Archived: Mayfield Adult Services

Mayfield Adult Services is a residential care home and supported living service providing personal care to five people living with a learning disability at the time of the inspection. Three people lived in the residential care home and two in supported living. The service can support up to four people at the residential care home.

The supported living service was one house with shared lounge and kitchen. There were three bedrooms, with two people living there at the time of the inspection.

The care home accommodates up to four people in one adapted building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was located with other homes run by the provider, in a campus style and a rural location. This is not in line with current best practice guidance. However, the impact of the rural location was mitigated as staff ensured people accessed the community regularly. Due to the service being located with other homes, in the campus style, the home appeared large. However, its style was in keeping with other local properties. Staff wore their own clothes when supporting people so as not to draw attention to the property being a care home.

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

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion, as far as possible. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were safe and protected from abuse by staff who understood safeguarding and how to respond to any concerns. Risks to people’s safety and wellbeing were assessed and mitigated. Staff had a positive approach to risk, to ensure people lived full lives. There were enough staff available to support people. People were supported to take their medicines safely. Infection control was well managed. When things went wrong, lessons were learnt.

People’s needs were holistically assessed and planned for in-line with evidence-based guidance. Staff were supported with induction, training and regular supervision. Staff had specialist training to meet the needs of people. People were supported to eat a healthy balanced diet. Staff worked with other professionals to ensure people’s healthcare needs were met.

People were treated with kindness, care and respect. Emotional support was provided as needed. People were able express their views and make decisions about their day to day support. People’s privacy and dignity were respected. Staff sought to encourage and develop people’s independence.

People received personalised care. Staff knew people well and activities were tailored to their interests and preferences. Staff understood people’s communication needs and used specialist techniques. People felt able to raise any concerns they had and complaints were responded to in a timely way. People’s needs at the end of the lives had been considered.

There was a positive and person-centred culture. Staff were well supported by the registered manager and had positive working relationships with their colleagues. The registered manager understood their responsibilities under the regulations and duty of candour. People, staff and other professionals were involved in the development of the service. Quality assurance processes were used to audit and improve the service. Staff worked in partnership with other agencies and professionals.

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

Rating at last inspection

The last rating for this service was Good (published 19 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

We last inspected Mayfield Adult Services in June 2014. The service met all the regulations we checked at that time.

The service had 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.

During this inspection, we found the service was exceptionally well led and was very responsive to individual people’s needs, wishes and preferences. All people, relatives, healthcare professionals and staff we spoke with were highly positive about Mayfield Adult Services and its management and staff. The registered manager encouraged people to aspire and achieve their goals.

Staff involved people in designing their care plans. Care plans were personalised. Staff looked at people’s progress towards meeting their goals at regular key working meetings. People and their relatives said the quality of care at the service had significantly improved people’s health and well- being. Staff supported people through positive behavioural support which contributed to them experiencing fewer incidents of behaviour which challenged the service.

People accessed healthcare services, specialist advice and treatment when needed and had regular reviews of their health. There was very good communication between the service and health care providers in monitoring and responding to people’s health conditions. This led to fewer avoidable hospital admissions and an improvement in people’s health.

People were safe at the service. Staff understood their responsibility and followed safeguarding procedures to report any concerns to protect people from harm. Staff felt confident to raise any concerns and felt that they would be dealt with promptly.

Risk assessments were centred on the needs of the individual. People and their relatives worked in collaboration with staff and healthcare professionals to identify and assess risks to people’s health and safety. Staff managed risks to people appropriately without restricting their freedom.

Staff were competent to manage and administer people’s medicines safely. Medicines were stored, recorded and disposed of safely and accurately.

The service empowered and gave people choice about their care. People received appropriate support to make decisions about their care in line with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People took part in activities they enjoyed and received support to pursue their goals. People were supported to develop their daily living skills and to live an active life. There were positive and friendly interactions between staff and people. People were treated with dignity and respect.

People had sufficient food to eat and drink. Staff encouraged people to eat healthily and helped them plan and prepare meals. People received specialist advice about nutrition from healthcare professionals and staff supported them to follow the guidance.

The registered manager encouraged learning for people, their relatives and staff about health conditions which enabled them to respond effectively to people’s needs. Staff received relevant and specialist training on the care of people with autism and attended refresher courses when due.

Staff received regular supervision and appraisal to monitor their performance and professional development. The registered manager was available to people and their relatives. The provider safely recruited staff. People were involved in recruiting and induction of staff.

There was an open and person centred culture at the service that ensured effective communication. People, their relatives and staff felt able to discuss ideas and appropriately challenge the service to improve the quality of care. The registered manager sought people and their relative’s views and used their feedback to improve care.

The provider and registered manager carried out regular audits on all aspects of care. There was effective follow up action when necessary to ensure improvements were made.

People and their relatives understood how to raise a complaint and any issues were investigated fully and resolved. Staff followed the procedure on incident and accident reporting.

At the time of the inspection there were three people who lived at the service and two people who were supported with personal care who lived in the community in supported living accommodation.

Our inspection team was made up of one adult social care inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained in safeguarding adults and told us they felt confident about the action they needed to take if they had any concerns. There were comprehensive policies and procedures in place to safeguard people that used the service. We found that people were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. Risks to people who used the service had been identified and there was detailed information on how to manage and minimise them. Staff had been trained to support people in managing challenging behaviour.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff had been trained to understand when an application should be made, and how to submit one. We found that the staff understood the requirements of the Mental Capacity Act 2005 and carried out decision specific mental capacity assessments and best interest meetings when needed.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received the training they needed to meet the needs of the people receiving care. Staff had regular opportunities to discuss work related issues and to express their views. The staff we spoke with said they were supported in their professional development. One staff member said "I think it's one of the nicest places I've been to".

Is the service caring?

People were supported by committed and caring staff. We observed that people appeared comfortable in the home and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. Staff made good use of alternative forms of communication to support people in their involvement in the service and to encourage choice. People were treated with respect and dignity.

Is the service responsive?

People's needs were continually assessed and reviewed. Records confirmed people's preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people's wishes. People had regular review meetings with their keyworker to make sure that changes in needs were identified and action taken. Support was person centred and people's wellbeing and development was central to the ethos of the service.

Is the service well-led?

The manager of the service demonstrated a commitment to providing a service which was continuously improving and focussed on the people who used the service. There were a range of quality assurance processes in place to maintain standards in the service and make improvements where these were identified. We saw that staff and people who used the service were given opportunities to express their views and that these were acted on. Complaints were investigated and appropriate action taken to resolve them.