Archived: Mayfield House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.At our last assessment we rated this key question requires improvement. At this assessment we rated this key question as inadequate. This meant the effectiveness of people’s care, treatment and support did not achieve good outcomes or was inconsistent. 

The service was in breach of legal regulation in relation to consent to care.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Staff completed assessments when people moved to the service, to assess any risks and help develop their care plans, Assessments were mainly carried out in person, however in some emergency cases, staff had relied on external assessment information to help develop care plans. This had not always ensured information was accurate and sufficiently detailed. The registered manager had made some changes to their admission procedures following a recent incident.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans did not always provide sufficient information to guide staff how best to support people and there was limited evidence people had been involved in planning for their care.

We were not assured some people living with dementia were effectively supported. For example, a relative had complained that staff had not supported their relative’s personal and continence care. Whilst we found their care plan said strategies had been put in place to assist if the person was reluctant to accept care, there was no further detailed guidance to support staff with this. Some people living with dementia appeared frustrated at times, during our visits there was minimal stimulation offered or activities taking place to support their wellbeing.

Overall, people were positive about the food on offer. Homecooked food with several choices was available, and people were offered various snacks and drinks throughout the day. Comments included, “The food is nice and there is always a choice of things to have” and "The food is great, as you can see, I have had plenty of lunch. It’s always good quality and they always give me a choice of what I want.” However, we were concerned staff had not always provided food at the correct texture to meet a person’s assessed needs. The person required a modified diet to reduce the risk of choking, however, records suggested staff had provided snacks which were not in line with this assessment. The registered manager took action to address this straight away.

The provider worked well across teams and services to support people. They shared their assessment of people’s needs when people moved between different services.

Records showed staff liaised with external health and social care professionals to support people’s overall care and wellbeing. Staff worked with other professionals to review people's health needs. They also worked with partners to consider the overall service and how improvements could be made. However, people’s care records were not always accurate and up to date. Where a person had been assessed by speech and language therapy, staff said they thought they knew the outcome, however this was not recorded in the person’s care plan. The registered manager agreed to address this straight away.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People had access to a GP and other health and social care professionals as required in support of their health and well-being. For instance, district nurses, dieticians, speech and language therapy and mental health teams. A relative said, “Outside professionals are used regularly such as the doctor and occupational health.”

However, the timeliness of communications needed to improve. For example, staff had not always escalated where there were concerns or changes to people’s needs. We observed a note left in a person’s ensuite which indicated a urine sample needed to be obtained for testing. However, this had not been taken and staff on duty knew nothing about this.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Staff reviewed people’s care plans monthly. However, we were not assured staff effectively monitored people’s health conditions. There was no evidence people’s views were considered as part of these reviews. The registered manager told us they were planning to introduce a new “Resident of the day” system which should help to improve this.

Staff had not always monitored people’s health and treatment needs. Where medicines had been prescribed to support people’s distress and /or agitation needs, care plans did not always contain sufficient information about when these should be administered or the effectiveness of these.

In other examples, records indicated staff had raised a concern about a person’s skin condition with senior staff. However, they had not taken any further action in response and there was no record about whether the condition had improved. We found staff had not been applying this person’s creams as prescribed. We asked the registered manager to address this straight away.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

Staff had received training in relation to The Mental Capacity Act 2005 (MCA) and understood they needed to obtain consent from people to provide care and support. However, the provider failed to ensure people were always supported to make decisions about their care and treatment in line with the MCA. Records relating to mental capacity assessments and best interest decisions were confusing and did not demonstrate people’s rights were fully protected.

Where people had restrictions placed on them, their capacity to consent had not always been assessed or a best interest decision recorded. For example, one person was moved to spend their time during the day in the smaller key coded unit, for safety reasons. However, staff had not undertaken a specific capacity assessment or best interest decision, including what had been considered to ensure this was the least restrictive option. There was no evidence staff had discussed or made a best interest decision about restrictions placed on people, for example locking people’s bedrooms when they were in the lounge, during the daytime. There were further examples where staff had made decisions, sometimes in consultation with family members, but these had not been recorded in line with the MCA.

Overall, Deprivation of Liberty Safeguards (DoLS) applications were made and monitored as required. However, we found an application for one person had not been made as required, the registered manager addressed this straight away.