Background to this inspection
Updated
3 August 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two inspectors
Service and service type
Mayfield House 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager had been absent from the service since the last inspection.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with three people who used the service and four members of staff. We also spoke with the nominated individual (NI) for the service.
We reviewed a range of records. This included three people’s care records and related documentation including medication records. We looked at two staff files in relation to recruitment and staff supervision and a variety of records relating to the management of the service.
Updated
3 August 2019
About the service
Mayfield House is a residential care home providing personal care to seven people at the time of the inspection. The service can support up to 20 people.
People’s experience of using this service and what we found
The provider had recognised the service provided was not in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance and was finalising the development of a supported living service for the people living at the home to move to which would support these values. The values of ‘Registering the Right Support’ include choice, promotion of independence and inclusion to make sure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People had not been supported to maintain person centred care plans to reflect their goals and aspirations. There was little evidence that people had been supported to develop and follow a programme of activity meaningful to them.
People were not always 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. For example, a condition on one person’s Deprivation of Liberty Safeguards (DoLS) was for the service to look at technology to reduce the level of staff observation. This had not been done.
Systems of governance and oversight were not sufficiently robust to have identified the issues we found during the inspection.
Staff were safely recruited and received the training and support they needed to undertake their role. However, our observations of practice evidenced that training might not always have been effective. The provider increased staffing levels following our feedback on the day of the inspection.
We have recommended the provider maintains an on-going review of staffing levels in accordance with people’s needs and assesses the effectiveness of staff training through observation and supervision.
People said they felt safe and would speak to a member of staff if they were not happy about something.
The service had appropriate checks and maintenance to ensure the service and equipment was safe for the people living at Mayfield House.
Assessments of people’s needs were in place, but care records did not always show the care and support being delivered met with people’s assessed needs.
We have recommended the provider audits care plans to make sure up to date healthcare information is included.
People spoke fondly of staff and we observed some caring interactions between staff and people who used the service.
More information is in the full report.
We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to need for consent and good governance. Details of action we have asked the provider to take can be found at the end of this report.
Rating at last inspection and update: The last rating for this service was requires improvement (published 12 June 2018) and there were three 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 had achieved compliance with two of these breaches but remained in breach of regulation 17 (Good governance).
Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.
Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
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