Archived: Mayfair Residential Home

•Mayfair Residential Home is a care home registered to provide personal care and accommodation to up to 16 people. The home specialises in the care of people who have mental health needs. At the time of the inspection 13 people lived at Mayfair Residential Home.

People’s experience of using this service:

•Some staff had not been provided with safeguarding training and risks to people had not always been assessed, monitored or reviewed. Where risks to people were identified, detailed management plans were not always in place and people were not always protected from environmental risks. The provider did not keep any records of legionella testing in the home even though there were several unused water outlets.

•Safe practice was not followed to ensure people’s medicines were safely administered. The provider did not have a competency assessment process to determine if staff were competent to administer medicine safely. Staff told us they did an on-line training module and that was not refreshed once completed.

•The home was not clean or well maintained. Toilet seats were broken and coated in faeces. People did not have working showers in their rooms. People told us, “No, it’s (the home) not cleaned enough. I can’t remember when they cleaned my room”.

•There were not enough staff to meet the needs of the people living at Mayfair Residential Home. Recruitment processes did not minimise the risk of employing unsuitable staff.

•Staff did not have a clear understanding of the Mental Capacity Act, (MCA). The provider had not completed specific capacity assessments for people.

•People were not always fully involved in their care and support. Care plans were not person-centred and lacked information about people’s needs, wishes and preferences and confidential information was not stored securely.

•The provider had not ensured there was an effective management structure in place to monitor the care provided. They had also failed to ensure staff were given the support they required to provide safe, effective, responsive care.

•We saw some positive interactions during the inspection, with most staff being kind and friendly when supporting people.

•The provider was trying to make improvements with limited resources available. Following the inspection, the provider sent us an action plan of how the planned to improve the service.

More information about the detailed findings can be found below.

Rating at last inspection:

•At the last inspection the service was rated as Requires Improvement (May 2018). At this inspection we found the service had deteriorated in several areas. The home has therefore been rated as inadequate overall.

Why we inspected:

•This inspection was a scheduled inspection based on the previous rating and aimed to follow up on concerns we found in May 2018.

Enforcement

•During the inspection we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk from harm because the provider’s actions did not sufficiently address the ongoing failings.

•Full information about CQCs regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

•Ensure that the provider found to be providing inadequate care, significantly improves.

•Provide a framework within which we use our enforcement powers in response to inadequate care, and work with, or signpost to, other organisations in the system to ensure improvements are made.

•Provide a clear timeframe within which the provider must improve the quality of care they provide, or we will seek to take further action, for example cancel their registration.

•If the provider does not demonstrate enough improvement is made within this timeframe, and there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service.

•This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

•Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the rating of this service improves to at least Good.

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

Mayfair Residential home 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 Mayfair Residential Home is registered to accommodate up to 16 people. The home specialises in the care of people who have mental health needs. The home does not provide nursing care. At the time of the inspection there were 14 people living at the home.

At the last inspection of the home in May 2016 the service was rated Good. At this inspection we found that improvements were needed in a number of areas. The home has therefore been given an overall rating of Requires Improvement.

The provider is the registered manager for the home. 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 that people did not always receive safe care. Risk assessments regarding fire safety and people’s individual care were not always up to date. Care plans were not comprehensive meaning staff did not have all the information they required to effectively support people and to ensure risks were minimised.

Although the provider had some systems to assess and monitor the service these had not been effective in ensuring people received a consistently good standard of care and support. The provider had taken action to address issues raised by outside professionals, but their internal monitoring had not identified the shortfalls. Some repair and refurbishment to the building had not been identified and rectified in a timely manner to maintain people’s safety and comfort. Staff had not received up to date training which would help to make sure the care provided was in accordance with up to date best practice guidance and legislation.

Although the majority of people were able to occupy themselves, there were limited opportunities for meaningful occupation for people who required staff support in this area. One person told us, “It would be nice if they could organise some trips, especially when the weather is nice.”

The provider was working in partnership with other professionals to ensure improvements were made at the home. Full reviews of people’s care and support needs had been carried out. New care and support plans and risk assessments were being put in place to make sure people’s up to date needs were met.

People told us they were happy at the home and felt safe. One person told us, “I feel safe. The staff look after me.” Another person said, “I can’t cope with things but I feel safe here.”

