Archived: Mayfair Residential Care Home Ltd

Mayfair Residential Care Home Ltd is a care home providing personal care to up to 20 older people, some of whom may be living with dementia. At the time of this inspection, 13 people were living at the service.

People’s experience of using this service and what we found

The service was not safe. Risks to people had not been assessed or recorded. Checks of equipment, maintenance checks and servicing had not been completed at required intervals. Where shortfalls had been found in relation to the health and safety of the service, action had not been taken to address this.

Medicines had not been administered or managed in a safe way. Safeguarding concerns had not been appropriately reported and thorough recruitment checks had not been completed prior to new staff commencing employment.

Staffing levels were not always sufficient which impacted on the quality of care provided. Staff had not been provided with sufficient support or training to ensure they had the skills and knowledge to carry out their roles.

Action had not always been taken to seek professional’s advice and support when people had lost weight or suffered a high number of falls. People’s care plans had not been updated to reflect people’s current needs, and end of life care plans only contained basic information. We have made a recommendation about end of life care planning.

There was a lack of activities and stimulation within the service. We have made a recommendation about activities. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice

There was a significant lack of provider oversight and leadership within the service. Quality assurance processes were either not in place or had not been completed for a considerable amount of time. The provider had failed to take action to ensure they were meeting regulatory requirements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 April 2020) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the lack of management oversight within the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

The provider acknowledged the significant shortfalls found during this inspection. They took action following the inspection to begin to address some of the shortfalls found. They produced an action plan and began to work with the local authority to make improvements.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayfair Residential Care Home Ltd on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to health and safety, assessing and managing risks, infection control, medicine management, recruitment processes, safeguarding people, nutritional needs, staff support and governance at this inspection.

You can see what enforcement action we took at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

• The service had measures in place to observe people and staff for signs and symptoms of the coronavirus. Both staff and residents had their temperatures taken daily and visitors were checked prior to admission into the service.

• All visits were escorted to ensure infection prevention and control procedures were followed. A separate entrance and exit were used for visitors, staff completed cleaning of all areas visited after visitors left the building.

• Staff supported people to communicate with their families. The service had recognised individual preferences of communication, such as; hand written letters, postcards and socially distanced visits outside the building. This reduce the risks of the virus being transmitted within the care home.

• The service had communicated well with people and their relatives, so they understood the current risks and were able to make informed choices.

Further information is in the detailed findings below.

Mayfair Residential Home is a care home providing personal care for up to 19 older people, some of whom may be living with a dementia related condition. At the time of this inspection the service was supporting 18 people.

People's experience of using this service and what we found

Since our last inspection the registered manager had been supported by two carers that had been promoted to senior management roles. Some areas such as infection control and fire safety had significantly improved. Other areas such as falls; medicines management; safety of equipment; records; quality assurance processes were still requiring further improvement.

Care plans were a working progress to include more detailed information to guide a consistent approach by staff to meet people’s needs. Some care plans were person-centred, but this was not consistent across all care plans. The provider advised these were being reviewed and updated to include more person-centred detail. The majority of staff knew people's needs well and how best to support them.

Risk assessments did not always include sufficient guidance for staff to mitigate risks to people's health and safety. Some risks had not been identified by the provider and assessed appropriately. Staff had not ensured people's medicines were always administered as prescribed and that sufficient stocks were in place. Records for topical medicines such as creams did not show they had been administered as prescribed.

The leadership and governance structures in place were not always effective in identifying areas that required further improvement.

Medicines had been monitored for their effectiveness and disposed of in line with best practice guidance. Infection prevention and control measures had been improved significantly and audits in this area were effective. People told us they felt safe and that staff worked well together to support them. Dependency tools were used to ensure staffing levels could meet the needs of people living at the service. These had been regularly reviewed and increased to meet people's changing needs. Staff respected people's dignity, privacy and encouraged them to be as independent as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported

this practice. Records were in place detailing those involved in making decisions relating to people's care and support needs. People were supported to access activities both in the service and outside in line with their hobbies and interests. A range of activities were available including exercises, quizzes and entertainers such as singers visiting the service. Staff supported people to access health care appointments as and when needed.

