Mayfield House

Mayfield House is a purpose-built residential care home providing personal care for up to 51 people. The service provides support to older adults and those living with dementia. At the time of our inspection there were 40 people using the service. Mayfield House accommodates people across two separate units, one of which specialises in care to people living with dementia.

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

We could not be assured people had received their medicines as prescribed. Systems in place to ensure the proper and safe management of medicines were not sufficiently robust. The provider’s efforts to address errors/discrepancies had not been effective. We referred these concerns to the local authority for further support.

Staff took some action to reduce potential risks to people. However, risk assessments did not always include enough individualised information about the support people needed to mitigate risks and some risk assessments were not in place where required.

The provider’s governance and oversight systems were not always effective. Despite their audits identifying areas which required improvement, they did not highlight all the issues we found during the inspection.

The premises were safe. However, fire evacuations which considered minimum staffing levels needed to be carried out. Following the inspection, the manager confirmed how they would address this.

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. Whilst the provider had processes in place for capacity assessments and best interest decisions to be made, gaps in staff knowledge had resulted in these not always being completed correctly in line with the MCA. We have made a recommendation about this.

There were enough staff to respond to peoples' needs during the inspection, however staffing levels varied at times. The provider was unable to demonstrate safe staffing numbers had been established based on the needs of the people being supported. The provider had recruited some new staff and was continuing to recruit. Staff were recruited safely. During the inspection, the management confirmed they would increase staffing numbers and would source a more effective dependency tool.

People were supported by familiar staff who understood their needs and respected their choices and preferences. However, care plans did not always contain enough information to guide staff about people’s care needs, taking account of their individual preferences.

People told us they felt safe living at the home and overall were complimentary about the support they received. Appropriate safeguarding arrangements were in place. Staff received appropriate training and support.

Relatives were positive about the communication at the service and felt well informed. Visiting was taking place in line with government guidance. A new activities coordinator was due to start at the home.

The provider had a quality improvement plan in place which was updated following the inspection to address the issues we identified. Since the last inspection the provider had made some improvements in relation to the management of complaints, some refurbishment of the premises and they planned to implement new electronic recording systems. Managers were responsive and keen to address any areas identified for improvement.

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 17 October 2019) and there were breaches of regulation. 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. The service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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, responsive and well-led sections of this full report. The provider has taken some immediate actions and provided an action plan. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayfield House 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 the safe management of medicines, management of risk and good governance at this inspection. We have made a recommendation in the effective section of this report.

Please see the action we have told the provider to take 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.

Mayfield House is a care home providing personal care and accommodation to 49 people living with different health needs, including dementia, at the time of the inspection. The service can support up to 51 people in one purpose built, two storey building.

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

We found that improvements were required in the way the service identified, assessed and reduced the risk of injury presented by people’s living environment. Some potential hazards had not been identified. No harm had been caused by this and the manager took effective action to ensure risk was minimised during the inspection.

Staff recruitment records showed that effective recruitment procedures had not always been followed in accordance with good practice. The registered manager acted during the inspection and completed all outstanding checks to ensure that staff had been recruited safely. We recommend the service develops and implements a quality assurance checklist designed to ensure that all required recruitment checks are in place before the relevant person starts work at the home.

People told us they were supported and treated with dignity and respect, but not always involved as partners in their care. People had been involved in the assessment of their needs, but improvement was needed to ensure that they were also involved in the development of their care and support plans.

The service had a suitable policy and procedure for investigating complaints, but improvement was required to ensure all complaints were acted upon, investigated and taken seriously.

The registered provider had not always notified the Care Quality Commission of incidences of abuse or allegations of abuse.

The systems in place to monitor the quality of the service were not always effective and had not highlighted the concerns identified during this inspection. The registered manager and management team were open and transparent and took immediate action to make necessary improvements and ensure people received safe and effective care.

Effective safeguarding systems, policies and procedures ensured people were safe and protected from abuse. People living at Mayfield House and their relatives told us that their experience of using the service was good overall. People told us that they felt safe and their relatives told us that they were confident that their loved ones were safeguarded from avoidable harm. Safeguarding concerns were responded to and managed effectively.

There was enough suitably trained and experienced staff who had good relationships with the people who used the service.

Medicines were managed safely and effectively.

Staff understood their role and responsibilities for maintaining high standards of cleanliness and hygiene in the premises.

Staff benefited from ongoing training including the nationally recognised qualifications in health and social care.

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.

People were supported to maintain a balanced diet and were able to access health care services as and when needed.