The provider had systems to minimise the risk of abuse to people. These included a robust recruitment process and training for staff. People told us they would be comfortable to talk with staff about any worries regarding their health or their care.

People we spoke with said they were happy with the meals provided and there was always a choice of food. People were able to make hot and cold drinks throughout the day.

People were cared for by staff who treated them as individuals and respected their lifestyle choices. People were able to follow their own daily routines and staff were available when people requested support.

People were fully involved in all decisions about their care and support and were able to refuse support if they chose to. Where people lacked the mental capacity to make certain decisions the staff acted in their best interests in consultation with other professionals.

People who felt confident to access community facilities without staff support were able to do so. One person said, “I’m free to come and go as I please, everyone here is.” Another person said, “I like it here. I can go out when I want to, I don’t need permission.”

People received their medicines safely. Clear records were kept showing when medicines had been administered or refused enabling the effectiveness of medicines to be monitored.

We found that people were not always supported in having information provided to them in a format they could understand in line with the Accessible Information Standard. We have made a recommendation to the provider in relation to this.

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 this report.

Further information is in the detailed findings below.

The Mayfair Residential Home is registered to provide care and accommodation to up to 16 people. The home specialises in providing care and support to people with long term mental health needs. At the time of this inspection there were 13 people using the service.

The provider is also registered to manage the home. 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 last inspection of the home was carried out in January 2015.At that inspection the service was rated as Requires Improvement. We found that improvements were needed to ensure there were adequate risk assessments in place to keep people safe. We also found that quality assurance systems were not effective in highlighting shortfalls and planning improvements.

At this inspection we found that improvements had been made. There were up to date risk assessments to reduce risks to people using the service and others. Improvements had also been made to make sure the quality assurance system identified shortfalls and enabled ongoing improvements to be planned.

The provider took overall responsibility for the management of the home and was supported by a care manager who carried out the day to day management. People and staff described the management as open and approachable.

People were cared for by staff who had the skills and knowledge to meet their needs and interacted with people in a patient and kind way. People felt safe at the home and with the staff who supported them. One person told us “I’m safe here.” Another person said “The staff are always kind to me.”

Staff had a good knowledge of each person and were able to monitor their mental and physical health. They worked with healthcare professionals to make sure people received the care and treatment they needed to meet their healthcare needs.

People’s medicines were safely administered by staff who had received specific training and supervision to carry out the task. People told us they received the correct medicines at the right time. One person said “I always check I have the right tablets. They always get it right.”

People continued to make choices about their day to day lives and were able to follow their chosen lifestyles. Care was planned and delivered in a way that met people’s needs and respected their wishes. People were fully involved in all decisions about their care.

There was a stable staff team which provided a consistent approach to people. It also enabled people to build relationships with the staff who supported them. Staff spent a lot of time chatting and socialising with people. We heard staff laughing and joking with people and there was lots of friendly banter which created a happy atmosphere. One person said “It’s nice to have a laugh.”

There were formal and informal ways for people to share their views, make suggestions or make a complaint. People felt comfortable to speak with the management or staff about any worries or concerns. One person told us “They listen to you and apologise when they get things wrong.”

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People told us they were very happy living in the home. We also had several 'thumbs up' from some of the residents when we asked what it was like to live there. We were told by one person, 'They give me all the help that I need.' Another person told us staff talked with them about their care and what they wanted.

People were provided with appropriate food and drink that met their needs and preferences. People who lived in the home told us that they enjoyed the food provided to them. We were told, 'We can have what we like and we don't have to have what is there if we do not want to.'

We saw there was a rolling programme of refurbishment and renewal to improve the quality of life for people living in the home.

People were protected by the safe staff recruitment practices carried out by the provider.

People told us they had very positive experiences with the staff working in the home. One person told us about how pleased they were with the manager of the home and said, 'They understand what I need and put things in place to help me.'

We spoke with nine people living in the home and the three staff on duty. The care manager who was not on duty at the time returned to the home to assist with the inspection process. We looked at records relating to the provision of care and support for three people and those for the administration and management of the home.

The people we spoke with said that they felt supported and cared for. They told us that staff helped them with their daily decisions but also encouraged them to be as independent as possible. We were told about how staff supported them to be part of the community such as dining out, participating in local events and socialising. We saw that people had very good relationships with the staff in the home. We found that staff spoke to them respectfully and listened to them. People told us that the felt safe living in the home and they had 'no worries.'