for their support.