Visiting health care professionals spoke highly of the staff and management team, reporting that they worked in partnership with them to ensure that people’s health care needs were met.

Morale amongst the staff team was high. Staff told us that they appreciated support, guidance and direction of the management team and all without exception said they were proud to be associated with the service and the standard of care and support provided.

The management team demonstrated a commitment to improving the service and delivery of person-centred, high quality care by engaging with everyone using the service and stakeholders.

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 (report published 10 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to complaints and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Mayfield house is registered to provide accommodation for a maximum of 51 people who may be living with dementia and require assistance with personal care. The two storey purpose built building is situated in a residential area of Crewe in Cheshire. Staff are on duty 24 hours a day to provide care and support for people who use the service.

At the time of the inspection a registered manager was 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.

People were complimentary about the support they received at Mayfield House. The registered manager was available throughout the inspection and engaged positively with the inspection process. The registered manager was friendly and approachable, she operated an open door policy for people using the service, staff and visitors

Staff had received training in safeguarding and understood their responsibilities to protect people from harm and abuse. Staff knew how to report concerns and told us that they felt able to raise concerns appropriately. People felt safe and told us that they received the support that they needed, in a way that respected their wishes. We found that there were sufficient staff, who ensured that they supported people in a thorough and unrushed way. We noted that some areas of the home would benefit from re decoration and some furnishings were in need of replacement.

We found that staff were skilled, knowledgeable and well trained. They received a thorough induction when they began their employment with the home and received on-going training updates. Staff were supported to develop their knowledge and skills.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act were met. People’s nutritional needs were met. We observed that people had plenty to eat and drink and were given appropriate food choices. We saw that staff supported people and understood their nutritional needs. The home had recently made improvements to the quality of the food and meal time experience.

We saw that people were well cared for and very comfortable in the home. The people and relatives who we spoke with were positive about the care they received and told us that the staff were kind and caring. We observed that staff were skilled and patient, treating people with dignity and respect.

All care plans were being re-written due to a new electronic recording system which had been implemented. We found that the focus was on person centred care.

Care records reflected the support that people needed so that staff could understand how to care for the person appropriately. The service was responsive to individual needs. We saw that activities were undertaken on a regular basis, however we found that these could be developed further.

We found that the home was well-led. People knew who the registered manager was and felt able to raise any concerns with her. Staff told us that they felt well supported. We saw that regular team meetings were held, as well as supervision meetings to support staff. A new quality manager role had been implemented and home improvement plan put in place. There were comprehensive quality assurance processes in place and people's feedback was sought about the quality of the care.

We carried out our inspection in the evening so we could speak with day staff and night staff when the shifts changed. We spoke to ten members of staff and they all said that the home was adequately staffed. They all said that the home was kept very clean and they worked as a team to maintain this.

We spoke to eight people who lived in the home. They all had no concerns about staff or the cleanliness in the home. Comments we received included; "The care staff and cleaners all work very hard here, we are very lucky and the home is very clean" and "They keep my bedroom beautiful and they change my bed all the time." In relation to the staff another person said; "There is always someone to help you if you need it. They are patient and don't rush you."

We could not substantiate any of the issues raised by the whistle blowers.

We reviewed information about five people's care and pathway tracked five people using the service. We found that their care needs were assessed and that care was planned. We also found that the staff understood people's care needs and how to protect them from risk and harm.

We saw that staff respected people's privacy and dignity, and took account of what people had to say in relation to the way their care was provided. For example, we saw that staff encouraged people to make informed choices about the food they ate and the social activities they participated in each day.

We also saw that people were actively encouraged and given support to maintain their independence.

The staff told us they enjoyed working at the home. We saw that all the required checks were made to ensure they were fit to do their job.

There were systems in place to ensure people could raise concerns and improve the quality of the care received.

We saw information which confirmed complaints were responded to and people were able to voice their opinions.

One visitor said "I think that the home is very good. The staff are respectful and polite. The home is clean and tidy. Mum is safe here'.

We spoke to three people who live at the home about their experience on being consulted about their care and they informed us that they were always consulted about their care and that "it was all very good". We spoke to two relatives of a person who lived at the home and they told us that they were fully involved with how care and treatment was provided and were happy with the outcome.

We spoke to three people who live in the home and they said that the staff "were always ready to help and the home was lovely". They also told us that they were consulted with the choice of menu and there was always something else if they didn't like it.

Of the three people we spoke to one person said the food was "very nice" and another said they liked sandwiches and could always have them if they wanted.

We observed care being given with care, safety and dignity.

We viewed records which showed evidence that staff received training and support to carry out their job and had the required checks and employment history information.