Feedback from people and their relatives was positive about the registered managers approachability and visibility within the service. Staff felt the manager was supportive and available to provide guidance to them when needed.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published July 2019) and there was a breach of regulation 17. This related to the governance of the service. We spoke with the provider following our last inspection and they provided regular actions plans, to show what they would do and by when to improve. At this inspection we found some improvements had been made. These were not sufficient to meet the breach of regulation 17 and a further breach of regulation 12 had been identified. This is the third consecutive inspection rated as requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: Work was still required to improve the staff and provider’s knowledge and practice in key areas such as medication, Mental Capacity Act 2005 where there is continued recommendations in this report. In addition, fire safety, infection control and risk management. Staff understood the basics around how to keep people safe. Information following accidents and incidents was not recorded to evidence action taken to reduce the likelihood of future harm. Systems to check that people were receiving safe and good quality care required further development.

The provider had worked hard since the last inspection to make changes that impacted positively on people’s experience of using the service. Staff understood the vision the provider had to ensure people received high quality person centred care. People said staff knew them very well, could anticipate their needs and that support was delivered in a timely way. People described good provision of activities and events that were tailored to their needs. People were supported to maintain relationships and afforded support to develop and build new relationships. People and their relatives described high levels of satisfaction with the service which impacted positively on their overall wellbeing. A relative told us, "It is a very warm place, not clinical. As you walk through the door it is a home. We feel as a family this is a home from home."

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 treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, this was carried out with compassion and dignity.

The environment enabled people to have time on their own and time with other people if they chose this.

The registered manager and management team were well respected. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to continuously improve the service.

For more details please see the full report either below or on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires improvement (Published 17 January 2018). The service remains rated requires improvement. This is the second time the service has been rated requires improvement. We will maintain contact with the provider until the next inspection to understand the action they are taking to improve the rating to at least good.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The Mayfair Residential Care Home Ltd is registered to provide residential care to up to 19 older people including people who are living with dementia. Residential accommodation is provided in an adapted building over five floors. A passenger lift is available. On the dates of our inspection there were 16 people who used the service.

At the last inspection, on 1 December 2015 the service was good. We made a recommendation in relation to one record which did not clearly show the service understood the reasons why a person was being lawfully deprived of their liberty.

At this inspection the service had 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 assessment monitoring and mitigation of risk towards people with regard to their support needs, the environment, medicines, and emergency planning was not robust. This meant people’s health and safety was at potential risk of harm.

Care files were inconsistent, with some documentation left blank or not updated in a timely way.

Effective management systems were not in place to safeguard and promote people’s welfare. There was a lack of robust audits and limited evidence of appropriate action being taken to improve the service.

Despite a previous recommendation the provider did not consistently apply the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We identified one person's mental capacity had not been assessed to determine whether an application was required to deprive the person of their liberty.

We made a recommendation that the provider develop their knowledge and understanding of the MCA and DoLS.

Staff showed a good understanding of the processes required to safeguard adults who may be vulnerable from abuse and they were able to explain to us what they would do if they had concerns.

People provided positive feedback about the food. The provider ensured people attended appointments with external healthcare professionals and appropriately sought advice and guidance to meet people's medical needs.

Robust recruitment practices were in place to ensure only suitable people were employed. We observed sufficient staff were deployed throughout the service to meet people's needs. Staff were well trained and received regular updates to enable them to develop their skills. Staff told us the manager was approachable and supportive.

People said staff were kind and caring. Staff had positive and meaningful relationships with the people they supported and they provided support in a compassionate and empathetic way. We observed people were happy, relaxed and content living at the service. People were supported to engage in a wide range of activities of their choosing and to access their wider community to enable them to have opportunities for social interaction and minimise risks of potential social isolation.

People we spoke with were complimentary about the management and staff of the organisation. We found no evidence of complaints being made to the service. People told us they could speak with the provider if they were unhappy about any aspect of their care and support.

We found the provider was in breach of three regulations relating to good governance, safe care and treatment and person-centred care. You can see what action we have told the provider to take at the back of the full version of the report.

People's care needs were assessed and care plans were drawn up which staff read and understood. Risks were considered to ensure people were protected from harm. Specialists were consulted to ensure people had the benefit of expert advice. Staff told us they communicated about people's care needs in meetings and at handover times between shifts.

People's capacity to consent to care and treatment was assessed and measures were in place to ensure people were not unlawfully deprived of their liberty.

Staff were suitably checked to ensure they were safe to work with vulnerable people. They had received training in safeguarding of adults and abuse awareness so that they knew who to refer to should they suspect abuse.

There were sufficient staff on duty at all times to ensure that people received the care they needed.

The home had systems in place to monitor and evaluate the quality of care so that the standard of service could improve.